OS BENEFÍCIOS DAS PARCERIAS UNIVERSITÁRIAS INTERNACIONAIS: AS PERSPECTIVAS DE UM MEMBRO DE FACULDADE CANADENSE

Em novembro de 2013, tive o privilégio de visitar a Escola de Enfermagem da Universidade Federal do Rio Grande do Sul (UFRGS), no Brasil. Durante minha visita de nove dias, me reuni com membros da faculdade e estudantes de pós-graduação, conduzi duas aulas de pós-graduação sobre integração de sistemas de saúde e visitei várias instalações de assistência à saúde. Essa visita teve em mim um impacto significativo em termos profissionais e pessoais. Parcerias internacionais na área de saúde entre universidades de vários países têm benefícios distintos. Gostaria de destacar cinco

Developing and Implementing a Community-Based Model of Care for Fibromyalgia: A Feasibility Study

Background. Fibromyalgia (FM) is a complex disease posing challenges for primary care providers and specialists in its management. Aim. To evaluate the development and implementation of a comprehensive, integrated, community-based model of care for FM. Methods. A mixed methods feasibility study was completed in a small urban centre in southern British Columbia, Canada. Eleven adults with FM and a team of seven health care providers (HCPs) participated in a 10-week intervention involving education, exercise, and sleep management. Monthly “team-huddle” sessions with HCPs facilitated the integration of care. Data included health questionnaires, patient interviews, provider focus group/interviews, and provider surveys. Results. Both patients and HCPs valued the interprofessional team approach to care. Other key aspects included the benefits of the group, exercise, and the positive focus of the program. Effectiveness of the model showed promising results: quality of care for chronic illness, quality of life, and sleep showed significant (P<0.05) differences from baseline to follow-up. Conclusions. Our community-based model of care for FM was successfully implemented. Further testing of the model will be required with a larger sample to determine its effectiveness, although promising results were apparent in our feasibility study

The Evolution of Primary Health Care Teams and Integrated Health Services Delivery in Four Canadian Provinces

Improving integrated health services for patients with two or more chronic illnesses is a priority in Canada as our health systems grapple with their complex needs and the services they require (Kirst et al. 2017; Suter et al. 2014). Team-based primary health care (PHC) models have been implemented in diverse ways to improve patient experience and to bet- ter coordinate integrated care to improve population health and reduce the cost of health care (Kirst et al. 2017; Buljac-Samardzic et al. 2010). The structure and composition of interprofessional primary health care (IPHC) models vary across provinces; however, their common goal is to address the four elements of the Quadruple Aim (population health, patient experience, provider experience, and reducing costs) (Bodenheimer and Sinsky 2014). Although research exists on interprofessional teams and health service integration, understanding the effectiveness of the development and implementation of team-based models for patients with two or more chronic illnesses has been challenging. Policymakers, decision-makers, providers, and patient groups have little evidence on what policies and structures facilitate, incentivize, or prevent integrated service delivery, especially for patients with complex needs. This knowledge gap has had an impact on the reform of service integration for patients with complex needs through IPHC teams. A policy analysis was conducted in four Canadian provinces to examine the policies and structures that scaffold such reform, identifying barriers and facilitators to the implementation of PHC teams and integrated health services. This study was carried out in British Columbia (BC), Alberta (AB), Ontario (ON), and Québec (QC) to understand different models implemented in these provinces and to ensure representation of east, west, and central Canada

Health systems integration: state of the evidence

Introduction: Integrated health systems are considered a solution to the challenge of maintaining the accessibility and integrity of healthcare in numerous jurisdictions worldwide. However, decision makers in a Canadian health region indicated they were challenged to find evidence-based information to assist with the planning and implementation of integrated healthcare systems. <br><br> Methods: A systematic literature review of peer-reviewed literature from health sciences and business databases, and targeted grey literature sources. <br><br> Results: Despite the large number of articles discussing integration, significant gaps in the research literature exist. There was a lack of high quality, empirical studies providing evidence on how health systems can improve service delivery and population health. No universal definition or concept of integration was found and multiple integration models from both the healthcare and business literature were proposed in the literature. The review also revealed a lack of standardized, validated tools that have been systematically used to evaluate integration outcomes. This makes measuring and comparing the impact of integration on system, provider and patient level challenging. <br><br> Discussion and conclusion: Healthcare is likely too complex for a one-size-fits-all integration solution. It is important for decision makers and planners to choose a set of complementary models, structures and processes to create an integrated health system that fits the needs of the population across the continuum of care. However, in order to have evidence available, decision makers and planners should include evaluation for accountability purposes and to ensure a better understanding of the effectiveness and impact of health systems integration

Analysis of Primary Health Care Teams and Integration Policy in Ontario

Improving the integration of health services for patients with complex needs is a priority across Canada. To improve patient experience and reduce costs, provinces and territories have implemented diverse team-based primary health care (PHC) models. In Ontario, a boom in both organizational and funding reforms in the early 2000s resulted in the addition of diverse primary care models. The goals of these reforms were to improve the quality of care, care coordination and the comprehensiveness of services. The reforms were reflected at both the provincial and regional (Local Health Integration Networks) levels through strategic guidance documents and through the establishment of primary care evaluation frameworks by key provincial leaders. This study seeks to examine policies and structures that facilitated the development, implementation, and sustainability of team-based PHC models. Analysis of Ontario provincial and regional-level policies released between 2009-2019 reveals that in the last decade, focus has shifted away from highlighting PHC teams as a strategy for integration, instead focusing on broader systems-level integration. Further, primary care evaluation frameworks were not implemented at the local level. More recently, Ontario Health Teams show great promise to reduce silos and improve integration, but the role of primary care and PHC teams in this reform remains unclear. Partout au Canada, l'amélioration de l'intégration des services de santé pour les patients ayant des besoins complexes est une priorité. Pour améliorer l'expérience des patients et réduire les coûts, les provinces et les territoires ont mis en place divers modèles de soins de santé primaires (SSP) basés sur le travail d’équipe. En Ontario, au début des années 2000, un florilège de réformes organisationnelles et financières ont fait éclore divers modèles de soins de première ligne. Les objectifs de ces réformes étaient d'améliorer la qualité et la coordination des soins, ainsi que d’offrir une gamme complète de services. Ces réformes ont été traduites aux niveaux provinciaux et régionaux (Réseaux Locaux d’Intégration des Services de Santé) dans des documents d’orientation stratégique et des cadres d’évaluation des services de première ligne. Cette étude vise à examiner les politiques et les structures qui ont facilité le développement, la mise en œuvre, et la durabilité des modèles de SSP en équipe. Toutefois, l'analyse des politiques provinciales et régionales de l'Ontario publiées entre 2009 et 2019 révèle qu'au cours de la dernière décennie, l'accent n'a plus été mis sur les équipes de SSP en tant que stratégie d'intégration, mais plutôt sur une intégration plus large au niveau du système de santé. En outre, les cadres d'évaluation des SSP n'ont pas été mis en œuvre au niveau local. Les équipes interdisciplinaires de première ligne de l'Ontario créées plus récemment sont très prometteuses pour réduire les cloisonnements et améliorer l'intégration, mais le rôle des soins primaires et des équipes de SSP dans cette réforme n’a pas été clarifié

Contribuições do programa de doutorado sanduíche nas abordagens metodológicas: relato de experiência

Objetivo: Compartilhar experiências e insights teóricos e metodológicos que os pesquisadores obtiveram ao trabalhar juntos durante um programa de doutorado sanduíche.Método: Trata-se de um estudo descritivo do tipo relato de experiência.Resultados: Incorporou-se o pensamento restaurativo no estudo da cultura de segurança do paciente e espera-se implementar o plano de knowledge translation utilizando os princípios do diálogo deliberativo como uma estratégia para aumentar a aplicabilidade dos resultados da pesquisa.Conclusão: A incorporação de novas metodologias nas pesquisas da enfermagem brasileira possui um papel fundamental para o alcance de visibilidade e participação internacional nas diferentes áreas de conhecimento da enfermagem.Palavras-chave: Intercâmbio educacional internacional. Enfermagem. Metodologia

Translação do conhecimento: traduzindo pesquisa para uso na prática e na formulação de políticas

Objetivo: Estudo teórico reflexivo de conceitos de translação do conhecimento e seu processo de implementação para usar evidências de pesquisas na prática e na formulação de políticas.Resultados: O processo de translação da pesquisa para a prática é interativo e dinâmico, com limites flexíveis entre criação do conhecimento e desenvolvimento das ações. A translação do conhecimento enfoca cocriação de conhecimento com os interessados e compartilhamento desse conhecimento para garantir utilização de pesquisas relevantes para facilitar tomada informada de decisões e mudanças na política, prática e prestação de serviços de saúde. No Brasil, existem muitos desafios para implementar a translação do conhecimento: falta de familiaridade; falta de parceria entre pesquisadores e usuários do conhecimento, e baixos orçamentos para pesquisa.Conclusões: Uma ênfase na translação do conhecimento tem potencial para impactar positivamente resultados de saúde. Futuras investigações são necessárias no Brasil para estudar abordagens para melhorar o uso de resultados de pesquisa.Palavras-chave: Disseminação de informação. Prática clínica baseada em evidências. Formulação de políticas

Care transition strategies in Latin American countries: an integrative review

Objective: To identify and analyze available literature on care transition strategies in LatinAmerican countries.Methods: Integrative literature review that included studies indexed in PubMed, LILACS, Webof Science Core Collection, CINAHL, SCOPUS databases, and the Scientific ElectronicLibrary Online (SciELO), published in Portuguese, Spanish or English, between 2010 and2017.Results: Eleven articles were selected and the strategies were grouped into components of caretransition: discharge planning, advanced care planning, patient education and promotion of selfmanagement,medication safety, complete communication of information, and outpatientfollow-up. These strategies were carried out by multidisciplinary team members, in whichnurses play a leading role in promoting safe care transitions.Conclusions: Care transition activities are generally initiated very close to patient discharge,this differs from recommendations of care transition programs and models, which suggestimplementing care transition strategies from the time of admission until discharge.Keywords: Continuity of patient care. Patient transfer. Health education. Discharge planning.Patient readmission

Elaboración de un instrumento para evaluar la transición segura del paciente al alta hospitalaria

Objetivo: Construir e validar o conteúdo de um instrumento de avaliação da qualidade da transição do cuidado e da segurança do paciente na alta hospitalar na perspectiva de enfermeiros. Métodos: Estudo metodológico, desenvolvido no Sul do Brasil entre abril de 2019 e janeiro de 2022, em três etapas: revisão integrativa e entrevistas semiestruturadas com seis enfermeiros para construção do instrumento; validação de conteúdo por comitê de 14 especialistas; e pré-teste com 20 enfermeiros. Empregou-se Índice de Validade de Conteúdo acima de 0,80. Resultados: Desenvolvido instrumento com 37 itens organizados em seis domínios: estrutura; planejamento de alta; orientações sobre cuidados; encaminhamento para continuidade de cuidados; cultura de segurança, e resultado da transição do cuidado. O Índice de Validade de Conteúdo geral foi 0,93. Conclusões: o instrumento apresentou validação de conteúdo e contribui para a compreensão da transição do cuidado no contexto nacional, propondo mudanças para qualificar e fortalecer a segurança do paciente na alta hospitalar.Objective: To develop and validate the content of a measurement instrument to assess the quality of care transitions and patient safety at hospital discharge from the nurses’ perspective. Methods: A methodological study developed in southern Brazil between April 2019 and January 2022, in three stages: integrative review and semi-structured interviews with six nurses for construction of the instrument; content validation with a committee of 14 experts; and a pre-test with 20 nurses. A Content Validity Index above 0.80 was employed. Results: A measurement instrument with 37 items organized into six domains was developed, as follows: structure; discharge planning; care education; referral for continuity of care; safety culture, and care transitions results. The general Content Validity Index reached 0.93. Conclusions: The measurement instrument presented content validation and will contribute to understanding transitional care in the Brazilian context, proposing changes to qualify and strengthen patient safety at hospital discharge.Objetivo: Construir y validar el contenido de un instrumento de evaluación de la calidad de la transición de la atención y la seguridad del paciente en alta hospitalaria desde la perspectiva de los enfermeros. Métodos: Estudio metodológico, desarrollado en el sur de Brasil entre abril de 2019 y enero de 2022, en tres etapas: revisión integradora y entrevistas semiestructuradas con seis enfermeras para construir el instrumento; validación de contenido por un comité de 14 expertos; y pre-test con 20 enfermeras. Se empleó un Índice de Validez del Contenido superior a 0,80. Resultados: Instrumento desarrollado con 37 ítems organizados en seis dominios: estructura; planificación del alta; pautas de atención; derivación a la continuidad asistencial; cultura de seguridad, y resultado de la transición asistencial. El Índice de Validez de Conocimiento general fue de 0,93. Conclusiones: El instrumento presentó un valor de contenido y contribuyó a la comprensión de la transición del cuidado en el contexto nacional, proponiendo cambios para calificar y fortalecer la seguridad del paciente en el hospital de alta

T-Cell Artificial Focal Triggering Tools: Linking Surface Interactions with Cell Response

T-cell activation is a key event in the immune system, involving the interaction of several receptor ligand pairs in a complex intercellular contact that forms between T-cell and antigen-presenting cells. Molecular components implicated in contact formation have been identified, but the mechanism of activation and the link between molecular interactions and cell response remain poorly understood due to the complexity and dynamics exhibited by whole cell-cell conjugates. Here we demonstrate that simplified model colloids grafted so as to target appropriate cell receptors can be efficiently used to explore the relationship of receptor engagement to the T-cell response. Using immortalized Jurkat T cells, we monitored both binding and activation events, as seen by changes in the intracellular calcium concentration. Our experimental strategy used flow cytometry analysis to follow the short time scale cell response in populations of thousands of cells. We targeted both T-cell receptor CD3 (TCR/CD3) and leukocyte-function-associated antigen (LFA-1) alone or in combination. We showed that specific engagement of TCR/CD3 with a single particle induced a transient calcium signal, confirming previous results and validating our approach. By decreasing anti-CD3 particle density, we showed that contact nucleation was the most crucial and determining step in the cell-particle interaction under dynamic conditions, due to shear stress produced by hydrodynamic flow. Introduction of LFA-1 adhesion molecule ligands at the surface of the particle overcame this limitation and elucidated the low TCR/CD3 ligand density regime. Despite their simplicity, model colloids induced relevant biological responses which consistently echoed whole cell behavior. We thus concluded that this biophysical approach provides useful tools for investigating initial events in T-cell activation, and should enable the design of intelligent artificial systems for adoptive immunotherapy