Objetivo: descrever as práticas obstétricas realizadas por uma parteira leiga tencionando uma reflexão sobre as contribuições dessas práticas para a gestão do cuidado de enfermagem à parturiente. Método: utilizou-se da história oral temática, na perspectiva qualitativa, tendo como participante, uma parteira leiga, residente em um município do Norte do Estado do Rio Grande do Sul, que atuou na assistência a gestantes, parturientes, puérperas, recém-nascidos e seus familiares. Na coleta de dados, utilizaram-se entrevistas e diário de campo. Os dados foram submetidos à análise temática de conteúdo. Resultados: demonstraram a atuação da parteira no pré-natal, no parto, no pós-parto e na condução de complicações, com práticas voltadas para a gestão do cuidado de Enfermagem durante o período gravídico-puerperal, pautadas na humanização do parto e nascimento, cuidado seguro e empoderamento da mulher. Conclusão: as práticas obstétricas realizadas pela parteira têm potencial para contribuir para a gestão do cuidado de Enfermagem à parturiente, embora algumas técnicas adotadas, nas décadas de 1940 a 1970, necessitem de respaldo científico.
Objetivo: identificar a presença de Burnout e seus fatores associados em preceptores e residentesde Programas de Residência.Método: estudo transversal realizado com 64 preceptores e residentes no contexto da AtençãoPrimária à Saúde, de outubro a novembro de 2016. Utilizou-se formulário socioprofissional e oquestionário Maslach Burnout Inventory. Para análise dos dados, aplicaram-se os testes Exato deFisher e Kruskal-Wallis. Considerou-se o nível de significância de 5% (p<0,05).Resultados: os participantes apresentaram sentimento de Incompetência Profissional, DesgasteEmocional e Despersonalização moderados, com médias de 23,1; 17,5 e 4,1, respectivamente.Evidenciou-se associação entre as dimensões do Maslach Burnout Inventory e a variável DistritoSanitário.Conclusão: não foi identificada a presença de Burnout entre os participantes. No entanto, níveismoderados de sentimento de incompetência profissional, desgaste emocional e despersonalizaçãopodem influenciar negativamente a qualidade da assistência prestada. Esta pesquisa contribui parao conhecimento pré-existente por envolver residentes e preceptores multiprofissionais.
Objectives: Many initiatives (e.g., PROTECT, EFSPI) are exploring quantitative methodologies to conduct benefit/risk assessments of medicines. Objectives of this study were to combine quantitative methodologies that can capture expert knowledge and decisionmakers insights to genuinely support real-world decisions. MethOds: Using the case study of efalizumab, approved by the EMA in 2004 for the treatment of plaque psoriasis and withdrawn in 2009, a pragmatic methodology was developed that combines advanced pharmacoepidemiology and MCDA for quantitative benefit/ risk assessment. Development involved application of: MCDA principles to ensure applicability to any therapeutic area, comparability across medicines, and portability over product cycle (re-evaluation); and advanced pharmacoepidemiology and Bayesian modeling to identify/generate most useful data. Overarching design was guided by ethical implications of criteria and data selection as well as applicability in real life settings including face validity, time constraints, complexity and transparency. Results: The hierarchical multicriteria model consists of two major domains: Benefits (favourable effects, covering the criteria Clinical efficacy/effectiveness and Patient Reported outcomes); and Risks (unfavourable effects -criterion Safety). The safety criterion is subdivided into three generic subcriteria (Adverse events, Serious AEs and Fatal AEs). The benefit criteria are subdivided into specific subcriteria that correspond to the most relevant outcomes for a treatment for plaque psoriasis. All performance are assigned relative to existing alternatives or placebo. Each subcriterion contributes to the output of the model, the Benefit/Risk Estimate, which is the sum of normalized weights for each subcriterion multiplied by the respective performance score. Pharmacoepidemiology data is provided in a standardized format for each subcriterion and includes meta-analytic comparative statistics based on clinical trials, observational data and Bayesian models. Uncertainty is explored in sensitivity analyses. cOnclusiOns: Integration of pragmatic MCDA modeling with advanced pharmacoepidemiology allows quantitative benefit/risk assessment that can be applicable and meaningful in real life regulatory settings.
A 1 -A 3 1 8 A263 with attracting CRS by using a case study with the region of Montreal. Methods: Information, gathered from Health Canada, Clinical trials.gov and the Patented Medicine Price Review Board of Canada, was used to evaluate the number of studies and expenses in CRS in Canada, Quebec and Montreal. A model was developed to extrapolate the expenses per study taking into account the type of diseases, the clinical phase and the research site (public or private). The data used in the model were validated with the three university research hospitals of Montreal. A survey with representatives of the private sector (Pharmaceutical companies and Contract Research Organizations) was conducted to gather information on resources allocation per study. Results: The analysis shows that doubling the number of patients engaged in early stage CRS with public and private organizations within the five years (equivalent to increase CRS spending by $CDN 36 M) would result in the creation (or maintain) of 500 jobs in the life science sector. The analysis also shows that close to 95% of related expenses would be made in the Montréal metropolitan area and that more than 50% of companies active in LS in and around Montréal would benefit from spinoffs of the early stage CRS. It would also benefit the research and development communities as well as the patient by providing access to innovative treatments unavailable elsewhere. ConClusions: This analysis suggests that a strategy to attract more CRS would benefit the region's economy by providing for job creation opportunities and wealth creation.
Study design A primary, observational, cross-sectional, analytical study. Objective The development of a framework for systematic telemedicine (TM) for orthopedic physicians in frequent clinical care may increase agreement in diagnosis and satisfaction among users of TM. Therefore, this study aimed to estimate the agreement in the diagnosis of low back pain (LBP) between TM, systematized by a self-completed digital questionnaire, and face-to-face (FF) care in patients with LBP. Methods This study included adults up to 75 years of age with LBP for more than 6 weeks. They were evaluated at 2 independent time points (TM and FF) by different orthopedists with 3 different levels of expertise. Professionals evaluated the sample without prior knowledge of the diagnosis, and each orthopedist provided a diagnosis. Diagnostic agreement was the primary outcome. Secondary outcomes were the duration of the visit and satisfaction among healthcare professionals. Results A total of 168 participants were eligible, of whom 126 sought care through TM and 122 sought FF care (mean age, 47 years [range, 18-75 years]; 66.4% women). The agreement among professionals regarding the diagnosis was moderate (kappa = .585, P = .001). TM was faster than FF (11.9 minutes (standard deviation = 4.1) vs 18.6 (SD = 6.9), P < .001). Professional satisfaction was higher among spine specialists than among orthopedic residents and orthopedists who were not specialists in spine surgery. Conclusion Agreement in diagnosis was moderate for TM, with a 30% shorter visit duration than FF. Satisfaction varied by professional expertise and was higher among spine specialists than among professionals with other expertise.
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