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Background: The COVID-19 pandemic is placing unprecedented pressure on a nursing workforce that is already under considerable mental strain due to an overloaded system. Convergent evidence from the current and previous pandemics indicates that nurses experience the highest levels of psychological distress compared with other health professionals. Nurse leaders face particular challenges in mitigating risk and supporting nursing staff to negotiate moral distress and fatigue during large-scale, sustained crises. Synthesizing the burgeoning literature on COVID-19-related burnout and moral distress faced by nurses and identifying effective interventions to reduce poor mental health outcomes will enable nurse leaders to support the resilience of their teams. Aim: This paper aims to (1) synthesize existing literature on COVID-19-related burnout and moral distress among nurses and (2) identify recommendations for nurse leaders to support the psychological needs of nursing staff. Methods: Comprehensive searches were conducted in Medline, Embase and PsycINFO (via Ovid); CINAHL (via EBSCOHost); and ERIC (via ProQUEST). The rapid review was completed in accordance with the World Health Organization Rapid Review Guide. Key Findings: Thematic analysis of selected studies suggests that nurses are at an increased risk for stress, burnout and depression during the ongoing COVID-19 pandemic. Younger female nurses with less clinical experience are more vulnerable to adverse mental health outcomes.

The COVID-19 pandemic has exacerbated pre-existing challenges with respect to access to elective surgery across Canada, and a single-entry model (SEM) approach has been proposed as an equitable and efficient method to help manage the backlog. With Ontario's recent investment in centralized surgical wait-list management, we sought to understand the views of health system leaders on the role of SEMs in managing the elective surgery backlog.We used the qualitative method of interpretive description to explore participant perspectives and identify practical strategies for policy-makers, administrators and clinical leaders. We conducted semistructured interviews with health system leaders from across Ontario on Zoom between March and June 2021. We used snowball and purposive sampling. Inclusion criteria included Ontario health care leaders, fluent in English or French, in positions relevant to managing the elective surgery backlog. Exclusion criteria were individuals who work outside Ontario, or do not hold relevant roles.Our interviews with 10 health system leaders - including hospital chief executive officers, surgeons, administrators and policy experts - resulted in 5 emergent domains: perceptions of the backlog, operationalizing and financing SEMs, barriers, facilitators, and equity and patient factors. All participants emphasized the need for clinical leaders to champion SEMs and the utility of SEMs in managing wait-lists for high-volume, low-acuity, low-complexity and low-variation surgeries.Although SEMs are no panacea, the participants in our study stated that they believe SEMs can improve quality and reduce variability in wait times when SEMs are designed to address local needs and are implemented with buy-in from champions. Health care leaders should consider SEMs for improving surgical backlog management in their local jurisdictions.

The healthcare system is complex and requires effective leaders who can navigate team, organizational and system dynamics. The objectives of this study were to explore competencies required to lead emerging healthcare challenges and identify strategies for developing successful leaders. Semi-structured interviews were conducted with 12 healthcare leaders from the government, hospitals and in consulting. This study unpacks competencies such as communication and change management and draws attention to the significance of emotional intelligence and working with data that have not traditionally been identified as key competencies. These findings can inform curriculum and modernization initiatives in healthcare leadership programs.

The COVID-19 pandemic burdens health-care workers (HCWs) worldwide. Amid high-stress conditions and unprecedented needs for crisis management, organizations face the grand challenge of supporting the mental health and well-being of their HCWs. The current literature on mental health and well-being primarily focuses on improving personal resilience among HCWs. However, this puts the responsibility for coping with COVID-19-related stress almost fully on the individual. This chapter discusses an important alternative framing of this issue - how health-care organizations (HCOs) can facilitate recovery from work processes (i.e., returning to a baseline level by engaging in nonwork activities after work) for their workers. Based on a narrative review of the occupational health psychology literature, we provide practical strategies for supporting the four key recovery experiences of detachment, control, mastery, and relaxation, as well as present general recommendations about how to promote recovery. These strategies can help HCOs facing the grand challenge of sustaining worker well-being and functioning during the COVID-19 pandemic, as well as during future pandemics and for workers facing high work pressure in general.

Despite transcatheter aortic valve implantation (TAVI) becoming a widely accepted therapeutic option for the management of aortic stenosis, post-procedure readmission rates remain high. Rehospitalization is associated with negative patient outcomes, as well as increased healthcare costs, and has therefore been identified as an important target for quality improvement. Strategies to reduce the post-TAVI readmission rate are needed but require the identification of patients at high risk for rehospitalization. Our systematic review aims to identify predictors of post-procedure readmission in patients eligible for TAVI.We conducted a comprehensive search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for the time period from 2015 to the present for articles evaluating risk factors for rehospitalization post-TAVI with a follow-up period of at least 30 days in adults age ≥ 70 years with aortic stenosis. The quality of included studies was evaluated using the Newcastle-Ottawa Scale. We present the results as a qualitative narrative review.We identified 49 studies involving 828,528 patients. Post-TAVI readmission is frequent, and rates vary (14.9% to 54.3% at 1 year). The most-frequent predictors identified for both 30-day and 1-year post-TAVI readmission are atrial fibrillation, lung disease, renal disease, diabetes mellitus, in-hospital life-threatening bleeding, and non-femoral access.This systematic review identifies the most-common predictors for 30-day and 1-year readmission post-TAVI, including comorbidities and potentially modifiable procedural approaches and complications. These predictors can be used to identify patients at high-risk for readmission who are most likely to benefit from increased support and follow-up post-TAVI.Bien que l’implantation valvulaire aortique par cathéter (IVAC) soit maintenant une option thérapeutique largement acceptée pour la prise en charge de la sténose aortique, les taux de réadmission des patients après cette intervention demeurent élevés. La réhospitalisation est associée à des résultats de santé défavorables pour les patients ainsi qu’à des coûts de soins de santé plus élevés, ce qui en fait une cible importante pour l’amélioration de la qualité des soins. Des stratégies de réduction des taux de réadmission après l’IVAC sont nécessaires, mais elles exigent de repérer les patients qui présentent des risques de réhospitalisation plus élevés. Notre revue systématique vise à cerner les facteurs prédictifs de réhospitalisation après l’intervention chez les patients admissibles à une IVAC.Nous avons effectué une recherche exhaustive dans les bases de données MEDLINE, Embase et Cochrane Central Register of Controlled Trials (CENTRAL) pour trouver les articles publiés entre 2015 et aujourd’hui qui rapportent les facteurs de risque de réhospitalisation suite à une IVAC chez les adultes âgés de 70 ans et plus atteints de sténose aortique, avec une période de suivi d’au moins 30 jours. La qualité des études retenues a été évaluée à l’aide de l’échelle Newscastle-Ottawa. Les résultats sont présentés sous forme d’une revue narrative qualitative.Nous avons retenu 49 études, réalisées auprès de 828 528 patients. La réhospitalisation après l’IVAC était fréquente, et les taux étaient variables (de 14,9 % à 54,3 % après un an). Les facteurs prédictifs de réhospitalisation les plus fréquents, déterminés 30 jours et un an après l’IVAC, étaient la fibrillation auriculaire, la maladie pulmonaire, la maladie rénale, le diabète, l’hémorragie menaçant le pronostic vital lors du séjour à l’hôpital, et l’approche par une voie non fémorale.La présente revue systématique nous a permis de caractériser les facteurs prédictifs les plus fréquents de réhospitalisation, 30 jours et un an après une IVAC, dont certaines affections concomitantes et certains facteurs potentiellement modifiables liés aux approches d’intervention et aux complications. Ces facteurs pourraient permettre de cibler les patients à risque élevé de réhospitalisation, qui seraient les plus susceptibles de bénéficier d’un soutien et d’un suivi accrus après une IVAC.

BACKGROUND The COVID-19 pandemic has exacerbated the mental health crisis within the health workforce. There is evidence that mobile apps that promote psychosocial wellness may be an effective, low-cost, and widely accessible tool to reduce stress and burnout among HCPs. OBJECTIVE The objective of this scoping review is to explore whether there are mobile-based apps tailored to HCPs for stress and burnout relief during a crisis time and explore their characteristics and key features. METHODS The Google Play and Apple app stores were searched for wellness apps using the key words “relaxation” and “mental wellness”. The first 100 search results were assessed for eligibility. This was supplemented by an online search for burnout and stress relief apps for physicians and/or nurses. The apps were included if they focused on burnout and/or stress relief and demonstrated relevance to HCPs. More specifically, the app must be marketed to HCPs, recommended by health professional organizations, or was studied for efficacy among HCPs. The details of included apps were extracted on Microsoft Excel. RESULTS Most burnout and/or stress relief apps are targeted to the general population. Few apps (n=8) were specifically built for HCPs, but the pandemic crisis has encouraged existing apps to create specific content for this group (n=7). The features within apps relevant to HCPs were largely mindfulness/meditation (n=19) and wellness education (n=12), whereas community support (n=9) and access to psychological services (n=4) were less common. CONCLUSIONS Stress and burnout are widespread and severe among HCPs during the COVID-19 crisis. Mobile apps may be a feasible tool to offer wellness interventions, but most existing apps do not provide targeted content for HCPs. For those that do, they largely focus on individual-based activities, rather than external support.

The global scale and unpredictable nature of the current COVID-19 pandemic have put a significant burden on health care and public health leaders, for whom preparedness plans and evidence-based guidelines have proven insufficient to guide actions. This article presents a review of empirical articles on the topics of “crisis leadership” and “pandemic” across medical and business databases between 2003 (since SARS) and—December 2020 and has identified 35 articles for detailed analyses. We use the articles’ evidence on leadership behaviors and skills that have been key to pandemic responses to characterize the types of leadership competencies commonly exhibited in a pandemic context. Task-oriented competencies, including preparing and planning, establishing collaborations, and conducting crisis communication, received the most attention. However, people-oriented and adaptive-oriented competencies were as fundamental in overcoming the structural, political, and cultural contexts unique to pandemics.

BACKGROUND Healthcare Information for All (HIFA) is a multidisciplinary global campaign consisting of more than 20,000 members worldwide committed to improving the availability and use of health care information in low- and middle-income countries (LMICs). During the COVID-19 pandemic, online HIFA forums saw a tremendous amount of discussion regarding the lack of information about COVID-19, the spread of misinformation, and the pandemic’s impact on different communities. OBJECTIVE This study aims to analyze the themes and perspectives shared in the COVID-19 discussion on English HIFA forums. METHODS Over a period of 8 months, a qualitative thematic content analysis of the COVID-19 discussion on English HIFA forums was conducted. In total, 865 posts between January 24 and October 31, 2020, from 246 unique study participants were included and analyzed. RESULTS In total, 6 major themes were identified: infodemic, health system, digital health literacy, economic consequences, marginalized peoples, and mental health. The geographical distribution of study participants involved in the discussion spanned across 46 different countries in every continent except Antarctica. Study participants’ professions included public health workers, health care providers, and researchers, among others. Study participants’ affiliation included nongovernment organizations (NGOs), commercial organizations, academic institutions, the United Nations (UN), the World Health Organization (WHO), and others. CONCLUSIONS The themes that emerged from this analysis highlight personal recounts, reflections, suggestions, and evidence around addressing COVID-19 related misinformation and might also help to understand the timeline of information evolution, focus, and needs surrounding the COVID-19 pandemic.

With a rapid shift to telehealth during the coronavirus disease 2019 (COVID-19) pandemic, clinicians, health care organizations, and policy makers must consider and address patients' evolving needs, concerns, and expectations.

ContextCOVID-19 has had an unprecedent impact on physicians, nurses, and other health professionals around the world, and a serious health care burnout crisis is emerging as a result of this pandemic.ObjectivesWe aim to identify the causes of occupational stress and burnout in women in medicine, nursing, and other health professions during the COVID-19 pandemic and interventions that can support female health professionals deal with this crisis through a rapid review.MethodsWe searched MEDLINE, Embase, CINAHL, PsycINFO, and ERIC from December 2019 through September 30, 2020. The review protocol was registered in PROSPERO and is available online. We selected all empirical studies that discussed stress and burnout in women health care workers during the COVID-19 pandemic.ResultsThe literature search identified 6148 citations. A review of abstracts led to the retrieval of 721 full-text articles for assessment, of which 47 articles were included for review. Our findings show that concerns of safety (65%), staff and resource adequacy (43%), workload and compensation (37%), job roles and security (41%) appeared as common triggers of stress in the literature.Conclusions and RelevanceThe current literature primarily focuses on self-focused initiatives such as wellness activities, coping strategies, reliance of family, friends and work colleagues to organizational led initiatives such as access to psychological support and training. Very limited evidence exists about the organizational interventions such as work modification, financial security, and systems improvement.

The COVID-19 pandemic burdens health-care workers (HCWs) worldwide. Amid high-stress conditions and unprecedented needs for crisis management, organizations face the grand challenge of supporting the mental health and well-being of their HCWs. The current literature on mental health and well-being primarily focuses on improving personal resilience among HCWs. However, this puts the responsibility for coping with COVID-19-related stress almost fully on the individual. This chapter discusses an important alternative framing of this issue - how health-care organizations (HCOs) can facilitate recovery from work processes (i.e., returning to a baseline level by engaging in nonwork activities after work) for their workers. Based on a narrative review of the occupational health psychology literature, we provide practical strategies for supporting the four key recovery experiences of detachment, control, mastery, and relaxation, as well as present general recommendations about how to promote recovery. These strategies can help HCOs facing the grand challenge of sustaining worker well-being and functioning during the COVID-19 pandemic, as well as during future pandemics and for workers facing high work pressure in general.

The COVID-19 pandemic has placed extraordinary pressure on an already strained healthcare workforce (HCWs). Public health measures, such as prolonged periods of social isolation, unexpected employment disruptions, school closures, financial distress, and changes to routine, are having an unprecedented negative impact on mental well-being. Unaddressed stress and burnout can lead to depression, suicidal ideation and substance abuse. We conducted a review of the literature (a) to synthesize the common triggers of stress, burnout and depression faced by HCWs during the COVID-19 pandemic and (b) to identify interventions at the individual, organizational and systemic levels that can support the well-being of HCWs during a pandemic. A systematic search of literature databases was conducted from 2003 to June 2020. We included review articles that reported on stress, burnout and depression in HCWs; that primarily focused on women; and that included the percentage or number of women surveyed. Of the 2,803 papers found, 31 were included. Our preliminary findings show that HCWs are at increased risk for stress, burnout and depression during the COVID-19 pandemic. These negative outcomes are triggered by individual-level factors such as gender, family status and lack of social support; organizational-level factors such as high workload and access to PPE;, and systemic-level factors such as prevalence of COVID-19, rapidly changing public health guidelines and a lack of recognition at work. There is a limited amount of evidence on effective interventions that prevent anxiety, stress, burnout and depression during a pandemic. Preliminary findings of causes of increased stress and mental health issues suggest possible strategies healthcare organizations can use to address modifiable factors such as ongoing training to increase confidence in caring for COVID-19 patients, clear infection control guidelines and sufficient PPE and optimization of working conditions for HCWs.

ObjectivesThe overall objectives of this rapid scoping review are to (a) synthesize the common triggers of stress, burnout, and depression faced by women in health care during the COVID-19 pandemic, and (b) identify individual-, organizational-, and systems-level interventions that can support the well-being of women HCWs during a pandemic.DesignThis scoping review is registered on Open Science Framework (OSF) and was guided by the JBI guide to scoping reviews and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping reviews. A systematic search of literature databases (Medline, EMBASE, CINAHL, PsycInfo and ERIC) was conducted from 2003 until June 12, 2020. Two reviewers independently assessed full-text articles according to predefined criteria.InterventionsWe included review articles and primary studies that reported on stress, burnout, and depression in HCWs; that primarily focused on women; and that included the percentage or number of women included. All English language studies from any geographical setting where COVID-19 has affected the population were reviewed.Primary and secondary outcome measuresStudies reporting on mental health outcomes (e.g., stress, burnout, and depression in HCWs), interventions to support mental health well-being were included.ResultsOf the 2,803 papers found, 31 were included. The triggers of stress, burnout and depression are grouped under individual-, organizational-, and systems-level factors. There is a limited amount of evidence on effective interventions that prevents anxiety, stress, burnout and depression during a pandemic.ConclusionsOur preliminary findings show that women HCWs are at increased risk for stress, burnout, and depression during the COVID-19 pandemic. These negative outcomes are triggered by individual level factors such as lack of social support; family status; organizational factors such as access to personal protective equipment or high workload; and systems-level factors such as prevalence of COVID-19, rapidly changing public health guidelines, and a lack of recognition at work.Strengths and limitations of this studyA rapid scoping review was conducted to identify stress, burnout and depression faced by women HCWs during COVID-19.To ensure the relevance of our review, representatives from the women HCWs were engaged in defining the review scope, developing review questions, approving the protocol and literature search strategies, and identifying key messages.It provides a descriptive synthesis of current evidence on interventions to prevent mental health for women HCWs.Most studies used cross-sectional surveys, making it difficult to determine the longitudinal impact.There was significant variability in the tools used to measure mental health.

Context: The COVID-19 pandemic has placed unprecedented stress on health care systems worldwide. The global scale of the outbreak and its unpredictable nature has put a significant leadership burde...

Background: Global health electives (GHEs) allow medical students to experience different health systems, but there are few instruments to assess performance, prompting us to adapt and pilot such an instrument. Methods: A tool to evaluate professionalism, communication and collaboration was developed and piloted on GHE students. The main outcome measure was Faculty assessment of students, but peer assessment and self-assessment were also performed and semi-structured interviews with students were used for corroboration. The 31 items were rated using a Likert scale and marks before and after the GHE were compared. Results: The tool was sensitive to change. Students improved in each competency, the greatest change being in collaboration, which moved from 4.5/7 to 5.44/7. Qualitative analyses supported observed changes. Conclusions: Our tool, adapted from accreditation bodies’ requirements, appeared to be able to discern changes in acquisition of skills in several important competencies in medical students p...

Internationally, there is a move to incorporate continuing medical education (CME) as an integral part of the medical education continuum. CME system is very complex. Unlike the undergraduate and postgraduate medical education systems, which are mainly situated within the medical schools, the CME system has many variations across the globe. To date, there have been few systematic approaches to document the CME systems internationally. This paper is an initial attempt to document some regional variations and trends related to CME credit systems. Very little has been written about the different CME credit systems in the scientific literature. The data for this paper were collected through field notes and gray literature, including conference proceedings. This paper is an overview paper of the CME credit systems, and we recognize this is an ambitious task given the professional, local, national and regional variations of CME credit systems. We hope this paper will create a discussion among the CME stakeholde...

What leadership roles can transnational medical professional societies play in addressing the life long learning needs of health professionals in emerging world? The World Federation of Neurology (WFN) provides neurological education programme in countries with unmet neurological training needs, in an effort to improve the knowledge and skills of neurologists. The WFN's experience provides a unique study to exemplify how global stakeholders collaborate with each other to deliver CME and to improve the quality of health care services. A multi-stage programme evaluation was undertaken to explore the WFN CME, in an effort to: a) understand how global CME programmes are organized, and b) understand the success factors and the challenges of delivering global CME. The programme evaluation was conducted between June 2005 and March 2006. The preliminary results were shared with the WFN education committee and national coordinators and international experts to check and confirm the findings from the study. The study results reveal that global CME programmes could be designed effectively with minimum costs. These programmes contribute to meeting the continued learning needs of neurologists in resource poor settings. Further, the WFN initiative provides, some initial evidence that these programs can contribute to systems level improvements.

The past decade has witnessed an increase in global partnerships created to strengthen health systems and provide training to health professionals in low- and middle-income countries. These partnerships are complex interventions. This study focused on unpacking the characteristics of global partnerships that provide continuing education for health professionals. A realist approach underpinned the research design to identify the mechanisms that shape successful global partnerships. Two case studies focusing on global continuing medical education (CME) were studied longitudinally using a realist evaluation approach. To complement that finding, published research reports of global CME partnerships were synthesized using a realist synthesis approach. Data were collected over a three-year period and included interviews, participant observations, document reviews, and surveys. A hybrid thematic approach guided the data analysis.\ud \ud The study results suggested that global CME partnerships are highly dependent on human factors. On the one hand, motivational factors related to individual players help to shape the partnership goals, directions, and outcomes. On the other hand, relational factors such as trust, communication, and understanding play a key role in developing and sustaining global partnerships. As such, these partnerships highly rely on the individuals who champion the partnership at the country level or at the partnership level and in their ability to build relationships as well as empower key stakeholders.

The pharmaceutical industry, by funding over 60% of programs in the United States and Canada, plays a major role in continuing medical education (CME), but there are concerns about bias in such CME programs. Bias is difficult to define, and currently no tool is available to measure it.Representatives from industry and academia collaborated to develop a tool to illuminate and measure bias in CME. The tool involved the rating of 14 statements (1 = strongly disagree, 4 = strongly agree) and was used to evaluate 17 live CME events. Cronbach's alpha was used to assess the internal consistency of the scale.Cronbach's alpha for the total score was 0.82, indicating excellent internal consistency. Incomplete or biased data, data presented in an unbalanced manner, and experience not integrated with evidence-based medicine were found to correlate strongly with the total score. Use of trade names showed a low correlation with the total, and nondeclaration of conflict of interest correlated negatively with the total. These associations suggest that whereas sponsor companies may declare conflicts of interest, such a declaration may not ensure an unbiased presentation.The tool and the data from this study can be used to raise awareness about bias in CME. Policymakers can use this tool to ensure that CME providers meet the standards for education, and CME providers can use the tool for conducting random audits of events they have accredited.

This article was migrated. The article was not marked as recommended. Faculty development for residents and nonfaculty instructors is an important component of medical school accreditation requirements. In medical schools with distributed clinical partners and independent graduate medical education programmes, mandating faculty development for residents at clinical partner locations is often difficult. In this article, we share the experience of Northeast Ohio Medical University (NEOMED) with introducing a mandatory faculty-development program for residents who practice in our 24 clinical partner locations.

Telemedicine and telehealth programs are generally more complex than their traditional on-site health care delivery counterparts. A few organizations have developed sustainable, multispecialty telemedicine programs, but single service programs, such as teleradiology and teledermatology, are common. Planning and maintaining a successful telemedicine program is challenging, and there are often barriers to developing sustainable telehealth programs. This article reviews some important aspects of developing a telehealth program, and provides two examples of currently operating successful model programs.

Globalization has opened the doors for medical students to undertake international health electives, providing an opportunity for them to gain valuable competencies and skills outside their formal curriculum. As the number of medical students embarking on these electives increases, there is a need to structure the electives with specific learning objectives and to ensure adequate educational outcomes.We describe the International Pediatric Emergency Medicine Elective (IPEME), which is a novel global health elective that brings together students from Canada and the Middle East who are selected on the basis of a competitive application process and brought to Toronto for a 4-week living and studying experience. The program was introduced in 2004 and uses four specific areas to provide its structure: pediatric emergency medicine, global health, leadership, and peace building. The elective uses core CanMEDS competencies to foster cross-cultural dialogue, networking, and cooperation and fulfills the program's aim of using health as a bridge to peace.The lessons learned from the curriculum planning and implementation process are highlighted and the impact of the program explored to help provide a framework for developing similar international electives.

Can you imagine Canadian, Israeli, Jordanian, and Palestinian medical students singing, volunteering, and working together to develop programs to address issues related to global pediatric emergency medicine? Such a program was first held in Toronto in 2003 and continues annually. Can you imagine Canadians, Israelis, Jordanians, and Palestinians jointly teaching and developing solutions, via video teleconference, to address behavioral neurological problems affecting elderly populations? Such an initiative began in 2006 and continues to expand today. Can you imagine senior Jordanian and Israeli ear surgeons operating together, successfully carrying out pioneering cochlear implant surgery on deaf infants, on Jordanian national television? Such a surgery was performed in Amman in December 2003. Can you imagine every newborn baby in Jordan having her or his hearing tested? Such a program began in January 2005 as a result of Canadian, Israeli, Palestinian, and Jordanian service, educational, and scientific research cooperation, becoming national health policy in Jordan in 2007. All of this and much more are the result of the Canada International Scientific Exchange Program (CISEPO) and its cooperation network of knowledge.

espanolEstudios recientes en America Latina corroboraron la prevalencia de la hipertension arterial, el colesterol elevado en plasma, los trastornos metabolicos y otros factores de riesgo cardiovascular (FRCV), todo esto sumado a la falta de control de la enfermedad, la escasa adhesion al tratamiento y el uso de pocas medidas preventivas, lo que derivo en la necesidad de educar tanto al medico como al paciente. Se han realizado estudios limitados para demostrar la efi cacia del desarrollo profesional continuo y su capacidad de infl uir positivamente en los indicadores de salud del paciente. En Venezuela se llevo a cabo un estudio para tratar de medir la efectividad de un curso combinado basado en actividades online y presenciales sobre el manejo de los FRCV, dirigido a medicos que trabajan en atencion primaria. Un grupo piloto de 37 medicos de atencion primaria del area metropolitana de Caracas completo una intervencion educativa de 12 semanas, la cual consistio en sesiones semanales en linea, utilizando la estrategia educativa basada en problemas sobre el manejo de los FRCV, asi como talleres presenciales relacionados con los cambios de comportamiento del medico y del paciente, utilizando los prin- cipios de la educacion terapeutica. Se trabajo con una cohorte de 303 pacientes con hipertension arterial de grado I-II no controlada y/o colesterol plasmatico elevado, y se llevo a cabo un seguimiento durante seis meses. Los resultados evidenciaron cambios signifi cativos en los medicos respecto a los aspectos cognitivos y al estilo de su practica profesional en el manejo de los FRCV. Los participantes se mostraron muy satisfechos con el contenido y el formato de la intervencion educativa. De igual manera, encontramos un resultado positivo en la induccion de cambios en toda la cohorte de pacientes, sobre todo en el perfi l lipidico, la presion arterial y la modifi cacion del estilo de vida. Seria interesante su aplicacion a mayor escala para medir su efectividad a largo plazo. EnglishRecent studies in Latin-America corroborated the prevalence of hypertension, elevated plasma cholesterol, metabolic disorders and other cardiovascular risk factors (CVRF) along with lack of disease awareness. Treatment and preventive measures indicated the urgent need for patient and physician education. Limited studies have been conducted to demonstrate the effectiveness of continual professional development (CPD) and its ability to positively improve health care outcomes. A study was done in Venezuela to measure the effectiveness of a blended web-based education in the management of CVRF by primary health care physicians (PCP), working in primary care services. A pilot group of 37 PCP, from the Caracas metropolitan area, completed a 12-week educational intervention consisting of weekly online problem- based sessions on CVRF management and face-to-face workshops on physician and patient behavioral changes, using principles of therapeutic education. A cohort of 303 of their patients with uncontrolled grade I-II arterial hypertension and/or elevated plasma cholesterol were included and followed up for a 6-month period. Signifi cant changes in the cognitive aspects and attitudes about the management of CVRF occurred among the PCP, who were highly satisfi ed with the content and format of the educational intervention. We also found a positive role in inducing changes in the entire patient cohort, particularly on the plasma lipid profi le, blood pressure, and lifestyle changes. Results of this pilot study refl ect the effective use of CPD on patient care and PCP interactions in creating synergy and understanding with participating institutions. There is a need of large scale implementation and more extensive comparison with other educational approaches.

Background Ongoing conflict in the Middle East poses a major threat to health and security. A project screening Arab and Israeli newborns for hearing loss provided an opportunity to evaluate ways for building cooperation. The aims of this study were to: a) examine what attracted Israeli, Jordanian and Palestinian participants to the project, b) describe challenges they faced, and c) draw lessons learned for guiding cross-border health initiatives. Methods A case study method was used involving 12 key informants stratified by country (3 Israeli, 3 Jordanian, 3 Palestinian, 3 Canadian). In-depth interviews were tape-recorded, transcribed and analyzed using an inductive qualitative approach to derive key themes. Results Major reasons for getting involved included: concern over an important health problem, curiosity about neighbors and opportunities for professional advancement. Participants were attracted to prospects for opening the dialogue, building relationships and facilitating cooperation in the region. The political situation was a major challenge that delayed implementation of the project and placed participants under social pressure. Among lessons learned, fostering personal relationships was viewed as critical for success of this initiative. Conclusion Arab and Israeli health professionals were prepared to get involved for two types of reasons: a) Project Level: opportunity to address a significant health issue (e.g. congenital hearing loss) while enhancing their professional careers, and b) Meta Level: concern about taking positive steps for building cooperation in the region. We invite discussion about roles that health professionals can play in building "cooperation networks" for underpinning health security, conflict resolution and global health promotion.

In this article, we present an educational approach uniquely linked to humanitarian and peace-building goals in conflicted regions of the world. We examine the Canada International Scientific Exchange Program and its lead program, the Middle East Association for Managing Hearing Loss, as a case study. Under a Canadian umbrella, continuing medical education and continuous professional development are used to gather academics from regions in conflict for mutually beneficial professional activities. Larger scale international prospects for educational programming, extending beyond the health sector, are ways of addressing the primary determinants of health and creating social capital.

espanolA los dinamicos y profundos cambios cientifi cos, tecnologicos, demografi cos y epidemiologicos en el area de la salud, se unen demandas de la poblacion para mejores y mas efi cientes servicios. Se da el hecho de que la educacion medica de pregrado y posgrado no garantiza las competencias de forma indefi nida, lo que hace necesarios mecanismos que aseguren una mejor calidad asistencial. El Consorcio Proyecto Global (PGC) sugiere una estrategia integral de educacion medica continua y de desarrollo profesional continuo estructurada, simplifi cada, evaluada y acreditada para contribuir a enfrentar estos desafios. Se ejecuto el proyecto en dos paises como prueba piloto (Rusia y Venezuela). Se implemento en cinco fases: construccion de relaciones institucionales, determinacion de necesidades educativas, implementacion y medicion del impacto, difusion del mensaje y expansion de experiencias, y ajuste e institucionalizacion del proyecto. Se involucro a un numero signifi cativo de medicos que trabajan en los servicios de atencion primaria de salud. Se identifi caron y probaron estandares globales de educacion medica continua y desarrollo profesional continuo, y se diseno un curriculo nuclear, comenzando con el area cardiovascular, con el objeto de mejorar los niveles de conocimiento y la practica de los medicos participantes, y evidenciarlo en cambios positivos en indicadores de los pacientes usuarios. Finalmente, se llego a la etapa de institucionalizacion y reforzamiento continuo, en la cual el PGC funciono como un proyecto piloto de intercambio internacional y como posible proveedor de educacion medica continua y desarrollo profesional continuo, con alta calidad, costos razonables y acreditacion academica. EnglishProject Globe Consortium (PGC) integrated one simplifi ed strategy in continuing medical education and continuing professional development. It was designed as an answer to the fast and intense changes in science, technology, demography, epidemiology, the increasing demands of the population, and the changing role of physicians in the current health care systems, under the awareness that the undergraduate medical education does not guarantee the required competencies indefi nitely thus implying the need of necessary mechanisms to ensure quality and professional healthcare. The project was implemented in two pilot countries (Russia and Venezuela). It was developed in fi ve phases: building up on institutional relationships, identifying local champions; identifying educational needs; implementation and impact measurement; sharing the message and experiences; maturing adjustments and institutionalization of the project. A signifi cant number of physicians working in primary health care settings were involved. Global standards of continuing medical education and continuing professional development were identifi ed and tested. A core curriculum was designed, starting with cardiovascular risk factors, to improve knowledge levels and professional practice of the physicians involved, along with signifi cant changes in patient indicators as biomarkers. Finally, the project reached the stage of institutionalization and continuous reinforcement in which the PGC represented an international networking and potential continuing medical education and continuing professional development, provider of, high quality, at reasonable costs and with academic accreditation