Empowering Cancer Patients with Self-Care and Pain Management Skills: A Quasi-Experimental Study.

BACKGROUND: Cancer patients experience distress as a result of their health condition, which, in turn, contributes to the progression of the disease. Moreover, their daily activities, well-being, and health status are significantly impacted by pain and other symptoms. In this context, empowering these patients with self-care and pain management skills can greatly contribute to effective symptom control. AIM: To develop and implement an educational approach focused on empowering family caregivers and patients with advanced cancer in effectively managing pain at home. METHOD: An educational program, PECP/C-Pain Management, was developed to empower family caregivers and cancer patients to manage pain at home. A quasi-experimental study involving 52 participants with advanced cancer was conducted to test the program. Participants' skills, behaviors, and knowledge related to self-care and pain management were assessed before and after the intervention using an appropriate instrument, the Pain Management Knowledge and Behavior Scale. RESULTS: Pain was reported as the primary symptom, and following the educational program, participants were able to monitor pain and other symptoms and effectively self-manage their treatment. CONCLUSIONS: The findings suggest that the PECP/C-Pain Management intervention was effective in improving participants' knowledge and skills in managing pain, leading to better symptom control. In addition, the Pain Management Knowledge and Behavior Scale is a reliable tool for measuring the outcomes of this intervention.

Pharmacovigilance teaching and learning: a mixed cross-sectional analysis of the Portuguese public higher education system.

Pharmacovigilance stands out for its importance in obtaining existing knowledge about medicine and patient safety and should be recognized as a continuous line of study. It constitutes a highly relevant component in the activities of health professionals, with spontaneous notification of suspected adverse drug reactions being its main emphasis. The underreporting that persists can be overcome through continuous professional development programs, reinforcing theoretical and practical knowledge in the curricular plans of health courses. As a result, more educated professionals will also allow citizens to recognize the importance of pharmacovigilance. The main objective of this study was to describe and characterize the teaching-learning process of pharmacovigilance in Portugal, analyzing the knowledge, perceptions and attitudes of students and health professionals. In total, ninety-three curricular unit forms of the seventeen healthcare courses included were analyzed, among which only three referred to pharmacovigilance as mandatory and thirty-nine did not address any keywords. The questionnaire applied was answered by 650 participants, both students (62%) and professionals (38%). Approximately 84.4% of the students and 54.7% of the professionals affirmed that they had never spontaneously reported an adverse drug reaction. Only 24.6% of the students and 17.8% of professionals referred to the existence of specific course content dedicated to pharmacovigilance in their coursework. In view of these results, it is evident that there is a need for a wider reflection regarding the further training and constant update of practicing professionals as well as in diverse health institutions, investing in the creation of an academic curriculum that integrates pharmacovigilance in healthcare courses.

Mobile apps for quick adverse drug reaction report: A scoping review.

PURPOSE: Spontaneous notification systems are essential in a post-marketing safety context. However, using this method, only about 6% of all adverse drug reactions are notified. To overcome this sub-notification problem, new methods need to be developed to improve and facilitate reporting. In this sense, the use of digital media, mainly medical mobile apps, has been presented as a powerful tool, including in pharmacovigilance. We performed a scope review to identify the available apps used to report adverse drug reactions around the world to eventually identify which of them best fits the Portuguese pharmacovigilance system. METHODS: The Joanna Briggs Institute guidelines were considered, and the framework proposed by Arksey and O'Malley was followed. All the articles that met the inclusion criteria were examined for this review. When the studies lacked in information about the app, Google was used to enhance the search for further information. RESULTS: A final number of five articles were included, revealing seven implemented mobile apps for adverse drug reaction report (Medwatcher, VigiBIP, Yellow Card, Bijwerking, Halmed, Med Safety, and ADR PvPi). These apps are implemented in the United States, France, United Kingdom, The Netherlands, Croatia, and India. Med Safety was originally designed for multi-region use and is implemented in 12 low and middle-income countries. CONCLUSIONS: Apps are easier and faster ways of reporting. The integration of such a tool in an individual care plan would allow to maintain a complete electronic health record at both individual and global level and could be eventually seen as an added value by both health professionals and patients. A country specific version of the WEB-RADR could be a solution for Portugal, in order to introduce an app to notify ADRs at the national level, due previous successful experiences in European countries.

Pharmacogenomic biomarkers as source of evidence of the effectiveness and safety of antidepressant therapy.

OBJECTIVE: The main goal of this work was to identify, describe, characterize, and classify the scientific evidence regarding the use of pharmacogenomic biomarkers in antidepressant treatment. METHODS: The work was developed in two phases: i) a search for pharmacogenomic biomarkers in summaries of antidepressant drugs with marketing authorization in Portugal; and ii) a systematic literature review based on the data obtained in the first phase, with the main objective of finding international literature that could describe and characterize previously reported biomarkers and identify other relevant biomarkers. Finally, the levels of evidence and recommendation grades were classified. RESULTS: Among the 26 drugs with marketing authorization in Portugal, only 16 had pharmacogenomic information. The most widely studied pharmacogenomic biomarker was CYP2D6. These results were mostly supported by the systematic literature review, which yielded 103 papers, 63 of which were ultimately included in the review. The systematic literature review also revealed the existence of other relevant biomarkers. Most of the included studies show a good level of evidence, which guarantees reliability and good recommendation grades. For the database (built during phase i), the results were informative but resulted in no specific recommendations. CONCLUSIONS: Most pharmacogenomic variants are not studied or acknowledged by genetic tests, and more scientific research is needed to confirm their usefulness. Therefore, only a small number of variants are considered when prescribing antidepressant drugs. In addition, genotyping of patients is not common in clinical practice.

Psychometric properties of the WHOQOL-BREF(PT) in a sample of elderly citizens.

BACKGROUND: The goal of this article was to research the psychometric properties of the WHOQOL-BREF(PT) instrument in a sample of elderly citizens residing in a rural area in their own homes or at family members' or friends' homes and to compare the results: (i) to those reported by the team of Portuguese researchers that undertaken the instrument's translation/validation to the Portuguese language and (ii) to those reported internationally by the World Health Organization Quality of Life group. An overall quality of life scoring (QOL24-all facets) is also proposed in this article as novelty. The correlation level between QOL24 and the instrument's general facet was also investigated. METHODS: This was a cross-sectional study with a sample of 351 elderly citizens (46.4% males and 53.6% females) randomly selected from the official dataset of the Local Health Unit of Baixo Alentejo. All the data were collected by health professionals at the participants' homes following the structured interview methodology and using the WHOQOL-BREF(PT) instrument. Three different structural equation models were developed: (i) a first-order confirmatory factor analysis, to assess the instrument's psychometric properties; (ii) a hierarchical second-order confirmatory factor analysis model, to allow determining the QOL24 scoring; and (iii) a more generic structural equation model, to investigate the correlation level between QOL24 and the instrument's general facet. RESULTS: The WHOQOL-BREF(PT) showed an "almost very good" goodness of fit (comparative fit index of 0.949 and Tucker-Lewis index of 0.943), an adequate internal consistency (Cronbach's alpha: from 0.64 to 0.90; composite reliability: from 0.59 to 0.88) and tolerable convergent validity (average variance extracted: from 0.374 to 0.614). However, discriminant validity was not reached because strong correlations between the first-order factors (four QOL domains) were obtained, together with low values of the average variance extracted. The scoring of QOL domains and QOL24, determined as weighted averages (proposed in this article as novelty) were significantly different than those determined as unweighted averages. The standardized correlation coefficient between QOL24 and the instrument's general facet was of 0.89 (statistically highly significant). CONCLUSIONS: The WHOQOL-BREF(PT) is a psychometrically sound instrument to assess the QOL of the considered population sample. However, the QOL domains were found strongly intertwined. More studies are necessary to validate the weighted average scoring strategy of QOL domains and QOL24. Concurrent validity between QOL24 and the instrument's general facet was considered as "strong".

The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: A prospective cohort study.

OBJECTIVES: To evaluate and compare nurses' depression, anxiety and stress symptoms at the beginning of the COVID-19 pandemic and after six months; to evaluate and compare the frequency of use of mental health promotion strategies during the same period; and to identify the relationship between the frequency of use of mental health promotion strategies, during the same period, with nurses' depression, anxiety and stress symptoms. METHODS: Data collection was carried out in two moments: at baseline and after six months. An online questionnaire was applied to nurses to assess the frequency of use of some mental health promotion strategies and their depression, anxiety, and stress symptoms (through the Depression Anxiety Stress Scales - short version (DASS-21)). RESULTS: The anxiety and stress symptoms significantly decreased over time. The physical activity increased, and a decrease was observed in the remote social contacts after six months. The stress, anxiety and depression scores were significantly lower in nurses who frequently or always used all strategies compared to participants who never or rarely used them, except for one strategy (rejecting information about COVID-19 from unreliable sources). CONCLUSIONS: Mental health promotion strategies, such as physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, breaks between work shifts, maintenance of remote social contacts, and verbalization of feelings/emotions, are crucial to reduce nurses' stress, anxiety and depression symptoms during the COVID-19 outbreak.

The Elderly Nursing Core Set and the cognition of Portuguese older adults: a cross-sectional study.

BACKGROUND: The aging population and its associated health needs require specific nursing care. The aim of this study was to draw an epidemiological profile of Portuguese elderly adults attending in residential homes and day centers and to evaluate the association between the functioning and cognition of these older adults and their sociodemographic characteristics and presence of multimorbidity. METHODS: This was a cross-sectional study of 613 older adults. Functioning was assessed using the Elderly Nursing Core Set, and cognition was assessed using the Mini Mental State Examination. Descriptive and inferential analyses were performed. RESULTS: The mean age was 85.73 years; the majority of the participants were female (69.3 %), widowed (67.0 %) and over 85 years old (60.4 %). A total of 68.2 % of the sample presented multimorbidity. A total of 54.5 % had cognitive impairment, and the average functional profile was classified as "moderate difficulty". Institutionalized older adults had more diseases than those who attended the day center. Women, those who were illiterate, those who were institutionalized and older adults who had diseases of the nervous system had a worse functional profile and greater cognitive impairment. Those with multimorbidity had a worse functional profile, and those without a spouse had greater cognitive impairment. CONCLUSIONS: Given the functional and cognitive profile of older adults, it is necessary to adopt care practices focused on the rehabilitation/maintenance of self-care and affective relationships. This care must be provided by highly qualified professionals. Therefore, it is necessary to increase the ratio of nurses per older adult in these institutions.

Parietal neurons encode expected gains in instrumental information.

In natural behavior, animals have access to multiple sources of information, but only a few of these sources are relevant for learning and actions. Beyond choosing an appropriate action, making good decisions entails the ability to choose the relevant information, but fundamental questions remain about the brain's information sampling policies. Recent studies described the neural correlates of seeking information about a reward, but it remains unknown whether, and how, neurons encode choices of instrumental information, in contexts in which the information guides subsequent actions. Here we show that parietal cortical neurons involved in oculomotor decisions encode, before an information sampling saccade, the reduction in uncertainty that the saccade is expected to bring for a subsequent action. These responses were distinct from the neurons' visual and saccadic modulations and from signals of expected reward or reward prediction errors. Therefore, even in an instrumental context when information and reward gains are closely correlated, individual cells encode decision variables that are based on informational factors and can guide the active sampling of action-relevant cues.

Prevalence of acute and chronic wounds - with emphasis on pressure ulcers - in integrated continuing care units in Alentejo, Portugal.

The aim of the study was to describe the prevalence and general characteristics of acute and chronic wounds in 2018 in Alentejo (Portugal) continuing care units. In order to look at associations, wound characteristics studied were location, type, place of acquisition, number, and duration, and patient characteristics were sex, age, and presence of risk factors. During the first 2 weeks of February 2018, a total of 770 patients were assessed at continuing care units of Alentejo. Of these, 135 exhibited wounds, a prevalence of 17.5%. Almost two out of three patients (63%) had arterial hypertension, slightly more than one in three (37%) had a stroke and/or immobility and 30% had diabetes. Of the total wounds identified, 18% were acute wounds and 82% were chronic wounds. Of the 24 acute wounds, traumatic wounds (76%), and surgical wounds (22%) were the most prevalent. The four types of pressure ulcers represented 80% of the chronic wounds. The median duration of the pressure ulcers was 5.5 months and 25% had duration over 10 months.

Family Self-Care in Chronic Disease Management: An Evolving Care Pattern?

Introduction: Self-care emerges in the family context, despite being seen as an individual determinant of health. The family, understood as a system and social unit, converges to a pattern of self-care and not to a sum of it, assuming relevance at certain moments of the life cycle, particularly in the management of chronic disease. Purpose: To perform the transposition of individual self-care to the family self-care, considering the current family's needs and characteristics, by adopting family self-care as the core concept of a care pattern as a determinant of family health. Conclusion: The family unit is the most influential factor in the health status of individuals, and it will be through family self-care behaviors that families can be healthier by managing their diseases more effectively. They seek to achieve family health, maintaining health through health promotion and disease management practices, always mediated by family self-care behaviors.

Immunotherapy-induced adverse events in metastatic renal cell carcinoma: A case of rapid response and complex challenges.

A 55-year-old woman with dyspnea was diagnosed with a 9.5cm left renal clear cell carcinoma and extensive metastatic disease. Initial treatment with Sunitinib was effective but discontinued due to severe dermatitis. Nivolumab therapy led to complete metastasis resolution and consequently nephrectomy was performed at 12 months. Postoperatively, she developed Vogt-Koyanagi-Harada-like disease, necessitating Nivolumab suspension and vision improvement with corticosteroids. After 24 disease-free months, a new contralateral renal lesion and pulmonary metastases were identified, prompting cabozantinib treatment. This resulted in clinical improvement and a partial response at the first follow-up.

Programmes Addressed to Informal Caregivers' Needs: A Systematic Literature Review.

BACKGROUND: Addressing informal caregivers' needs is essential for ensuring quality healthcare and promoting citizen-centred care. This systematic review assessed current knowledge about programmes aimed at meeting the needs of informal caregivers of adults who are dependent on others for daily life activities. METHODS: Following the PRISMA guidelines, the electronic databases EBSCOhost Research Platform, MEDLINE, CINAHL, Scopus, Web of Science and The Virtual Health Library were searched for randomized experimental studies published between 2012 and 2022 that implemented programmes addressing informal caregivers' needs to improve their experiences, health, and well-being. Quality was assessed using the standardized critical evaluation tools from the Joanna Briggs Institute. Two independent investigators performed the eligibility assessment and data extraction. Quantitative data on the effectiveness of interventions were collected, and the content of each intervention was synthesized and aggregated into categories, through narrative synthesis. RESULTS: The majority of the included studies (n = 16) were conducted in European countries and implemented a structured intervention programme compared to the provision of usual care. The studies were of fair to high methodological quality, with a higher risk of bias related to blinding. The results supported the achievement of favourable health outcomes among informal caregivers, namely improvements in mental health (n = 3) and quality of life (n = 3) and a decrease in psychological symptomatology (n = 5) and burden (n = 3). None of the interventions reported adverse outcomes; however, five studies did not describe significant differences in the outcomes assessed after the implementation of the programmes. Interventions focusing on training and educating caregivers (n = 14) and cognitive-behavioural strategies (n = 7) were the most common, while programmes focusing on emotional and psychological support as a resource to improve caregivers' psychological outcomes were scarce. CONCLUSIONS: This systematic review adds to the growing body of evidence and insight showing that programmes that address informal caregivers' needs seem to contribute to better physical and psychological health outcomes through the promotion of caregivers' educational support and the implementation of cognitive-behavioural strategies. Future research should implement methodologically robust cross-country programmes tailored to informal caregivers' physical, emotional, psychosocial, societal, and educational needs throughout the care trajectory.

Impact of family-centered care in families with children with intellectual disability: A systematic review.

Background: Family-Centered Care (FCC) is an approach to healthcare planning, delivery and evaluation, based on beneficial partnerships between health professionals, patients and families. FCC may be particularly relevant for families with children with intellectual disability (ID), given their needs of continuum care. Objective: To identify which components of the FCC are practiced and which health outcomes are considered effective in families with children with ID. Method: A systematic review guided by the PRISMA STATEMENT 2020 approach and the STROBE reporting guidelines was performed on specific databases through the EBSCOhost Web platform: MEDLINE with Full Text, CINAHL PLUS with Full Text, Academic Search Complete and Psychology and Behavioral Sciences Collection. Peer-reviewed articles published in English or Portuguese languages from 2018 to September 2023 were retrieved. Methodological quality was established using the Quality Assessment Tool for Observational, Cohort and Cross-Sectional Studies - NHLBI, NIH. Results: Ten studies met the eligibility criteria and were synthetized. The results revealed nine components, reflecting the way FCC was developed: shared decision-making; family education; respect for culture; family engagement; recognition of the family's needs, characteristics and interests; specialized care support; social and emotional support; family functionality; and family seen as a unit. The health outcomes demonstrate effective gains in improving children's health through family satisfaction with health services. Also achieved psychological and social benefits, with improved family well-being and quality of life, favoring family empowerment. Conclusions: The evidence suggests that FCC components involves an effective partnership between the family and health professionals as the main key in developing care plans, as well as the experience that the family unit brings to the delivery of care. FCC approach include all family members as decision-makers, providing emotional, physical and instrumental levels of support. Health outcomes emerged in three strands; for children with ID, families and health services.

Advances in Personalized Nursing Care.

Patient-centered care reflects the quality of personal, professional, and organizational relationships [...].

A nursing care-sensitive patient satisfaction measure in older patients.

As a novelty, this article proposes the empirical operationalization of an indicator sensitive to nursing care called patient satisfaction based on functional capacity and quality of life assessments. This was a descriptive cross-sectional study with a sample of 351 individuals aged 65 and older residing in the community. Data acquisition was performed using the structured interview method, employing a core set of 25 codes taken from the International Classification of Functioning, Disability, and Health and the WHOQOL-BREF instrument of the World Health Organization. Confirmatory factor analysis was used to infer the reliability and construct validity of the proposed model, involving three latent factors: functional capacity, quality of life, and patient satisfaction with nursing care received. The proposed model showed good reliability and construct validity, although it failed regarding discriminant validity between latent factors. The greatest statistically significant predictor of the patient satisfaction latent factor was the quality of life latent factor ([Formula: see text]), followed by the functional capacity latent factor ([Formula: see text]). The findings seem to suggest that patient satisfaction is an indicator that may be quantitatively measurable, with functional capacity and quality of life considered very significant predictors of patient satisfaction with the nursing care experience.

Quality and Safety of Proximity Care Centered on the Person and Their Home: A Systematic Review Protocol.

The quality and safety of health care is a priority, a requirement and a demand of health organizations and social institutions with concrete purposes of progressively providing people with a higher level of health and well-being. It is in the development of this path that home care currently represents an area of gradual investment and where health care services and the scientific community have shown interest in building circuits and instruments that can respond to needs. It is essencial that care must be centered and in close proximity to the person and their family, their context. On the other hand, in Portugal, there are already quality and safety models for the institutionalization context however it is non-existent for home care. In this sense, our objective is to identify, through a systematic review of the literature, particularly from the last 5 years, areas of quality and safety in home care.

Quality and Safety of Proximity Care Centered on the Person and Their Domiciliation: Systematic Literature Review.

The quality and safety of health care are a priority for health organizations and social institutions to progressively provide people with a higher level of health and well-being. It is in the development of this path that home care currently represents an area of gradual investment and where health care services and the scientific community have shown interest in building circuits and instruments that can respond to needs. The purpose of this article is to identify areas and criteria for quality and safety in home care. The method used was a systematic review registered in PROSPERO (CRD42022380989). The search was systematically carried out in CINAHL Plus with Full Text, MEDLINE with Full Text and Psychology and Behavioral Sciences Collection, using the following criteria: articles published in Portuguese and English, from January 2017 to November 2022. The results of the analysis of the articles showed areas of quality and safety in home care with their respective dimensions and operational criteria. We concluded that there are three areas: the intervention with the patient, with proximity and patient-centered care, which integrates the individual care plan and the proximity of professionals to the patient and family; the intervention of care and service management, with care management and clinical governance that includes the integrated model of health care, goal management, and context management; and the intervention related to training and professional development, where we have the skills and training of professionals.

"Geriatric Proximity" Intervention in COVID-19 Context: Contribution to Reducing Loneliness and Improving Affectivity.

(1) Background: The pandemic context has limited the social and family contacts of institutionalized older adults, and intervention is urgently needed. The aim of this study is to assess the impact of the implementation of a "Geriatric Proximity" intervention on the functioning, satisfaction with social support, affective experience, and feelings of loneliness of institutionalized older adults in the times of the pandemic. (2) Methods: This is a pilot study. An experimental group (subject to the "Geriatric Proximity" intervention) and a control group were constituted. Four assessment instruments were applied to both groups: the satisfaction with social support scale; the elderly nursing core set; the positive and negative affect schedule; and the UCLA loneliness scale. (3) Results: The control group shows no differences between the three measurement instants, while the experimental group shows between first and third measurements (all p < 0.05). We observed a reduction in the scores of loneliness scale, negative affect, and cognition functioning and an increase in satisfaction with social support and positive affect. (4) Conclusions: The intervention "Geriatric Proximity" showed a positive contribution by decreasing loneliness and increasing affectivity, satisfaction with social support, and cognitive function during the pandemic period.

Sleep Quality between Nurses and the General Population during the COVID-19 Pandemic in Portugal: What Are the Differences?

Although several studies have described the impact of the COVID-19 pandemic, particularly on sleep quality, there are few studies that, in the same time period and using the same assessment tools, compare sleep quality and mental health status between nurses and the general population. Thus, the aim of this study was to (a) examine whether there were differences between nurses and the general population regarding sleep quality and mental health status during the COVID-19 pandemic and (b) identify which factors may explain sleep quality during the COVID-19 pandemic. To do that, we carried out a cross-sectional study in Portugal. Data were collected using an online survey platform during the first COVID-19 wave, from April to August 2020. Nurses presented poorer sleep quality than the general population, as well as higher anxiety levels. Irritability and worries about the future were two of the factors that might explain those differences. Thus, we can conclude that irritability and worries about the future are dimensions of anxiety that were associated with poor sleep quality during the COVID-19 pandemic. Thus, it would be important to adopt regular anxiety and sleep assessments, particularly for nurses, and to implement strategies to reduce this problem.

Predictive factors for successful testicular biopsy.

INTRODUCTION: Infertility, the inability to conceive, constitutes a major problem in modern societies. It affects 10 to 15 percent of couples in the United States. Evaluation of infertile men is usually complex and often demands a testicular biopsy. MATERIALS AND METHODS: We reviewed all azoospermic men submitted to testicular biopsy, in our center, during infertility investigation between January 2015 and December 2021. RESULTS: A total of 117 patients with a mean age of 36.5 was considered. Biopsy was positive, as defined by the presence of viable spermatozoids by microscopy, in 48.7% of patients (n = 57). Patients were divided in two separate groups based on positive (PB) or negative biopsy (NB) and compared. PB-group had normal serum total testosterone levels and higher than NB-group (3.7 ng/mL vs. 2.85 ng/mL, p = 0.021), and normal serum FSH levels and lower than NB-group (6.0 mIU/mL vs. 16.0 mIU/mL, p < 0.001). The groups were similar concerning serum LH levels (3.9 mIU/mL vs. 6.3 mIU/mL, p = 0.343. CONCLUSIONS: Predicting outcomes of testicular biopsy is a difficult task. Our study found that men with normal testicular volume, normal levels of testosterone and FSH and those with type 1 diabetes mellitus had a higher probability of positive testicular biopsy.