Evaluation of Online Information on Complementary and Alternative Treatments for Dry Eye Disease.

SIGNIFICANCE: Dry eye disease is a common condition with many complementary and alternative therapies promoted online. Patients may inquire about these therapies, and clinicians should be aware of the existence, safety, and efficacy of these therapies, as well as the quality of available online information. PURPOSE: Complementary and alternative medicine is a multibillion-dollar industry with increasing popularity. Dry eye disease is a chronic condition with many complementary and alternative therapies described online. Patients may inquire about and elect to forgo conventional treatments in favor of these therapies. This study identified alternative treatments for dry eye disease described online and evaluated the Web sites that described them. METHODS: An Internet search algorithm identified Web sites describing complementary and alternative therapies for dry eye disease. Web site quality was assessed using the Sandvik score to evaluate Web site ownership, authorship, source, currency, interactivity, navigability, and balance. The potential risk of Web sites to patients was assessed using a risk scoring system. A list of described therapies was compiled. RESULTS: Eight Web sites describing complementary and alternative therapies for dry eye disease were assessed. The Sandvik score classified more than half of the Web sites as "satisfactory" and none as "poor." The overall mean risk score was low at 0.9. One Web site displayed information that discouraged the use of conventional medicine, whereas no Web sites discouraged adhering to clinicians' advice. The Web sites listed 12 therapies with a further 32 found in Web site comments. The most common therapies were acupuncture, vitamin supplements, homeopathic eye drops, castor oil, coconut oil, and chamomile eye wash. CONCLUSIONS: The majority of analyzed Web sites were of satisfactory quality with a low potential risk to patients. However, some Web sites were biased toward their own therapies, lacked proper referencing, and/or did not identify authorship. Further research is required to ascertain the efficacy and safety of these therapies.

The ABC Topical Management of Atopic Dermatitis in Philippines: Expert Recommendations.

Atopic dermatitis (AD) has been shown to have an increasing incidence in Asia, congruous with the trends observed worldwide. The severity of the condition has been associated with challenges in disease control. Moreover, a significant number of patients do not adhere to their physicians’ recommendations correctly and prefer alternative treatments. Better education regarding the nature of the disease and its appropriate management may improve patient compliance and lead to better control. An ABC scheme of AD management entails anti-inflammatory, barrier repair and basic skin care strategies to adequately manage AD. It is an easy-to-follow model which helps lessen distress and improve the quality of life amongst patients. An expert panel composed of specialists in the field of dermatology and pediatric dermatology in the Philippines convened to review current data and management practices in order to provide key treatment recommendations and identify current gaps in the treatment of mild to moderate atopic dermatitis. This scientific expert panel, likewise, seeks to provide guidance for all healthcare professionals involved in the care and management of AD patients.J Drugs Dermatol. 2021;20(1):84-87. doi:10.36849/JDD.5080.

Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

The Effect of Educational Program for New Mothers about Infant Abdominal Massage and Foot Reflexology for Decreasing Colic at Najran City.

As part of an emerging movement in complementary therapy, the practice of infant foot reflexology and abdominal massage is gaining widespread acceptance as a therapeutic approach to the relief of infantile colic. The objective of the current research is to offer an evaluation of knowledge, attitudes and practice amongst new mothers in relation to infant massage and reflexology. Specifically, the intention is to apply any insights gained to the establishment of appropriate educational programmes in line with the requirements of new mothers. This is to be achieved through the appraisal of any perceived improvements in the knowledge, attitudes and practices of new mothers following the completion of any programme. A quasi-experimental design is adopted in this research and applied in the setting of the outpatient clinic at the University Hospital in Najran, Saudi Arabia. A convenience sample, comprising sixty-two new mothers, all of whom have infants ranging in age from one month to four months. All the infants experience colic. The first instrument employed in this research comprises a structured interview wherein interviewees are presented with a two-part sheet. Section one is devoted to the obtaining of socio-demographic data regarding the mothers and the infants, whilst section two consists of a questionnaire devoted to gauging the level of knowledge of new mothers. The second research instrument is an observation checklist aimed at evaluating the practical skills of new mothers, whereas the third research tool employed in this study is a Likert scale which judges the attitudes of new mothers toward foot reflexology and abdominal massage. The findings of the research reveal that most new mothers demonstrated improvements to their attitudes, knowledge, and practice following the programme. Specifically, there was found to be statistically significant correlation between the age, educational level, and work experience of new mothers and their scores for attitudes, knowledge, and practices. Hence, it was possible to conclude that educational programmes for new mothers can augment their knowledge, refine their practices and improve their attitudes in respect of abdominal massage and foot reflexology as a means of treating colic in infants. Thus, the authors recommend that educational programmes constitute a significant means by which abdominal massage and foot reflexology can be promoted as a therapy for the treatment of colic.

Specialist thyroid package 1 (PS1) in outpatient endocrine care [Pakiet specjalistyczny dotyczacy tarczycy (PS1) w ambulatoryjnej opiece endokrynologicznej].

The article presents the assumptions of a new specialist thyroid package (PS1) in outpatient specialist care in the field of endocrinology, which was introduced by the National Health Fund (NFZ - Narodowy Fundusz Zdrowia) from January 2020. It became an impulse to characterize the current problems affecting specialist care in the field of endocrinology, search for their potential causes and propose strategies that are intended to contribute to increasing the efficiency of the system.

Perceptions of the Value of Clinical Pharmacy Medication Review for Women During Early Pregnancy.

BACKGROUND: The benefit of continuing medications to prevent or treat illness is often overlooked, since pregnant women tend to overestimate the teratogenic risk of medications. Pharmacists can serve as a resource to prescribers and pregnant women with their knowledge of the appropriate use and management of medications during pregnancy. Little information exists on the value women place on pharmacists' medication management during pregnancy. OBJECTIVE: To assess pregnant women's perceptions of an ambulatory care clinical pharmacist (CP) medication review service during early pregnancy that provided education regarding the risks and benefits of medication use during pregnancy. METHODS: This was a qualitative study of pregnant women using semistructured telephone interviews performed between December 12, 2018, and January 18, 2019, and conducted in an integrated health care delivery system. Potential participants were identified from CP encounter records. Consented English-speaking women aged ≥ 18 years participated in an up to 30-minute interview within 1 week of the CP encounter. Interviews were professionally transcribed and coded line by line using the constant comparison method with grounded theory used to gain insight into participants' perspectives. RESULTS: 62 women were invited to participate in semistructured telephone interviews of whom 24 (39%) completed the interview. Three main themes emerged from the qualitative analysis: satisfaction with the service, comfort with medication use during pregnancy, and connectedness to the health care team. Overall, the CP medication review and education service was perceived positively by the participants. Participants reported satisfaction in the quality, timeliness, and convenience of the service and found it beneficial to have their medications reviewed early during pregnancy to assist in medication use decisions before their first obstetric visit. CONCLUSIONS: CP medication review provided a comforting, valuable service for women during early pregnancy when medication-taking decisions can feel exigent. DISCLOSURES: This study was funded by Kaiser Permanente. The authors have nothing to disclose. Preliminary results were presented at the Mountain States Conference for Residents and Preceptors, May 2019, in Salt Lake City, UT.

Are YouTube videos useful for patient self-education in type 2 diabetes?

OBJECTIVE: To evaluate the usefulness of YouTube videos as an educative tool for type 2 diabetes self-management. DESIGN: Search terms were "diabetes diet" and "diabetes treatment." Videos were jointly assessed by two reviewers. A third investigator evaluated a random sample to check for agreement. MAIN MEASURES: Usefulness defined as making reference to AAD7 Self-Care Behaviors™ and presence of misleading information. RESULTS: Of the 393 videos included, 42.2 percent (n = 166) classified as "alternative medicine." 40.2 percent (n = 158) contained useful information. 25.7 percent (n = 101) videos contained misleading information. Videos displaying "alternative medicine" professionals (60 out of 200) were less useful (17% vs 57%; p < 0.001) and more misleading (40% vs 2%; p < 0.001). CONCLUSION: The probability of finding videos that relate to AADE7™ self-care behaviors is below 50 percent. The odds of finding misleading information are high. Therefore, it is inadvisable for professionals to recommend the use of YouTube as an educating tool if specific videos are not suggested.

Three randomized controlled trials evaluating the impact of "spin" in health news stories reporting studies of pharmacologic treatments on patients'/caregivers' interpretation of treatment benefit.

BACKGROUND: News stories represent an important source of information. We aimed to evaluate the impact of "spin" (i.e., misrepresentation of study results) in health news stories reporting studies of pharmacologic treatments on patients'/caregivers' interpretation of treatment benefit. METHODS: We conducted three two-arm, parallel-group, Internet-based randomized trials (RCTs) comparing the interpretation of news stories reported with or without spin. Each RCT considered news stories reporting a different type of study: (1) pre-clinical study, (2) phase I/II non-RCT, and (3) phase III/IV RCT. For each type of study, we identified news stories reported with spin that had earned mention in the press. Two versions of the news stories were used: the version with spin and a version rewritten without spin. Participants were patients/caregivers involved in Inspire, a large online community of more than one million patients/caregivers. The primary outcome was participants' interpretation assessed by one specific question "What do you think is the probability that 'treatment X' would be beneficial to patients?" (scale, 0 [very unlikely] to 10 [very likely]). RESULTS: For each RCT, 300 participants were randomly assigned to assess a news story with spin (n = 150) or without spin (n = 150), and 900 participants assessed a news story. Participants were more likely to consider that the treatment would be beneficial to patients when the news story was reported with spin. The mean (SD) score for the primary outcome for abstracts reported with and without spin for pre-clinical studies was 7.5 (2.2) versus 5.8 (2.8) (mean difference [95% CI] 1.7 [1.0-2.3], p < 0.001); for phase I/II non-randomized trials, 7.6 (2.2) versus 5.8 (2.7) (mean difference 1.8 [1.0-2.5], p < 0.001); and for phase III/IV RCTs, 7.2 (2.3) versus 4.9 (2.8) (mean difference 2.3 [1.4-3.2], p < 0.001). CONCLUSIONS: Spin in health news stories reporting studies of pharmacologic treatments affects patients'/caregivers' interpretation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03094078 , NCT03094104 , NCT03095586.

An education intervention to improve decision making and health literacy among older Australians: a randomised controlled trial.

BACKGROUND: National policies seek to involve older Australian's in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults' decision self-efficacy and health literacy. METHODS: A randomised controlled trial was conducted. We recruited individuals aged over 65 years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using a website or DVD plus booklet versus booklet only. The primary outcome was decision self-efficacy. A secondary outcome included the Preparation for Decision-Making scale and health literacy. Outcomes were collected at 3 weeks, and 2 months from baseline, and analysed using an adjusted ANOVA, or repeated measures ANOVA. RESULT: We randomised 153 participants. Follow up at 3 weeks and 2 months was completed by 131 participants. There was a 14% (n = 22) attrition rate. At the end of the intervention, we found no significant differences between groups for decision self-efficacy (mean difference (MD) 3.8, 95% confidence interval (CI) -2.0 to 9.6 p = 0.20), there were no differences between groups on nine health literacy domains, and the Preparation for Decision-Making scale. Over 80% of participants in both groups rated the content as excellent or good. CONCLUSION: Decision self-efficacy improved for participants, but did not differ between groups. Decision self-efficacy and health literacy outcomes were not influenced by the delivery of education using a website, DVD or booklet. Participants found the resources useful, and rated the content as good or excellent. CM Web or DVD and booklet resources have the potential for wider application. TRIAL REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trials Registry: ACTRN ( ACTRN12616000135415 ). The trial was registered on 5 February 2016.

Guidelines for review of patients on haemodialysis: Are we meeting patient needs?

AIM: This study aimed to determine satisfaction with dietetic services, identify barriers and enablers to engaging with dietetic services and acceptable methods of delivering nutrition care to patients on haemodialysis. METHODS: A questionnaire was developed based on existing satisfaction surveys and key constructs from the Theoretical Domains Framework to understand patient behaviours around accessing dietetic services. Constructs were grouped according to the COM-B model (Capability, Opportunity and Motivation) of the Behaviour Change Wheel to inform future interventions. Patients at three Brisbane haemodialysis units participated, with questionnaire administered via laptop (by dietetic assistants) or paper-based version (by nurses). RESULTS: Sixty-six patients completed the questionnaire (response rate 40%, 62 ± 14 years, 58% male). Most respondents (n = 63, 95%) reported seeing a dietitian since commencing haemodialysis. A quarter of respondents reported declining or not wanting to see the dietitian. Despite this, questions pertaining to service satisfaction were largely positive. Questions related to enablers and barriers to engaging with the dietitian revealed the domain of motivation as the main barrier with 41% (n = 26) participants not wanting to make dietary changes. The domains of capability and opportunity were not barriers. Patients preferred receiving nutrition information from dietitians, when they had a question or concern, rather than at predefined intervals. Telehealth was not acceptable to the majority of participants. CONCLUSIONS: While patients were satisfied with dietetic care, their preferences for dietetic service delivery were not aligned with current evidence-based guidelines, highlighting need for alternative models of care. Dietetic interventions need to be delivered in a way that addresses motivation.

Evaluation Breast Cancer Information on The Internet in Arabic.

Nowadays, medical information regarding various diseases and disorders is available online. The Internet has become the first choice for the patient when it comes to gathering detailed information about a disease or problem. Therefore, in view of this frequent occurrence, the information that is provided online needs to be accurate; providing comprehensive facts, transparency, and quality. A study was carried out to determine the accuracy of information related to breast cancer on various websites. Websites which share information online about breast cancer, in the Arabic language, were selected. The quality of the websites was to be evaluated; however, there is no standard method for evaluating the quality of health websites. Hence, a rating form was developed for this study, to determine the completeness and transparency of a specific number of websites using three popular search engines. A 16-item questionnaire was prepared and validated to determine the quality of individual websites in addition to using the DISCERN instrument for assessing consumer health information. Most of the websites (approximately 47%) were deemed to be commercial in nature. Thirty-three percent were developed by non-profit organizations. They disseminated information concerning the risk factors (93%), screening, mammography (93%), surgical treatment (93%), chemotherapy (89%), radiotherapy (93%), and complementary medicine (0%) surrounding the treatment of breast cancer. About 67% of the websites were estimated to give completely correct information. Incidentally, only five websites had a healthcare professional or expert as the author, while nine of them had no author. Although numerous breast cancer-related websites exist, most do a poor job in providing Arabic-speaking women with comprehensive information about breast cancer surgery. Providing easily-accessible, high-quality online information has the potential to significantly improve patients' experiences.

Assessing pharmacy student confidence to answer patient questions regarding herbal medicines and natural product drugs.

BACKGROUND AND PURPOSE: To assess the change in confidence answering questions about herbal medicines and natural product drugs (HMNPD) in third year professional pharmacy students in an HMNPD course. EDUCATIONAL ACTIVITY AND SETTING: A questionnaire was developed to query confidence in responding to patient questions, recommending specific products, and ability to retrieve resources regarding HMNPD. It was administered the first and last week of the semester; responses were evaluated using a Chi-squared test. FINDINGS: At baseline, 46 students (84%) were "very hesitant", "hesitant", or "neither hesitant nor confident" in responding to HMNPD questions; after the course, most students were "confident" or "very confident" (n=30, 54%) (p < .001). Confidence in finding reliable resources increased from the first week (29 students [40%] were "confident" or "very confident") to the last week (51 students [91%] were "confident" or "very confident" [p < .001]). At baseline, five students (9%) were "confident" or "very confident" in ability to recommend a specific product; after the course, 26 students (46%) were "confident" or "very confident" (p < .001). Nine students (16%) felt "very confident" or "confident" in HMNPD safety/effectiveness at baseline; the same proportion felt this way at conclusion (p = .93). Four students (7%) were confident in HMNPD efficacy at baseline and nine (16%) felt the same way at the end (p = .12). DISCUSSION: Significant increases in student confidence answering patient questions, responding to disease-specific queries, and using appropriate resources were found. There was no difference in confidence in HMNPD safety/efficacy. SUMMARY: This study supported continued HMNPD education in the pharmacy program.

[The challenges of time in therapeutic education]. / Les enjeux du temps dans l'éducation thérapeutique.

The notion of temporality is particularly important in the management of a chronic disease. Therapeutic education of the patient represents a holistic care approach in which his life history plays a role. Establishing a context favourable to personalised support requires one to consider one's cultural interactions. Adapted communication will favour an adjustment of behaviour and the improvement of one's quality of life.

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

BACKGROUND: Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE: To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING: Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS: This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS: A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION: Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.

Permanent education in the vaccination room: what is the reality?

OBJECTIVE: To understand, from the perspective of the professional, the Permanent Education (PE) in the vaccination room in its real context. METHOD: Multiple holistic-qualitative case studies, based on Maffesoli's Interpretive Sociology with 56 participants from four microregions of the Western Extended Region of Minas Gerais State. RESULTS: They present PE as infrequent and insufficient. They denote that the practical-theoretical experience with vaccine contributes to the work; the search for knowledge, starting from the professional itself; and the professional training fails to perform in the vaccination room. FINAL CONSIDERATIONS: The notions of PE are linked to the daily needs of individuals and services, with indication of being interactive, periodic, in specific and non-global issues for better assimilation. Obstacles to the non-implementation of PEH are realized by the workload associated with insufficient human resources, the distance of the nurses from the vaccination room and the lack of support from the higher levels.

Pulmonary Rehabilitation and Exercise Training in Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common condition that is becoming increasingly prevalent. It affects 13.2% of the population over age 40 in Germany. In 2020, it will be the third most common cause of morbidity and mortality around the world. It markedly impairs the quality of life of those who suffer from it and presents a major economic challenge to the health-care system. METHODS: This review is based on pertinent publications retrieved by a selective literature search and on the authors' clinical experience. RESULTS: Pulmonary rehabilitation (PR) for patients with COPD is supported by evidence on the highest level. It is associated with statistically significant (p <0.001) and clinically relevant improvement in physical performance (6-minute walk distance: + 44 m; 95% confidence interval [33; 55]), shortness of breath (Chronic Respiratory Disease Questionnaire: +0.79 points [0.56; 1.03]), and the quality of life (Saint George´s Respiratory Questionnaire: -6.9 points [-9.3; -4.5]). The benefits of PR are especially evident after an acute exacerbation of COPD: it significantly lowers the rate of readmission to the hospital (odds ratio 0.22 [0.08; 0.58], p = 0.002) and improves physical performance ability (6-minute walk distance: + 62 m [38; 86] and the quality of life (Saint George´s Respiratory Questionnaire: -7.8 points [-12.1; -3.5]; p <0.001 for both). CONCLUSION: PR is an effective and cost-effective therapeutic intervention that improves physical performance ability, shortness of breath, and the quality of life in patients with COPD, but it has not yet been fully implemented as recommended in the relevant guidelines. There is a need for targeted, problem-oriented referral to a range of PR programs with problem-specific content. The necessary outpatient PR structures still need to be established in Germany.

Patient Counseling Guidelines for the Use of Cannabis for the Treatment of Chemotherapy-Induced Nausea/Vomiting and Chronic Pain.

The use of cannabis medications has grown in recent years for the symptomatic relief of chemotherapy-induced nausea/vomiting (CINV) and chronic pain (cancer-related and non-cancer-related). As states legalize the use of cannabis, it is important for pharmacists and other health care professionals to be aware of how to counsel patients receiving prescriptions for cannabis medications. The aim of this study was to develop patient counseling guidelines for the use of cannabis products in treatment of CINV and chronic pain. A literature search was performed using Medline/PubMed resources and Google Scholar between July 2015 and August 2018 using broad search terms, e.g., cannabinoids adverse effects, cannabis, natural cannabinoids, and tetrahydrocannabinol. Using the American Society of Health-System Pharmacists patient counseling guidelines and medical information on cannabis medications gathered from drug databases, a comprehensive counseling guideline was developed. Medical evidence of the use of natural cannabis medications that are smoked or orally ingested have not been studied as extensively as oral therapeutic agents currently available. Cannabis medications have become more prevalent by approval of legislators in several states. Hence, pharmacists and health care professionals should counsel patients effectively on its use. This guideline needs to be tested to assess its utility in patients.

Permanent education in the vaccination room: what is the reality? / Educación permanente en sala de vacuna: ¿cuál es la realidad? / Educação permanente em sala de vacina: qual a realidade?

ABSTRACT Objective: To understand, from the perspective of the professional, the Permanent Education (PE) in the vaccination room in its real context. Method: Multiple holistic-qualitative case studies, based on Maffesoli's Interpretive Sociology with 56 participants from four microregions of the Western Extended Region of Minas Gerais State. Results: They present PE as infrequent and insufficient. They denote that the practical-theoretical experience with vaccine contributes to the work; the search for knowledge, starting from the professional itself; and the professional training fails to perform in the vaccination room. Final considerations: The notions of PE are linked to the daily needs of individuals and services, with indication of being interactive, periodic, in specific and non-global issues for better assimilation. Obstacles to the non-implementation of PEH are realized by the workload associated with insufficient human resources, the distance of the nurses from the vaccination room and the lack of support from the higher levels.

RESUMEN Objetivo: Comprender, bajo la óptica del profesional, la Educación Permanente (EP) en sala de vacuna en su contexto real. Método: Estudio de casos múltiples holístico-cualitativo, fundamentado en la Sociología Comprensiva del Cotidiano con 56 participantes de cuatro microrregiones de la Región Ampliada Oeste de Minas Gerais. Resultados: Presentan la EP como poco frecuente e insuficiente. Denotan que la experiencia práctico-teórica con vacuna contribuye con el trabajo, la búsqueda del conocimiento partiendo del propio profesional y la formación profesional falla para la actuación en sala de vacuna. Consideraciones finales: Los conceptos de EP están ligadas a las necesidades cotidianas individuales y de los servicios, con indicios de ser interactiva, periódica, en temas puntuales y no globales para una mejor asimilación. Los obstáculos para la no realización de la EPS se concretan en la sobrecarga de trabajo asociada a los recursos humanos insuficientes, el distanciamiento del enfermero de la sala de vacuna y la falta de apoyo de las instancias superiores.

RESUMO Objetivo: Compreender, sob a ótica do profissional, a Educação Permanente (EP) em sala de vacina em seu contexto real. Método: Estudo de casos múltiplos holístico-qualitativo, fundamentado na Sociologia Compreensiva do Cotidiano com 56 participantes de quatro microrregiões da Região Ampliada Oeste de Minas Gerais. Resultados: Apresentam a EP como pouco frequente e insuficiente. Denotam que a experiência prático-teórica com vacina contribui com o trabalho, a busca do conhecimento partindo do próprio profissional e a formação profissional falha para atuação em sala de vacina. Considerações finais: As noções de EP vêm atreladas às necessidades cotidianas individuais e dos serviços, com indicação de ser interativa, periódica, em temas pontuais e não globais para melhor assimilação. Os entraves para não realização da EPS se concretizam na sobrecarga de trabalho associada a recursos humanos insuficientes, o distanciamento do enfermeiro da sala de vacina e a falta de apoio das instâncias superiores.

Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD.

BACKGROUND AND OBJECTIVES: Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record-based enhanced personal health record to disseminate CKD stage-specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: (1) enhanced personal health record only, (2) patient navigator only, (3) both, and (4) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates. RESULTS: Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups (P=0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups. CONCLUSIONS: We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators and patient education through an enhanced personal health record in those with CKD.