A Formação na Maturidade como Apropriação da Própria História de Vida

No presente artigo, a disposição e a competência para a apropriação da própria história de vida são consideradas como modos de formação1 na maturidade. Estas se relacionam com fatores históricos e sócio-políticos e estão inscritas em contextos multigeracionais de formação e processos de desenvolvimento ao longo da vida. Nesta perspectiva, conceitos como geração, geracionalidade, geratividade e transmissão transgeracional ganham destaque e serão aprofundados no texto. A linha argumentativa que sustenta este ponto de vista baseia-se em estudos de países de língua alemã sobre crianças da Segunda Guerra Mundial que envelheceram. Apesar de se tratar de uma situação específica, nos parece possível a extensão das reflexões também para o contexto brasileiro

Oral and Subcutaneous Anticancer Therapy Training Course for Non-physician Healthcare Professionals: a Survey Evaluating the Relevance of its Content and its Implications in the Practice of Cancer Care.

The creation of antitumor agents with an oral or subcutaneous route of administration has had important positive implications in the development of drugs to treat cancers, but issues such as false drug intake, uncontrolled side effects, and limited supervision may jeopardize the ability of these agents to improve treatment. A potential solution is the recruitment of non-physician healthcare professionals (i.e., nurses and physician assistants) and a special training course for them that focuses on the improvement of patient compliance. We developed and implemented three special professional training modules for non-physician healthcare professionals, which focus on the pharmacological aspects and side effects of oral and subcutaneous antitumor medications in regard to management strategies and communication issues that these non-physician healthcare professionals should address. Subsequently, we administered a questionnaire survey evaluating the course content and the implementation of the course in practice to the training participants to collect data for its implementation. Of 165 questionnaires that were administered, 44 (27%) were answered. The participants rated the course as being highly useful for their daily work. The participants reported a significant improvement in their professional expertise from the course. They emphasized the importance of medical topics and practical content to be included in the course delivery. The course encouraged 75% of the responders to start independent consultations with cancer patients that focused on questions of medication adherence for oral and subcutaneous antitumor medications, as well as the management of their side effects. Based on our results, at least a portion of the non-physician healthcare workforce is highly interested in engaging in active and autonomous co-supervision of patients who are treated with oral and subcutaneous antitumor medications. In addition to the theoretical basics of the treatment modalities, educational courses on oral and subcutaneous antitumor medications for non-physician healthcare professionals should focus on practical training and topics relevant to patient care

Oral and Subcutaneous Anticancer Therapy Training Course for Non-physician Healthcare Professionals: a Survey Evaluating the Relevance of its Content and its Implications in the Practice of Cancer Care

The creation of antitumor agents with an oral or subcutaneous route of administration has had important positive implications in the development of drugs to treat cancers, but issues such as false drug intake, uncontrolled side effects, and limited supervision may jeopardize the ability of these agents to improve treatment. A potential solution is the recruitment of non-physician healthcare professionals (i.e., nurses and physician assistants) and a special training course for them that focuses on the improvement of patient compliance. We developed and implemented three special professional training modules for non-physician healthcare professionals, which focus on the pharmacological aspects and side effects of oral and subcutaneous antitumor medications in regard to management strategies and communication issues that these non-physician healthcare professionals should address. Subsequently, we administered a questionnaire survey evaluating the course content and the implementation of the course in practice to the training participants to collect data for its implementation. Of 165 questionnaires that were administered, 44 (27%) were answered. The participants rated the course as being highly useful for their daily work. The participants reported a significant improvement in their professional expertise from the course. They emphasized the importance of medical topics and practical content to be included in the course delivery. The course encouraged 75% of the responders to start independent consultations with cancer patients that focused on questions of medication adherence for oral and subcutaneous antitumor medications, as well as the management of their side effects. Based on our results, at least a portion of the non-physician healthcare workforce is highly interested in engaging in active and autonomous co-supervision of patients who are treated with oral and subcutaneous antitumor medications. In addition to the theoretical basics of the treatment modalities, educational courses on oral and subcutaneous antitumor medications for non-physician healthcare professionals should focus on practical training and topics relevant to patient care

Evaluation eines frühen interdisziplinären multimodalen Assessments für Patienten mit Schmerzen

Die Versorgung von Patienten mit Schmerzen und Chronifizierungsrisiko ist nach wie vor gekennzeichnet durch Über-, Fehl- und Unterversorgung. Das Projekt PAIN2020 (Innovationsfonds 01NVF17049) hat zum Ziel, durch die Einführung eines frühzeitigen, auf Schmerz spezialisierten interdisziplinären diagnostischen Ansatzes die ambulante Versorgung von Patienten im Hinblick auf Schmerzen und das Funktionsniveau zu verbessern. Im Rahmen einer randomisierten kontrollierten Studie werden bundesweit in 31 Einrichtungen der Regelversorgung mit einem schmerzspezialisierten Angebot Patientinnen und Patienten mit Risikofaktoren bei bestehenden Schmerzen einer frühen Schmerzdiagnostik zugeführt. Die Interventionsbedingung besteht dabei in einem interdisziplinären multimodalen Assessment mit den beteiligten Disziplinen Schmerzmedizin, Physiotherapie und Psychologie. Die Kontrollbedingung umfasst einen einmaligen Termin bei einem Schmerztherapeuten der Qualitätssicherungsvereinbarung Schmerzmedizin bzw. mit Zusatzbezeichnung spezielle Schmerztherapie. Patienten und Vorbehandler erhalten entsprechend der Befunde detaillierte Empfehlungen für eine weitere bedarfsgerechte Behandlung. Es sind zwei Evaluationsansätze geplant. Für den ersten beträgt die zu erreichende Nettofallzahl 3840 Patienten, deren klinische Daten (Deutscher Schmerzfragebogen, zusätzliche Skalen) längsschnittlich erhoben (Einschluss, drei und sechs Monate nach Diagnostik) und auf Grundlage eines Mehr-Ebenen-Modells ausgewertet werden. Im Rahmen eines zweiten Ansatzes werden diese klinischen Daten einerseits um Sekundärdaten der BARMER ergänzt sowie die Patienten des ersten Evaluationsansatzes mit BARMER-Versicherten gematcht, die an dem Projekt nicht teilgenommen haben. Die Auswertung übernimmt ein externes Evaluationsinstitut. Das Projekt startete im April 2018, die erste Patientin wurde im März 2019 in die Studie aufgenommen

Developing a core outcome-domain set to assessing effectiveness of interdisciplinary multimodal pain therapy: the VAPAIN consensus statement on core outcome-domains

Interdisciplinary multimodal pain therapy (IMPT) is a biopsychosocial treatment approach for patients with chronic pain that comprises at least psychological and physiotherapeutic interventions. Core Outcome Sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcome-domains, and measurement instruments in clinical trials, to make trial results meaningful, to pool trial results, and to allow indirect comparison between interventions. The objective of this study was to develop a COS of patient-relevant outcome-domains for chronic pain in IMPT clinical trials. An international, multi-professional panel (patient representatives (n=5), physicians specialized in pain medicine (n=5), physiotherapists (n=5), clinical psychologists (n=5), and methodological researchers (n=5)) was recruited for a 3-stage consensus study, which consisted of a mixed-method approach comprising an exploratory systematic review, a preparing online survey to identify important outcome-domains, a face-to-face consensus meeting to agree on COS domains, and a second online survey (Delphi) establishing agreement on definitions for the domains included. The panel agreed on the following eight domains to be included into the COS for IMPT: pain intensity, pain frequency, physical activity, emotional wellbeing, satisfaction with social roles and activities, productivity (paid and unpaid, at home and at work, inclusive presentism and absenteeism), health-related quality of life, and patient's perception of treatment goal achievement. The complexity of chronic pain in a biopsychosocial context is reflected in the current recommendation, and includes physical, mental and social outcomes. In a subsequent step measurement instruments will be identified via systematic reviews.status: publishe

Developing a core outcome domain set to assessing effectiveness of interdisciplinary multimodal pain therapy: the VAPAIN consensus statement on core outcome domains

Interdisciplinarymultimodal pain therapy (IMPT) is a biopsychosocial treatment approach for patientswith chronic pain that comprises at least psychological and physiotherapeutic interventions. Core outcome sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcome domains, and measurement instruments in clinical trials, to make trial results meaningful, to pool trial results, and to allow indirect comparison between interventions. The objective of this study was to develop aCOSof patient-relevant outcome domains for chronic pain in IMPT clinical trials. An international, multiprofessional panel (patient representatives [n=5], physicians specialized in pain medicine [n = 5], physiotherapists [n = 5], clinical psychologists [n = 5], and methodological researchers [n = 5]) was recruited for a 3-stage consensus study, which consisted of a mixed-method approach comprising an exploratory systematic review, a preparing online survey to identify important outcome domains, a face-to-face consensus meeting to agree on COS domains, and a second online survey (Delphi) establishing agreement on definitions for the domains included. The panel agreed on the following 8 domains to be included into the COS for IMPT: pain intensity, pain frequency, physical activity, emotional wellbeing, satisfaction with social roles and activities, productivity (paid and unpaid, at home and at work, inclusive presentism and absenteeism), health-related quality of life, and patient's perception of treatment goal achievement. The complexity of chronic pain in a biopsychosocial context is reflected in the current recommendation and includes physical, mental, and social outcomes. In a subsequent step, measurement instruments will be identified via systematic reviews