[Scientific medicine and care relationship: From the therapeutic alliance to the therapeutic effect of the alliance]. / Médecine scientifique et relation de soin : de l'alliance thérapeutique à l'effet thérapeutique de l'alliance.

The new paradigm of precision medicine in oncology questions today the respective place of evidence-based medicine and doctor-patient relationship. Based on the results of a randomized study comparing the efficacy of a homeopathic molecule in the prevention of nausea and vomiting induced by chemotherapy in non-metastatic breast cancer, this article extends and develops the discussion of maintaining an unresolved tension between medical art and medical science, between care and cure. This tension sets a base for the authors of the therapeutic alliance in medicine, defined as a dialectic constantly adjourned between the alliance of the doctor with the patient and his therapy, and the therapeutic effect of this alliance. Because if a policy or a public opinion were to promote an exclusively rational medicine deprived of the field of relation to care, or on the contrary a medicine based only on clinical sense and intuition, then respectively the ethics of care and the progress of therapy would be threatened. It is advisable to be aware of erring from the truth, amplified today by social networks, as much due to a tide of scientific positivism, as an excess of the "good caring soul". Taking into account the therapeutic alliance makes it possible to no longer oppose scientific medicine and care relationship.

Cuidados paliativos nas mídias sociais: revisão integrativa de literatura / Palliative care in social media: integrative literature review / Atención paliativa en medios sociales: revisión integrativa de la literatura

Este artigo traz o estudo realizado com o objetivo de identificar as publicações sobre como os cuidados paliativos são abordados nas mídias sociais. Trata-se de uma revisão integrativa de literatura, com pesquisa de artigos nas bases Medical Literature Analysis and Retrieval System Online (Medline), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) e Scientific Eletronic Library Online (SciELO), em português, inglês e espanhol. Foram selecionados quinze artigos que atendiam aos critérios de seleção propostos, e são aqui apresentados por meio da construção de um quadro sinóptico, contendo título do estudo, periódico, ano de publicação e abordagem dos cuidados paliativos nas mídias sociais. Os resultados dos estudos demonstram que os cuidados paliativos necessitam ser melhor difundidos nas mídias sociais. Entretanto, tal evolução deve ocorrer com cautela, de modo a evitar riscos de comprometer a qualidade das informações e a respeitar questões éticas que envolvem pacientes e profissionais de saúde. Cabe destacar o papel do enfermeiro em ações de educação em saúde relacionadas com cuidados paliativos.

The study presented in this article aims to identify publications which reveal how palliative care is approached on social media. It is an integrative literature review, using search of articles in the bases Medical Literature Analysis and Retrieval System Online (Medline), Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO), in Portuguese, English and Spanish languages. Fifteen articles that met the proposed selection criteria were selected, and they are presented here through the construction of a synoptic table, containing the title of the study, the journal in which it was published, its publication date and the specific approaches to palliative care in social media. The results of the studies demonstrate that the palliative care needs to be better disseminated on social media. However, caution should be taken while such dissemination occuring, in order to prevent risks damaging the quality of information and to follow ethical issues involving patients and health professionals. The role of nurses in health education actions regarding the palliative care should be highlighted.

El estudio presentado en este artículo tiene el objetivo de identificar publicaciones sobre cómo se aborda el cuidado paliativo en las redes sociales. Es una revisión literaria integrativa, haciendo una búsqueda de artículos en las bases del Medical Literature Analysis and Retrieval System Online (Medline), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs) y Scientific Eletronic Library Online (SciELO), en portugués, inglés y español. Se seleccionaron quince artículos que cumplían los criterios de selección propuestos, y ellos son presentados aquí a través de la construcción de un cuadro sinóptico, que contiene el título del estudio, la revista en la cual ha sido publicado, el año de publicación y el abordaje de los cuidados paliativos en las redes sociales. Los resultados de los estudios demuestran que los cuidados paliativos deben ser mejor difundidos en las redes sociales. Sin embargo, dicha difusión debe ocurrir con precaución para evitar riesgos de perjudicar la calidad de la información y para cumplir las cuestiones éticas que involucran pacientes y profesionales de la salud. El papel de los enfermeros y de las enfermeras en las acciones de educación en salud relacionadas con cuidados paliativos debe ser destacado.

O Psicodrama clínico on-line: uma conexão possível / Online clinical psychodrama: a possible connection / Psicodrama clínico en línea: una posible conexión

Este artigo tem por objetivo refletir sobre as possibilidades de atuação em psicoterapia da relação, psicodrama bipessoal e psicodrama interno, por meio de atendimentos on-line. Foram utilizados relatos de experiência para ilustrar as possibilidades em relação a etapas, instrumentos e técnicas. Ao longo da discussão, é clarificado que a ação espontânea do psicodramatista frente ao cliente é imprescindível. Portanto, no atendimento on-line, é possível a manutenção do aquecimento, a aplicação das técnicas e o manejo das cenas, considerando a necessidade do reconhecimento de cenário do paciente e do diretor, bem como da possibilidade do recurso da realidade suplementar para o alcance de cenas, objetos ausentes e personagens.(AU)

This article aims to reflect on the acting possibilities in relationship psychotherapy, bipersonal psychodrama, and internal psychodrama, through online activities. Experience reports were used to illustrate the possibilities in relation to stages, instruments and techniques. Throughout the discussion, it is clarified that the spontaneous action of the psychodramatist towards the client is essential. Therefore, in online care, it is possible to maintain the heating, to apply the techniques and to manage the scenes, considering the need to recognize the patient's and the director's scenario, as well as the possibility of using the supplementary reality to reach the scenes, missing objects, and characters.(AU)

Este artículo tiene como objetivo reflexionar sobre las posibilidades de actuar en psicoterapia relacional, psicodrama bipersonal y psicodrama interno a través de actividades en línea. Fueron utilizados relatos de experiencia para ilustrar como posibilidades en relação à etapas, instrumentos y técnicas. A lo largo de la discusión, é clarificado que acción espontánea del psicodramatista frente al cliente é imprescindible. Por lo tanto, en atendimiento en línea, es posible manutención de calefacción, aplicación de las técnicas y manejo das cenas, la necesidad de un reconocimiento del centro del paciente y el director, debido a la posibilidad de un recurso de realimentación suplementaria para el alcance de los cenas, objetos ausentes e personajes.(AU)

The use of information and communication technologies to promote healthy lifestyle behaviour: a systematic scoping review.

INTRODUCTION: Health-promoting lifestyle behaviours are part of the activities of daily living that influence individual happiness, values and well-being. They play a crucial role in prevention and control of non-communicable diseases (NCDs) among all age groups. Current statistics on mortality, disability and morbidity associated with NCDs are alarming globally. The use of information and communication technology (ICT) for a health-promoting lifestyle behaviour programme enhances health behaviours that are important in the prevention and control of both communicable and non-communicable diseases. Our study aimed to map evidence on the use of ICT in comprehensive health-promoting lifestyle behaviour among healthy adults. METHODS: Eleven electronic databases were searched for the study. We included studies published in English between January 2007 and December 2018 reporting on healthy adults, ICT and any subscales of the health-promoting lifestyle profile (HPLP). Studies focusing on diseases or disease management and studies that combine monitoring tools in the form of hardware (accelerometer or pedometer) with ICT or computer games were excluded. Data were summarised numerically and thematically. RESULTS: All the studies reviewed were conducted in developed countries. Most of the studies reported on physical activity, and findings of one study covered all the subscales of HPLP. The use of ICT for health-promoting lifestyle behaviours was reported to be effective in ensuring health behaviours that can improve physical and mental health. CONCLUSION: Our findings showed that there is a dearth of knowledge on comprehensive health-promoting lifestyle behaviour that can be beneficial for the control and prevention of NCDs. There is a need to carry out primary studies on the use of ICT and comprehensive health-promoting lifestyle, especially among adults in low-income and middle-income countries where there are alarming statistics for mortality and disability associated with NCDs. PROSPERO REGISTRATION NUMBER: CRD42016042568.

It Takes an E-Village: Supporting African American Mothers in Sustaining Breastfeeding Through Facebook Communities.

BACKGROUND: Lack of breastfeeding support is a common barrier reported by African American mothers, whose breastfeeding rates remain significantly below the national average. Despite mothers' reported use of social network sites to access support on topics relating to child rearing, few studies have examined their use to exchange breastfeeding support. RESEARCH AIMS: To describe (1) the experiences of African American mothers who participate in breastfeeding support groups on Facebook and (2) the breastfeeding beliefs, practices, and outcomes for this population of mothers. METHODS: This was a prospective, cross-sectional qualitative study with an online focus group design. The study was guided by Black Feminist Thought and an integrated model of behavior prediction. Four online focus groups (N = 22) were conducted using video conferencing during September 2017 with African American mothers who were participating in breastfeeding support groups on Facebook. RESULTS: Thematic analysis was used to develop four themes and two subthemes, including creating a community for Black mothers, online interactions and levels of engagement, advantages of participating in online support groups, critiques of online support groups, empowerment of self and others, and shifts in breastfeeding perceptions and decisions. Among participants in this study, positive imagery of African American breastfeeding mothers and ongoing support from women with shared experiences improved confidence with public breastfeeding and prolonged goals for breastfeeding duration. CONCLUSION: Receiving peer support within Facebook communities may positively influence breastfeeding norms and confidence in breastfeeding, help mothers to overcome breastfeeding challenges, and ultimately extend intended breastfeeding duration.

HORYZONS trial: protocol for a randomised controlled trial of a moderated online social therapy to maintain treatment effects from first-episode psychosis services.

INTRODUCTION: Specialised early intervention services have demonstrated improved outcomes in first-episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many patients with FEP remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has developed a moderated online social media therapy (HORYZONS) designed to enhance social functioning and maintain clinical gains from specialist FEP services. HORYZONS merges: (1) peer-to-peer social networking; (2) tailored therapeutic interventions; (3) expert and peer-moderation; and (4) new models of psychological therapy (strengths and mindfulness-based interventions) targeting social functioning. The aim of this trial is to determine whether following 2 years of specialised support and 18-month online social media-based intervention (HORYZONS) is superior to 18 months of regular care. METHODS AND ANALYSIS: This study is a single-blind randomised controlled trial. The treatment conditions include HORYZONS plus treatment as usual (TAU) or TAU alone. We recruited 170 young people with FEP, aged 16-27 years, in clinical remission and nearing discharge from Early Psychosis Prevention and Intervention Centre, Melbourne. The study includes four assessment time points, namely, baseline, 6-month, 12-month and 18-month follow-up. The study is due for completion in July 2018 and included a 40-month recruitment period and an 18-month treatment phase. The primary outcome is social functioning at 18 months. Secondary outcome measures include rate of hospital admissions, cost-effectiveness, vocational status, depression, social support, loneliness, self-esteem, self-efficacy, anxiety, psychological well-being, satisfaction with life, quality of life, positive and negative psychotic symptoms and substance use. Social functioning will be also assessed in real time through our Smartphone Ecological Momentary Assessment tool. ETHICS AND DISSEMINATION: Melbourne Health Human Research Ethics Committee (2013.146) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. TRIAL REGISTRATION NUMBER: ACTRN12614000009617; Pre-results.

Social media in nursing and midwifery education: A mixed study systematic review.

AIM: To synthesize evidence on the effectiveness of social media in nursing and midwifery education. BACKGROUND: Social media are being explored to see if these online tools can support teaching, learning, and assessment. DESIGN: A mixed study systematic review. DATA SOURCES: A systematic search of PubMed, MEDLINE, CINAHL, Scopus, and ERIC was run in January 2016. An updated search was run in June 2017. No date limits were applied. METHODS: Titles, abstracts, and full papers were screened against inclusion criteria by two independent reviewers, who extracted and quality assessed data. Synthesis followed a sequential explanatory approach. RESULTS: Twelve studies were included. Social media seemed to support students to acquire new knowledge and skills. The learning process centred on the interactive nature of the platforms which allow information to be dynamically shared and discussed in near real time. The characteristics of social media enabled social support and a more student-centred setting, which appeared to enhance collaborative learning, although information quality was sometimes problematic. Learning via social media was underpinned by how well the educational interventions were organized, digital literacy and e-Professionalism of students and faculty, the accessibility of the online applications, and personal motivation. CONCLUSION: This review provides the first rigorous synthesis of social media in nursing and midwifery education. A new Social Media Learning Model was conceptualized to aid our understanding of learning via this technology. Knowledge gaps are identified and recommendations on how to capitalize on social media to improve learning in higher and continuing education provided.

Cancer-Related Internet Use and Online Social Networking Among Patients in an Early-Phase Clinical Trials Clinic at a Comprehensive Cancer Center.

PURPOSE: We examined patterns, correlates, and the impact of cancer-related Internet use among patients with advanced cancer in a phase I clinical trials clinic for molecularly targeted oncologic agents. METHODS: An anonymous questionnaire on Internet use for cancer-related purposes that incorporated input from phase I clinical trial oncologists and patients was self-administered by patients age ≥ 18 years in a phase I clinic. Multivariable modeling was used. Data were analyzed for the overall sample and by generation, which was defined by year of birth. RESULTS: Of 291 patients (52% women, 82% non-Hispanic white, 50% age ≤ 60 years), 62% were cancer-related Internet users (CIUs). Cancer-related Internet use was associated with an income of ≥ $60,000 (odds ratio, 2.42; P = .004). CIUs used the Internet to learn about their cancer (85%), treatment adverse effects (65%), clinical trials (52%), new alternative treatments (42%), and symptom management (41%). CIUs most frequently used the hospital Web site (70%) to learn about clinical trials, followed by ClinicalTrials.gov (42%) and search engines (41%). The emotional impact of Internet-derived cancer information on CIUs varied-56% felt empowered, 34% anxious, 29% relieved, and 17% confused. Cancer-related Internet information made 51% of patients from the Millennial (born after 1990) and Generation X/Y (born 1965 to 1990) CIU populations anxious compared with < 29% of CIUs from older generations (born 1964 and before). Most CIUs desired more online information about new experimental drugs (91%) and US Food and Drug Administration-approved drugs for cancer (72%). CONCLUSION: As most phase I patients use the Internet for cancer-related purposes, the Internet overall and hospital Web sites should provide more extensive, pertinent, and helpful information on clinical trials and cancer treatment to phase I patients.

Is Cancer Information Exchanged on Social Media Scientifically Accurate?

Cancer patients and their caregivers are increasingly using social media as a platform to share cancer experiences, connect with support, and exchange cancer-related information. Yet, little is known about the nature and scientific accuracy of cancer-related information exchanged on social media. We conducted a content analysis of 12 months of data from 18 publically available Facebook Pages hosted by parents of children with acute lymphoblastic leukemia (N = 15,852 posts) and extracted all exchanges of medically-oriented cancer information. We systematically coded for themes in the nature of cancer-related information exchanged on personal Facebook Pages and two oncology experts independently evaluated the scientific accuracy of each post. Of the 15,852 total posts, 171 posts contained medically-oriented cancer information. The most frequent type of cancer information exchanged was information related to treatment protocols and health services use (35%) followed by information related to side effects and late effects (26%), medication (16%), medical caregiving strategies (13%), alternative and complementary therapies (8%), and other (2%). Overall, 67% of all cancer information exchanged was deemed medically/scientifically accurate, 19% was not medically/scientifically accurate, and 14% described unproven treatment modalities. These findings highlight the potential utility of social media as a cancer-related resource, but also indicate that providers should focus on recommending reliable, evidence-based sources to patients and caregivers.