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BackgroundDeaths in the intensive care unit (ICU) represent an experience of suffering for patients, their families, and professionals. End-of-life (EOL) care has been added to the responsibilities of the ICU team, but the evidence supporting EOL care is scarce, and there are many barriers to implementing the clinical recommendations that do exist.ObjectivesTo explore the experiences and perspectives of the various members of an ICU care team in Chile regarding the EOL care of their patients.MethodsA qualitative study was performed in the ICU of a high-complexity academic urban hospital. The study used purposive sampling with focus groups as a data collection method. A narrative analysis based on grounded theory was done.ResultsFour discipline-specific focus groups were conducted; participants included 8 nurses, 6 nursing assistants, 8 junior physicians, and 6 senior physicians. The main themes that emerged in the analysis were emotional impact and barriers to carrying out EOL care. The main barriers identified were cultural difficulties related to decision-making, lack of interprofessional clinical practice, and lack of effective communication. Communication difficulties within the team were described along with lack of self-efficacy for family-centered communication.ConclusionThese qualitative findings expose gaps in care that must be filled to achieve high-quality EOL care in the ICU. Significant emotional impact, barriers related to EOL decision-making, limited interprofessional clinical practice, and communication difficulties were the main findings cross-referenced.

Women's pain is still poorly understood. Moreover, maladaptive pain beliefs contribute to the disability associated with low back pain and play a key role in the transition from acute to chronic symptoms.To explore the beliefs of women with non-specific chronic low back pain in terms of nature of symptoms, fears associated with pain, expectations for recovery, family, social and work-related limitations, and perceived self-efficacy.A qualitative study with an interpretative approach was undertaken. Face-to-face, semi-structured individual interviews were performed. Study participants were 10 women with non-specific chronic low back pain living in the Metropolitan Region of Chile. Thematic analysis was used to analyze the data. A deductive process was used to code the text and categorize the data.Participants described maladaptive beliefs about pain, leading to fearful attitudes and low expectations for recovery. These beliefs seemed to perpetuate pain and limit engagement in daily tasks and meaningful activities. Some of these beliefs were associated with information provided by healthcare professions. Despite having maladaptive beliefs, women perceived themselves as self-effective.Women with chronic low back pain described a range of different pain beliefs across a complex categorial structure. The contents of such structure may interfere with their decisions about therapeutic options. Their beliefs were often ungrounded in scientific principles, even if the information may have been provided by healthcare providers. Physical therapists would benefit from these findings to improve communication with their patients and assess the role of beliefs in decision-making.

RESUMEN INTRODUCCIÓN : La rehabilitación basada en la comunidad (RBC) busca mejorar el acceso a la rehabilitación y la inclusión social de las personas con discapacidad. Los escasos estudios realizados muestran experiencias heterogéneas en su implementación. El objetivo de este estudio fue describir las experiencias y percepciones sobre RBC de profesionales sanitarios, personas con discapacidad y familiares participantes en centros de atención primaria de la Región Metropolitana de Chile. MÉTODOS : Se realizó un estudio cualitativo exploratorio-descriptivo. A través de un muestreo de caso típico se seleccionaron profesionales sanitarios, hombres y mujeres con discapacidad física y familiares. Se desarrollaron 16 entrevistas grupales semiestructuradas, 4 por cada grupo. Se realizó análisis de contenido semántico mediante codificación inductiva y deductiva. RESULTADOS : La RBC es valorada positivamente por las personas con discapacidad y familiares. Sin embargo, los profesionales consideran que es insuficiente para lograr la inclusión social. DISCUSIÓN : Existen barreras y facilitadores para la implementación de la RBC. Su ubicación en la Atención Primaria permite flexibilidad en la atención. No obstante, se centra en intervenciones de rehabilitación física, relegando la salud integral y el trabajo intersectorial a un segundo plano. Se requiere capacitar a los equipos sanitarios para proveer una rehabilitación integral, que contribuya a la inclusión social de las personas con discapacidad. ABSTRACT INTRODUCTION : Community-based rehabilitation (CBR) seeks to improve access to rehabilitation and social inclusión of people with disabilities. Few studies show heterogeneous experiences in its implementation. The objective of this study was to describe the experiences and perceptions about CBR of health professionals, people with disabilities and family members participating in primary care centers in the Metropolitan Region of Chile. METHODS : An exploratory-descriptive qualitative study was carried out. Through a typical case sample, health professionals, men and women with physical disabilities and family members were selected. A total of 16 semi-structured group interviews were developed, 4 for each group. Semantic content analysis was performed using inductive and deductive coding. RESULTS : CBR is valuedpositively by people with disabilities and their families. However, professionals consider that it is insufficient to achieve social inclusion. DISCUSSION : There are barriers and facilitators to the implementation of CBR. Its location in Primary Care allows flexibility in care. However, it focuses on physical rehabilitation interventions, relegating comprehensive health and intersectoral work. Training of health teams is required to provide comprehensive rehabilitation that contributes to the social inclusion of people with disabilities.

Multiple interprofessional integrated modules (MIIM) 1 and 2 are two required, cross-curricular courses developed by a team of health professions faculty, as well as experts in education, within the Faculty of Medicine of the University of Chile. MIIM 1 focused on virtual cases requiring team decision-making in real time. MIIM 2 focused on a team-based community project. The evaluation of MIIM included student, teacher, and coordinator perspectives. To explore the perceptions of this interprofessional experience quantitative data in the form of standardised course evaluations regarding teaching methodology, interpersonal relations and the course organisation and logistics were gathered. In addition, qualitative perceptions were collected from student focus groups and meetings with tutors and coordinators. Between 2010 and 2014, 881 students enrolled in MIIM. Their evaluation scores rated interpersonal relations most highly, followed by organisation and logistics, and then teaching methodology. A key result was the learning related to interprofessional team work by the teaching coordinators, as well as the participating faculty. The strengths of this experience included student integration and construction of new knowledge, skill development in making decisions, and collective self-learning. Challenges included additional time management and tutors' role. This work requires valuation of an alternative way of learning, which is critical for the performance of future health professionals.

OBJECTIVE To describe the implementation status of the Community-Based Rehabilitation in Chile. METHODS Quantitative, transversal and descriptive study. The scope was constituted by the 66 community-based rehabilitation centers in the Chilean Metropolitan Region that implemented Community-Based Rehabilitation until December 2016. The sampling was based on a census method, so all the community centers were contacted. A self-administered questionnaire designed based on the Community-Based Rehabilitation matrix defined by the World Health Organization was applied. The questionnaire was answered on-line by the coordinators of the strategy in their respective centers. The data analysis was performed using descriptive statistics. RESULTS A heterogeneous level of implementation of Community-Based Rehabilitation was identified, specifically in terms of the components of the matrix described by the World Health Organization. The most implemented component was Health; the Social, Livelihood and Empowerment components were moderately implemented; and the Education component was the least implemented. CONCLUSION The implementation of Community-Based Rehabilitation is mainly based on the Health component. The level implementation of the other components of the matrix needs to be increased, as well as interdisciplinary and intersectoral strategies to achieve greater social inclusion of people with disabilities. RESUMEN OBJETIVO Describir el estado de implementación de la Rehabilitación Basada en la Comunidad en Chile. MÉTODOS Estudio cuantitativo, transversal y descriptivo. El universo estuvo conformado por los 66 centros comunitarios de rehabilitación de la Región Metropolitana de Chile que implementaron la Rehabilitación Basada en la Comunidad hasta diciembre de 2016. El muestreo tuvo intención censal, por lo que se contactaron todos los centros comunitarios. Se aplicó un cuestionario autoadministrado diseñado con base a la matriz de Rehabilitación Basada en la Comunidad definida por la Organización Mundial de la Salud. El cuestionario fue respondido on-line por los coordinadores de la estrategia en sus respectivos centros. El análisis de datos se realizó utilizando estadígrafos descriptivos. RESULTADOS Se identificó un nivel heterogéneo de implementación de la Rehabilitación Basada en la Comunidad, específicamente en cuanto a los componentes de la matriz descrita por la Organización Mundial de la Salud. El componente más implementado fue Salud; los componentes Social, Subsistencia y Fortalecimiento fueron medianamente implementados; y el componente Educación fue el menos implementado. CONCLUSIÓN La implementación de la Rehabilitación Basada en la Comunidad se basa principalmente en el componente Salud. Se requiere aumentar el nivel de implementación de los otros componentes de la matriz, así como de estrategias interdisciplinarias e intersectoriales para lograr una mayor inclusión social de las personas con discapacidad.