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The usual treatment of American Cutaneous Leishmaniasis is based on intravenous drugs of the 1940s and causes adverse events, having as first choice pentavalent antimonials that require clinical and laboratory follow-up in the hospital setting. The present study aimed to identify potentially more effective and safe oral therapies, applying Technological Horizon Scanning.
The searches were divided into three blocks: clinical trials through the Clinical Trials Registry Platform on the WHO search portal; searches in the PubMed, Embase, Cochrane Library, Lilacs and Center for Reviews and Dissemination databases; and search for patents in the Orbit base. The searches aimed at identifying drugs, authors, institutions and therapeutic classes in order to proceed with scanning process.
We found 197 studies and selected 33 in the Americas region. Of these, seventeen (51%) investigated miltefosine, six (18%) had azithromycin, four (12%) Fluconazole, two (6%) pentoxifylline, two (6%) allopurinol and one (3%) terbinafine. Of the 26 clinical studies, twelve presented positive results for oral medications, six related to miltefosine, two to fluconazole, two to pentoxifylline, one to azithromycin and one to allopurinol. Through the analysis of patents, 35 documents involving 32 institutions and 134 inventors were identified. Of the 32 institutions that registered patent documents, Novartis is the one with the highest number of inventors.
Miltefosine is in the incorporation phase in the Brazilian health system, evaluating its performance and effectiveness in the services. Pentoxifylline was recently incorporated as a coadjuvant to the treatment, and Fluconazole presented positive results, however with a small number of patients and uncertain outcomes. It is recommended to carry out more research directed to the drug association, since the studies indicate the possibility of decreasing occurrence of relapses, dosages and treatment time, increasing adherence to treatment.
Professionals dealing with children with Neurodevelopmental Disorders (NDDs) need to be constantly trained because of the numerous challenges posed by the particularities arising from the multiple conditions that pervade child development. The aim of this study is to describe the training processes of education, health and social care professionals who care for children aged 0 to 12 years with neurodevelopmental disorders.
The revision overview was registered in the PROSPERO platform CRD42018100715 that followed the parameters of the PRISMA protocol and aimed to identify the existing multi-professional training processes, aimed at health professionals, education and social assistance aimed at promoting skills for care with children and families with TND. The research question was structured according to the acronym PICO. The search was performed in PubMed, Embase, Cochrane Library, CRD, Web of Science, Campbell Library, Health System Evidence, Epistemonikos and Joanna Briggs databases in May 2018.
We selected 23 articles. Of these, 21 (91 percent) were health professionals, 22 (96 percent) referred to intellectual disability, 16 (71 percent) were in the American continent and 15 (65 percent) used in-service training as educational resource. The outcomes showed that the structuring of teaching-learning in the practice of health, education and social care professionals determines a more inclusive proposal in the treatment of children with NDD.
The health professional is the most trained to attend children with NDD, however, training and development policies are lacking for professionals from other areas who act as a gateway to diagnostic services. Establishing in-service training initiatives strengthens the support and structuring of intersectoral programs that would facilitate multi-professional participation in the prognosis and treatment directed at children with NDD. Therefore, associating the use of assistive technologies allows new opportunities to access tools and electronic devices that allow the formation of professionals.
The Federal District in Brazil has about 2.9 million inhabitants and the public health system is focused on medical specialties, with one university hospital and twenty regional hospitals. This ecosystem is favorable for fostering health technology assessment (HTA) to improve the efficiency and effectiveness of health care. The objective was to identify institutions that could form a HTA network to support decision-oriented evidence in the public health system.
Stakeholders from the hospitals and training/research institutions in the Federal District were surveyed. An online questionnaire (Google Docs) was developed to identify the potential and capacity of institutions to analyze or produce clinical and economic evidence. Two HTA seminars were held to spread knowledge about HTA and to encourage stakeholders to complete the survey.
The questionnaire response rate was thirty-five percent (25/70). Fifteen institutions were cited by the respondents as having the potential to build a HTA network. Twelve of the institutions produced rapid reviews and clinical guidelines, but only three of these had an organized priority setting process or produced assessments at the request of the hospital manager. The challenges identified were training and willingness of decision makers to organize HTA units in the hospitals.
An executive group was created which defined a strategy to support the implementation of HTA units as part of the HTA National Network (REBRATS). A regulation proposal was also created to encourage decision makers to activate a HTA network in the Federal District.
São Paulo city in Brazil has implemented social and health care for homeless people with pulmonary tuberculosis since 2007. We conducted a health technology assessment (HTA) of the interventions provided based on a national theoretical model using 2015 data and an overview of systematic reviews. The HTA was requested by national policymakers. The results demonstrated that the interventions for pulmonary tuberculosis were satisfactory. The municipal secretariat implemented actions to improve the national treatment recommendations and adopted incentives to increase adherence to treatments. Our objective was to describe the feedback process for the Health Secretariat.
The feedback was categorized as: (i) an executive abstract with key messages (i.e. ninety-seven percent of notified cases underwent sputum smears, nineteen percent were hospitalized, and fifty-nine percent were cured) reported to policymakers involved in the surveillance program; and (ii) three meetings were organized jointly by the research group and local policymakers.
In 2016 we conducted a meeting to present the results. Thirty-nine professionals involved in the primary care team working on the streets (thirty-five percent) and the Tuberculosis Surveillance and Control Program (five percent) were present. The main barriers presented by the professionals were issues of human resources (i.e. suboptimal professional staff and having two different social organizations responsible for health care). The main facilitators presented by professionals were: (i) using homeless-peers as healthcare workers; (ii) having a network linking the primary care and surveillance programs; and (iii) periodic training.
In addition to the positive results, the HTA presented an opportunity to discuss the sustainability of incentives for adhering to treatments adopted by the policymakers, such as meal allowances and housing support, to improve social conditions among the homeless.
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