"Teaching: Individual" to increase adherence to therapeutic regimen in people with hypertension and type-2 diabetes: protocol of the controlled clinical trial ENURSIN.

BACKGROUND: Worldwide, hypertension affects approximately 25% of the adult population and diabetes about 8.5%. Lack of adherence to prescribed treatment regimen remains a problem among patients undergoing long-term treatment, showing high non-adherence rates, at estimated range of between 36 and 93%. In our city, patients with hypertension and diabetes in primary care are looked after mainly by doctors with little nursing support; also, there is no published dataset among Colombian populations on the effect of nursing intervention to increase adherence to therapeutic regimen. The aim of this study was to evaluate the efficacy of nursing intervention "Teaching: Individual" compared with usual care, to increase adherence to therapeutic regimen in people with hypertension and/or type-2 diabetes, and to analyze the impact to glycosylated hemoglobin and systolic blood pressure levels. METHODS: A two-arm, single-blinded, randomized controlled trial, with participants allocated to either intervention group with "Teaching: Individual" provided by two nurses, or control group receiving routine care only. Two Hundred patients attending cardiovascular risk programs of Bucaramanga, Colombia were included. Nursing intervention consisted of six educational sessions about Coping Enhancement; Behavior Modification; Teaching: Disease Process, Prescribed Medication, Prescribed Diet and Prescribed Exercise. The outcomes were Treatment Behavior: Illness or Injury (adherence to treatment), levels of both glycosylated hemoglobin (HbA1c) and systolic blood pressure for 24 h, to be measured at baseline and two follow-up time points. Basic characteristics of the groups were compared through chi-square/Fisher's exact or Students-T/Mann-Whitney U test. Outcomes were evaluated with repeated data methods and investigated changes in the outcomes over time and to compare these changes among treatment groups, and statistical significance with p-value < 0.05 were considered. DISCUSSION: The nursing intervention "Teaching: Individual" to increase adherence to therapeutic regimen in people with hypertension and/or type-2 diabetes represents an innovative care approach intended for low-income population. The study will advise district health system policy makers and managers as to the efficacy of implementing this intervention. Should this intervention turn out efficacious, it can potentially achieve wide application in cardiovascular risk programs. TRIAL REGISTRATION: ENURSIN was registered in ClinicalTrials.gov (NCT02758275) on April 27, 2016, protocol number 01.

Evidence-informed development of women-focused cardiac rehabilitation education.

BACKGROUND: Despite their differential risk factor burden, context and often different forms of heart disease, cardiac rehabilitation (CR) programs generally do not provide women with needed secondary prevention information specific to them. OBJECTIVE: to co-design evidence-informed, theory-based comprehensive women-focused education, building from Health e-University's Cardiac College for CR. METHODS: A multi-disciplinary, multi-stakeholder steering committee (N = 18) oversaw the four-phase development of the women-focused curriculum. Phase 1 involved a literature review on women's CR information needs and preferences, phase 2 a CR program needs assessment, phase 3 content development (including determining content and mode, assigning experts to create the content, plain language review and translation), and phase 4 will comprise evaluation and implementation. In phase 2, a focus group was conducted with Canadian CR providers; it was analyzed using Braun and Clarke's iterative approach. RESULTS: Nineteen providers participated in the focus group, with four themes emerging: current status of education, challenges to delivering women-focused education, delivery modes and topical resources. Results were consistent with those from our related global survey, supporting saturation of themes. Co-designed educational materials included 19 videos. These were organized across 5 webpages in English and French, specific to tests and treatments, exercise, diet, psychosocial well-being, and self-management. Twelve corresponding session slide decks with notes for clinicians were created, to support program delivery in CR flexibly. CONCLUSION: While further evaluation is underway, these open-access CR education resources will be disseminated for implementation, to support women in reducing their risk of cardiovascular sequelae.

Preliminary Effects of a Structured Educational Program in Cardiac Patients at Different Stages of Enrollment in Cardiovascular Rehabilitation.

This quasi-experimental study investigated the preliminary effects of a structured education intervention in a pooled sample of cardiovascular rehabilitation (CR) patients in Brazil. Recently enrolled (RE) and long-term enrolled (LTE) patients attended 12 weekly education sessions in addition to three weekly exercise sessions. Patients completed surveys assessing disease-related knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was assessed by the 6-minutes walking test. All outcomes were assessed at pre-,post-CR, and 6-months follow-up. Bonferroni correction was applied. In total, 69 (69.7%) patients completed all three assessments. There were significant improvements in knowledge pre-to post-test in both subgroups (p < 0.001), and in functional capacity (p ≤ 0.001) and food intake (p ≤ 0.001) pre-to post-test in the RE subgroup. Post-test knowledge was correlated to physical activity, functional capacity and health literacy. This preliminary study suggests the importance of structured education for CR patients. A larger study using a randomized controlled design is needed to determine efficacy.

Is YouTube™ a good source of information for patients to understand laparoscopic fundoplication?

INTRODUCTION: Gastro-oesophageal reflux disease affects 10-20% of the population, and laparoscopic fundoplication is one management option. As the most frequently accessed video-sharing website, YouTube has become a popular source of information for patients. This study conducted a cross-sectional analysis of the quality and demographics of patient education videos available on YouTube for laparoscopic fundoplication. METHODS: Three searches were performed on YouTube using the phrases 'laparoscopic fundoplication', 'heartburn surgery' and 'reflux operation'. The Health on The Net (HON) code, DISCERN and Journal of the American Medical Association (JAMA) systems were used to score the first 75 results from each query. Information about each video was collected, including number of views, time since posting, number of comments and the author of the video. Relationships between these variables and video quality were investigated. RESULTS: The median number of views was 3,793. The most common author category was videos produced by surgeons. Overall the quality was poor, mean HON score was 2.5/8, mean DISCERN score was 29.3/80 and mean JAMA score was 1.5/4. Surgeon-authored videos scored higher when scored using the HON and JAMA systems. Videos of longer duration scored higher using all three scoring systems. No other factors were found to be associated with video quality. CONCLUSION: The quality of information in YouTube videos on laparoscopic fundoplication is unreliable. Doctors should be aware of this and caution their patients of YouTube's limitations. Further research is needed to develop validated scoring systems for evaluating the quality of patient education videos.

Use of visual aids in general practice consultations: A questionnaire-based survey.

Objectives: Visual aids (VAs) seem effective to improve doctor-patient communication. The objective was to describe how VAs are used in consultation and what French general practitioners (GPs) expect of them. Methods: Cross-sectional study using a self-administered questionnaire among French GPs in 2019. Descriptive and multinominal logistic regression analyses were performed. Results: Of the 376 respondents, 70% used VAs at least weekly and 34% daily; 94% considered VAs useful/very useful; 77% felt they did not use VAs enough. Sketches were the most used VAs and considered the most useful. Younger age was significantly associated with a higher rate of use of simple digital images. VAs were mainly used to describe anatomy and facilitate patient comprehension. Main reasons for not using VAs more often were time spent searching, lack of habit and poor quality of available VAs. Many GPs requested a database of good quality VAs. Conclusions: GPs use VAs regularly in consultations but would like to use them more often. Informing GPs of the usefulness of VAs, training them to draw adapted sketches and creating a good quality databank are some possible strategies to increase the use of VAs. Innovation: This study described in detail the use of VAs as tool for doctor-patient communication.

YouTube® in Spanish as an information source for patients with autoimmune hepatitis.

INTRODUCTION AND AIM: A large number of patients with autoimmune hepatitis (AH) seek information about their disease on the Internet. The reliability, comprehensiveness, and quality of said information in Spanish has not been studied. Our aim was to describe the characteristics of the information about AH on YouTube®. METHODS: An analytic observational study evaluated videos in Spanish about AH available on YouTube®, describing their general characteristics, viewer engagement, and information sources. Standardized tools were utilized to analyze reliability (DISCERN), comprehensiveness, and overall quality (Global Quality Score [GQS]). RESULTS: One hundred videos were included, 93% of which provided information from healthcare professionals (group 1), and 7% of which reflected patient opinions (group 2). There were differences in the median reliability (DISCERN 4 vs 2, p ≤ 0.05) and comprehensiveness (4 vs 2, p ≤ 0.05) scores between groups, but equal overall quality (GQS 3 vs 2, p = 0.2). Reliability (DISCERN 4; RIC 3-4) and comprehensiveness (4.5; IQR 3-5) were higher in videos by professional organizations, compared with those by independent users, healthcare information websites, and for-profit organizations (DISCERN 3; IQR 2.5-3.5) (p < 0.001). Reliability (DISCERN 2; IQR 1.5-3), comprehensiveness (2; IQR 1.5-2.5), and quality (GQS 2.5; IQR 1.5-3.5) were lower for videos made by for-profit organizations. CONCLUSION: The majority of videos about AH in Spanish on YouTube® have good reliability, comprehensiveness, and quality. Videos created by academic organizations had higher scores, thus their collaboration, with respect to patient opinion videos, is suggested.

YouTube® in Spanish as a source of information for patients with inflammatory bowel disease.

INTRODUCTION AND AIM: The majority of patients with inflammatory bowel disease (IBD) seek information about their disease on the Internet. The reliability, comprehensiveness, and quality of said information in Spanish has not previously been studied. MATERIALS AND METHODS: An analytic observational study was conducted that included YouTube® videos on IBD available in Spanish, describing general characteristics, engagement, and sources. Standard tools for evaluating reliability (DISCERN), comprehensiveness, and overall quality (Global Quality Score, GQS) were employed. RESULTS: One hundred videos were included. Eighty-eight videos consisted of information produced by healthcare professionals (group 1) and 12 included patient opinions (group 2). There were no differences in the median scores for reliability (DISCERN 3 vs 3, p = 0.554) or comprehensiveness (3 vs 2.5, p = 0.768) between the two groups, but there was greater overall quality in the group 2 videos (GQS 3 vs 4, p = 0.007). Reliability was higher for the videos produced by professional organizations (DISCERN 4; IQR 3-4), when compared with healthcare information websites and for-profit agencies (DISCERN 3; IQR 2.5-3.5) (p < 0.001), but the videos with healthcare information website and for-profit sources had a higher quality score (GQS 3 vs 4, p < 0.001). Comprehensiveness scores were similar. CONCLUSION: The majority of YouTube® videos in Spanish on IBD have good reliability, comprehensiveness, and quality. Reliability was greater for the videos produced by professional organizations, whereas quality was higher for those created from healthcare information websites and for-profit agencies.

Barriers and facilitators to virtual education in cardiac rehabilitation: a systematic review of qualitative studies.

BACKGROUND: Due to restrictions imposed by the severe acute respiratory syndrome coronavirus 2 pandemic much attention has been given to virtual education in cardiac rehabilitation (CR). Despite growing evidence that virtual education is effective in teaching patients how to better self-manage their conditions, there is very limited evidence on barriers and facilitators of CR patients in the virtual world. AIMS: To identify barriers and facilitators to virtual education participation and learning in CR. METHODS: A systematic review of peer-reviewed literature was conducted. Medline, Embase, Emcare, CINAHL, PubMed, and APA PsycInfo were searched from inception through April 2021. Following the PRISMA checklist, only qualitative studies were considered. Theoretical domains framework (TDF) was used to guide thematic analysis. The Critical Appraisal Skills Program was used to assess the quality of the studies. RESULTS: Out of 6662 initial citations, 12 qualitative studies were included (58% 'high' quality). A total of five major barriers and facilitators were identified under the determinants of TDF. The most common facilitator was accessibility, followed by empowerment, technology, and social support. Format of the delivered material was the most common barrier. Technology and social support also emerged as barriers. CONCLUSION: This is the first systematic review, to our knowledge, to provide a synthesis of qualitative studies that identify barriers and facilitators to virtual education in CR. Cardiac rehabilitation patients face multiple barriers to virtual education participation and learning. While 12 qualitative studies were found, future research should aim to identify these aspects in low-income countries, as well as during the pandemic, and methods of overcoming the barriers described.

Discovering new perspectives - strengthening autonomy. Students from different healthcare professions interact with patients and provide care in a self-determined and interprofessional manner.

The Careum Summer School (CSS) is a learning setting that enables self-regulated learning in an environment in which trainees and students from the various medical, nursing and therapeutic healthcare professions taught in the Swiss education system (upper secondary and tertiary levels A and B) develop project ideas together with patients and their caregivers. The aim of this learning setting is to promote a positive attitude among trainees and students towards interprofessional collaboration that includes patients as cooperation partners. Objective: The evaluation examines the extent to which trainees' and students' attitudes towards interprofessional collaboration changed. Information was also obtained on the experiences patients and their caregivers had during their participation in the CSS programme. Methodology: A total of 69 trainees and students were given access to an online survey in the form of the German version of the University of the West of England Interprofessional Questionnaire (UWE-IP) one week before the CSS programme began and six weeks after it concluded. Problem-focused interviews were also conducted with 11 patients and their caregivers. Results: The attitudes of the trainees and students in the UWE-IP Interprofessional Learning Scale improved significantly after the CSS programme was conducted (median t1=22.0/t2=16.0). The effect size was r=0.839 (Wilcoxon test for dependent samples). No significant results could be identified for the other three UWE-IP scales. Patients and their caregivers reported that they were able to actively participate in the CSS programme and felt valued and appreciated. Conclusion: The CSS offered a learning environment in which all participants were able to exchange knowledge and information in an interprofessional manner and work collaboratively on the development of a project idea - for example an interprofessional competency passport with a spider diagram.

Examining clinicians' perceptions of head and neck cancer (HNC) information.

BACKGROUND: Providing appropriate educational resources to patients with head and neck cancer (HNC) is important but challenging. The aim of this study was to determine Australian clinicians' perceptions of currently used HNC information resources. METHODS: A purpose-designed questionnaire was disseminated electronically to clinician members of the Australian and New Zealand Head and Neck Cancer Society (ANZHNCS) and The Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS). RESULTS: Of the 648 clinicians invited, 112 responded to the survey (17.3% response rate). Overall, 85% utilized written information as their primary mode of patient education and 49% received information on treatment details. Areas for improvement include information provision, pain management, emerging risk factors, survivorship and side effects. The majority (66%) of clinicians had a preference for internet patient education materials. CONCLUSIONS: Clinicians predominantly utilized written HNC information rather than multimedia or interactive resources. However, they expressed the desire to be able to deliver HNC information resources via an internet-based platform covering the psychosocial effects of treatment.

Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in School-Aged Children, Adolescents, and Young Adults With Autism via a Digital Smartglasses-Based Socioemotional Coaching Aid: Short-Term, Uncontrolled Pilot Study.

BACKGROUND: People with autism spectrum disorder (ASD) commonly experience symptoms related to attention-deficit/hyperactivity disorder (ADHD), including hyperactivity, inattention, and impulsivity. One-third of ASD cases may be complicated by the presence of ADHD. Individuals with dual diagnoses face greater barriers to accessing treatment for ADHD and respond less positively to primary pharmacologic interventions. Nonpharmacologic technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. OBJECTIVE: The objective of this preliminary study was to describe the changes in ADHD-related symptoms in children, adolescents, and young adults with ASD immediately after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses. METHODS: We recruited 8 children, adolescents, and young adults with ASD (male to female ratio of 7:1, mean age 15 years, range 11.7-20.5 years) through a Web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n=4, ABC-H≥13) and a low ADHD-related symptom group (n=4, ABC-H<13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. We then calculated caregiver-reported ABC-H scores at 24 and 48 hours after the session. RESULTS: All 8 participants were able to complete the intervention session. Postintervention ABC-H scores were lower for most participants at 24 hours (n=6, 75%) and for all participants at 48 hours (n=8, 100%). At 24 hours after the session, average participant ABC-H scores decreased by 54.9% in the high ADHD symptom group and by 20% in the low ADHD symptom group. At 48 hours after the session, ABC-H scores compared with baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. CONCLUSIONS: This study provides initial evidence for the possible potential of the Empowered Brain system to reduce ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children, adolescents, and young adults with ASD. This digital smartglasses intervention can potentially be targeted at a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand the clinical importance of these observed changes and to conduct longitudinal studies on this intervention with control groups and larger sample sizes.

The use of an E-pain technology in the management of chronic pain. Case report / O uso de uma tecnologia E-Pain para o manuseio da dor crônica. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain treatment includes nonpharmacologic therapies such as exercise, neuroscience pain education and behavioral interventions. It is necessary to reduce barriers to treatment and provide interventions in an accessible way to all individuals who may benefit. There is a significant interest in the potential of pain management programs administered via the Internet (E-pain technology). The objective of this case report was to assess the application of an online intervention (Caminho da Recuperação) in the management of a patient with chronic pain. CASE REPORT: A 62-year-old male patient with chronic shoulder pain who underwent rotator cuff reconstruction. The Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK) and the Shoulder Pain and Disability Index (SPADI-Brazil) were collected on the first and second visits to the physiotherapy service. At the pre-intervention visit, the patient reported intensity of pain (60/100), TSK (39/64), PCS (26/52), SPADI disability (61.2) and SPADI pain (86). The post-intervention results showed improvements in all domains, pain intensity (10/100), TSK (33/64), PCS (5/52), SPADI disability (38) and SPADI pain (42). CONCLUSION: The "Caminho da Recuperação" showed to be viable for clinical practice and may help patients in remote areas or with physical and financial constraints. The results of the present study should be interpreted with caution. We recommend the development of clinical trials to test the effectiveness and cost analysis of the intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: O tratamento de pessoas com dor crônica inclui terapias não farmacológicas como exercícios, educação em dor e intervenções comportamentais. É necessário diminuir as barreiras ao tratamento e fornecer intervenções de forma acessível a todos os indivíduos que possam se beneficiar. Existe um interesse significativo no potencial de programas de gerenciamento da dor administrados via Internet (tecnologia E-pain). Este relato teve como objetivo avaliar a aplicação de uma intervenção online (Caminho da Recuperação) no manuseio de um paciente com dor crônica. RELATO DO CASO: Paciente do sexo masculino, 62 anos de idade, com dor crônica no ombro submetido à reconstrução do manguito rotador. Foram coletados o Inventário Breve de Dor (BPI), a Escala de Pensamentos Catastróficos (PCS), Escala de Tampa para Cinesiofobia (TSK) e Índice de Dor e Deficiência no Ombro (SPADI-Brasil) nas primeira e segunda visitas ao serviço de fisioterapia. Os resultados pré-intervenção da intensidade da dor (60/100), TSK (39/64), PCS (26/52), SPADI incapacidade (61,2) e SPADI dor (86). Os resultados pós-intervenção mostraram melhoras em todos os domínios, intensidade da dor (10/100), TSK (33/64), PCS (5/52), SPADI incapacidade (38) e SPADI dor (42). CONCLUSÃO: O Caminho da Recuperação apresentou viabilidade para uso na prática clínica podendo auxiliar pessoas em áreas remotas ou com restrições físicas e financeiras. Os resultados do presente estudo devem ser interpretados com cautela. Recomenda-se o desenvolvimento de ensaios clínicos quanto à efetividade da intervenção e análise de custos.

Programas de ensino-aprendizagem para o cuidado com o cateter venoso central de longa permanência em pacientes oncológicos: revisão sistemática / Teaching-learning programs for the care of long-term central venous catheters in cancer patients: systematic review

Introdução: Pacientes oncológicos em quimioterapia que fazem o uso de Cateter Venoso Central de Longa Permanência (CVC-LP) apresentam riscos inerentes de complicações clínicas, dentre elas, as complicações infecciosas, as quais pode acarretar em maiores taxas de morbimortalidade. Para garantir a prevenção e controle de tais complicações, profissionais de saúde podem recorrer a implementação de outras estratégias de educação em saúde além do fornecimento de, somente, orientações padronizadas ou do cuidado usual, tais como programas de ensino-aprendizagem, direcionados a pacientes oncológicos e/ou seus respectivos cuidadores/familiares, os quais abordem técnicas de manipulação e cuidados adequados com o dispositivo. Objetivo: Avaliar a eficácia de programas de ensino-aprendizagem sobre o cuidado com o CVC-LP, direcionados a pacientes oncológicos em quimioterapia endovenosa e/ou seus respectivos cuidadores/familiares, na prevenção e controle de complicações infecciosas relacionadas a este dispositivo. Método: Revisão sistemática da literatura, relatada segundo as etapas propostas pelo PRISMA. A busca por estudos foi realizada nas bases de dados eletrônicas CINAHL, Cochrane Library, EMBASE, LILACS, MEDLINE via portal PubMed, Scopus e Web of Science. A literatura cinzenta foi consultada a partir do Google Scholar. As estratégias de busca foram formuladas e adaptadas segundo as especificidades de cada uma das fontes de informação utilizadas, contendo descritores controlados e palavras-chave. A seleção dos estudos elegíveis foi realizada, por dois revisores de maneira independente e cega, levando em consideração os critérios de elegibilidade previamente estabelecidos. Um terceiro revisor foi consultado para resolver eventuais conflitos. Ao final da seleção, realizou-se a busca manual nas listas de referências dos estudos incluídos, a fim de identificar outros estudos para a inclusão. Os estudos incluídos foram analisados criteriosamente, e submetidos ao processo de extração de dados. Em seguida, o risco de viés de cada estudo foi avaliado utilizando as ferramentas RoB 2 e ROBINS-I, disponibilizadas pela Colaboração Cochrane. Os dados obtidos foram, então, sintetizados, somente, de forma qualitativa, uma vez que, devido a significativa heterogeneidade quanto às configurações metodológicas dos estudos incluídos, não foi possível a realização da síntese quantitativa (metanálise). Resultados: Sete estudos foram considerados elegíveis para compor a presente revisão, sendo dois ensaios clínicos randomizados, dois ensaios clínicos não-randomizados, e três estudos quase-experimentais. Quatro estudos foram realizados com pacientes pediátricos e seus cuidadores/familiares, e três estudos foram realizados com pacientes adultos. Os programas de ensino-aprendizagem implementados para a educação do paciente e/ou cuidador/familiar, sobre o cuidado com o CVC-LP, foram desenvolvidas por meio de dimensões teórico-práticas, em cinco estudos, e por meio de dimensões somente teóricas, em dois estudos. Conclusões: Os programas de ensino-aprendizagem, tanto teóricos como teórico-práticos sobre o cuidado com o CVC-LP, direcionados a pacientes oncológicos em quimioterapia endovenosa e/ou seus respectivos cuidadores/familiares, são mais eficazes na prevenção e controle de complicações infecciosas relacionadas a este dispositivo, do que somente o fornecimento de orientações-padrão e/ou cuidados usuais fornecidos pela equipe de saúde

Background: Cancer patients undergoing chemotherapy who use the Long Term Central Venous Catheter (LT-CVC) present inherent risks of clinical complications, including infectious complications, which can lead to higher rates of morbidity and mortality. To ensure the prevention and control of such complications, healthcare professionals can resort to implementing other health education strategies besides the provision of only standardized guidelines or the usual care, such as teaching-learning programs, aimed to cancer patients and/or their respective caregivers/parents, that address handling techniques and proper care of the device. Objective: To evaluate the effectiveness of teaching-learning programs about LT-CVC care, aimed at cancer patients undergoing intravenous chemotherapy and/or their respective caregivers/parents, in the prevention and control of infectious complications related to this device. Method: Systematic review of the literature, reported according to the steps proposed by PRISMA. The search for studies was performed in the electronic databases CINAHL, Cochrane Library, EMBASE, LILACS, MEDLINE via PubMed portal, Scopus and Web of Science. Gray literature was consulted using Google Scholar. Search strategies was formulated and adapted according to the specificities of each information source, containing controlled descriptors and keywords. The selection of eligible studies was performed by two reviewers independently and blindly, take into account previously established eligibility criteria. A third reviewer was consulted to resolve any conflicts. At the end of the selection, a hand search was performed in the references lists of included studies, in order to identify other studies for inclusion. The included studies were carefully analyzed, and submitted to the process of data extraction. After that, the risk of bias of each study was assessed using the RoB 2 and ROBINS-I tools provided by the Cochrane Collaboration. The data obtained were then synthesized only qualitatively, since, due to significant heterogeneity regarding the methodological configurations of the included studies, it was not possible to perform a quantitative synthesis (meta-analysis). Results: Seven studies were considered eligible to compose the present review, being two randomized clinical trials, two non-randomized clinical trials, and three quasi-experimental studies. Four studies were performed with pediatric patients and their caregivers/parents, and three studies were performed with adult patients. The teaching-learning programs implemented for patient and caregivers/parents education on the LT-CVC care were developed through theoretical-practical dimensions, in five studies, and through only theoretical dimensions, in two studies. Conclusions: Teaching-learning programs, both theoretical and theoretical-practical, aimed to cancer patients undergoing intravenous chemotherapy and/or their respective caregivers/parents, are more effective in preventing and controlling infectious complications related to this device, than, only, the provision of standard-orientations and/or usual care provided by the healthcare team

Significados e reflexões sobre o ser portador de hipertensão / Meanings and reflections upon being a hypertensive patient / Significados y reflexiones sobre ser portador de hipertensión arterial

O objetivo com este estudo foi conhecer os significados que os portadores de hipertensão, participantes das Reuniões Educativas promovidas pelo Programa de Saúde da Família (PSF), atribuem à doença. Trata-se de um estudo qualitativo e descritivo, orientado pelo materialismo dialético. Utilizou-se como instrumento de coleta de dados a entrevista semiestruturada, tendo como sujeitos oito portadores de hipertensão, definidos por meio de sorteio entre os cadastrados, em uma Equipe de Saúde da Família (ESF). Nesse sorteio, foram contemplados sujeitos dos sexos masculino e feminino e de quatro faixas etárias preestabelecidas. A análise dos dados foi realizada por meio da técnica de análise do discurso. Os resultados revelaram o que a hipertensão arterial significa para os portadores de hipertensão entrevistados, os sintomas, as causas, o tratamento e o prognóstico da dela. Os entrevistados percebem a doença de forma negativa, pois a condição crônica de uma enfermidade pode ocasionar perdas nos relacionamentos sociais, nas atividades de lazer e no prazer. Essas perdas levam, muitas vezes, ao desânimo, à tristeza, à depressão e à frustração, além de ser um agravante no momento de mudar e de adaptar-se a um novo estilo de vida. A opção metodológica adotada nas Reuniões Educativas mostrou-se pouco emancipatória e fortemente centrada na atenção curativa, bem como no atendimento chamado "queixa-conduta". Conclui-se que há necessidade de reflexões sobre o ser hipertenso para subsidiar o aperfeiçoamento das ações educativas para os usuários.

This study aims to understand what hypertensive patients that participate on educational meetings promoted by the Family Health Program (FHP) think about their illness. It is a qualitative and descriptive study guided by dialectic materialism. A semi-structuralized interview was used as data collection tool. The subjects were eight hypertensive patients chosen among those who were enrolled in the FHP. Men and women from four different groups of ages were considered. Data analysis was performed by using discourse analysis technique. Results show what hypertension means to the interviewed patients in terms of illness symptoms, causes, treatment options and prognosis. Patients see the disease as something negative once its chronic condition may cause losses in social life, in leisure and in pleasant activities. On the other hand, these losses may lead to dejection, sadness, depression and frustration which may complicate adaptation to new life styles. The methodology used in the educational meetings had little emancipatory potential and was strongly centered in curative attention, as well as in conduct complaints services. We conclude that we need to think over the meaning of hypertension to the patients in order to subsidize the development of educational actions.

El estudio tiene como objetivo conocer los significados que los portadores de hipertensión arterial participantes de las Reuniones Educativas promovidas por el PSF atribuyen a la enfermedad. Se trata de un estudio cualitativo descriptivo orientado por el materialismo dialéctico. La recogida de datos se llevó a cabo mediante el instrumento entrevista semiestructurada con ocho sujetos portadores de hipertensión seleccionados por sorteo entre pacientes inscritos en el PSF. En este sorteo se consideraron sujetos del sexo masculino y femenino de cuatro franjas de edad preestablecidas. El análisis de datos fue realizado por medio de la técnica análisis del discurso. Los resultados revelan el significado de la hipertensión arterial atribuido por los portadores de hipertensión, sus síntomas, causas, tratamientos y pronóstico. Los entrevistados sienten que la enfermedad es algo negativo porque su condición crónica puede conllevar a pérdidas en las relaciones sociales, actividades de ocio y placer. Todas estas pérdidas pueden conducir al desánimo, tristeza, depresión y frustración, aparte de agravarse cuando se desea cambiar para adaptarse a un nuevo estilo de vida. La opción metodología adoptada en las reuniones se mostró poco emancipadora, muy centrada en la atención curativa y en la atención llamada 'queja-conducta'. Se concluye que hay que reflexionar más sobre el hipertenso para ayudar a desarrollar medidas educativas para los usuarios.