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1.
Farm Hosp ; 44(7): 61-65, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32533674

RESUMO

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health  crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical  outcomes and reduce the risk of contagion. The purpose of this article is to  describe and analyze the experience of HPSs with outpatient Telepharmacy  during the COVID-19 pandemic and expose the lessons learned. Measures have  been adopted in on-site outpatient pharmacy clinics to prevent exposure of  patients and professionals to the virus. These measures are based on national  and international recommendations on social distancing and hygiene. With  regard to remote outpatient pharmacy services, teleconsultation with drug  dispensing has been promoted based on five basic procedures, each with its  advantages and limitations: home drug delivery from HPSs, with the advantage  of universal access and the limitation of entailing a substantial investment in  resources; HPS coordination with primary care pharmacists, which requires no  investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which  requires the patient to go to the pharmacy, without confidentiality being  guaranteed for any patient; geolocation and hospital-based medication  dispensing, which provides universal access and direct traceability, but entails  investment in human resources; and HPS coordination with associations of  patients, which does not entail any additional cost but limits the information  available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of  medication (with a high level of satisfaction among patients); and the need to  foster Telepharmacy as a complementary tool through a mixed model of  outpatient pharmacy consultation service that incorporates the advantages of  each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus , Assistência à Saúde/organização & administração , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Telemedicina/organização & administração , Assistência à Saúde/estatística & dados numéricos , Aconselhamento Diretivo/organização & administração , Aconselhamento à Distância/organização & administração , Previsões , Geografia Médica , Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Hospitais Universitários/organização & administração , Humanos , Sistemas de Medicação no Hospital/organização & administração , Pacientes Ambulatoriais , Educação de Pacientes como Assunto/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Espanha
2.
J Perinat Med ; 48(5): 450-452, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32401227

RESUMO

If the worries about the coronavirus disease 2019 (COVID-19) pandemic are not already enough, some pregnant women have been questioning whether the hospital is a safe or safe enough place to deliver their babies and therefore whether they should deliver out-of-hospital during the pandemic. In the United States, planned out-of-hospital births are associated with significantly increased risks of neonatal morbidity and death. In addition, there are obstetric emergencies during out-of-hospital births that can lead to adverse outcomes, partly because of the delay in transporting the woman to the hospital. In other countries with well-integrated obstetric services and well-trained midwives, the differences in outcomes of planned hospital birth and planned home birth are smaller. Women are empowered to make informed decisions when the obstetrician makes ethically justified recommendations, which is known as directive counseling. Recommendations are ethically justified when the outcomes of one form of management is clinically superior to another. The outcomes of morbidity and mortality and of infection control and prevention of planned hospital birth are clinically superior to those of out-of-hospital birth. The obstetrician therefore should recommend planned hospital birth and recommend against planned out-of-hospital birth during the COVID-19 pandemic. The COVID-19 pandemic has increased stress levels for all patients and even more so for pregnant patients and their families. The response in this difficult time should be to mitigate this stress and empower women to make informed decisions by routinely providing counseling that is evidence-based and directive.


Assuntos
Betacoronavirus , Entorno do Parto , Infecções por Coronavirus/prevenção & controle , Aconselhamento Diretivo/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidado Pré-Natal/métodos , Parto Obstétrico/ética , Parto Obstétrico/métodos , Aconselhamento Diretivo/ética , Medicina Baseada em Evidências , Feminino , Hospitalização , Humanos , Participação do Paciente/métodos , Segurança do Paciente , Gravidez , Cuidado Pré-Natal/ética
4.
PLoS One ; 15(2): e0229069, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32078646

RESUMO

Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. There is a lack of qualitative data on women's partners' involvement in these choices in the Dutch maternity care system, where integrated midwifery care and home birth are regular options in low risk pregnancies. The majority of available literature focuses on the women's motivations, while the partner's influence on these decisions is much less well understood. We aimed to examine partners' involvement in the decision to birth outside the system, in order to provide medical professionals with insight and recommendations regarding their interactions with these partners in the outpatient clinic. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. In-depth interviews were performed with twenty-one partners on their involvement in the decision to go against medical advice in choosing a high risk childbirth setting. Open, axial and selective coding of the interview data was done in order to generate themes. Four main themes were found: 1) Talking it through, 2) A shared vision, 3) Defending our views, and 4) Doing it together. One overarching theme emerged that covered all other themes: 'She convinced me'. These data show that the idea to choose a high risk birth setting almost invariably originated with the women, who did most of the research online, filtered the information and convinced the partners of the merit of their plans. Once the partners were convinced, they took a very active and supportive role in defending the plan to the outside world, as well as in preparing for the birth. Maternity care providers can use these findings in cases where there is a discrepancy between the wishes of the woman and the advice of the professional, so they can attempt to involve partners actively during consultations in pregnancy. That will ensure that partners also receive information on all options, risks and benefits of possible birth choices, and that they are truly in support of a final plan.


Assuntos
Aconselhamento Diretivo , Parto Domiciliar , Serviços de Saúde Materna , Tocologia , Adulto , Entorno do Parto , Comportamento de Escolha , Feminino , Humanos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Parto , Vigilância em Saúde Pública , Pesquisa Qualitativa , Medição de Risco , Adulto Jovem
5.
Urology ; 136: 218-224, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31765653

RESUMO

OBJECTIVE: To understand the extent to which pediatricians are providing advice on care of the uncircumcised penis and the advice they are providing. We hypothesized that pediatric residents lack preparedness to offer parents advice on caring for the uncircumcised penis and as such are unlikely to offer such advice. METHODS: An IRB approved, anonymous survey was administered to 244 pediatric residents in 5 urban training programs (Appendix). Descriptive statistics were used for clinical and demographic data and Fisher's exact and Kruskal-Wallis tests were used for comparative analysis. RESULTS: Eighty-three residents completed the survey for a response rate of 34%. Less than half (45%) of the residents surveyed were likely, or extremely likely to voluntarily offer advice to parents on care of the uncircumcised penis. On a scale of 0-100, the median confidence level in offering advice was 48 (interquartile range [IQR] 30-52). Forty-nine percent of residents reported never being taught care of the uncircumcised penis. Of those who received education, 72% reported learning informally from a senior resident or attending and only 9% learned from a formal lecture. Pediatric residents varied greatly on advice given to parents in regards to the frequency of retraction and 40% offered no advice. CONCLUSION: This study demonstrates that pediatric residents currently lack confidence in providing parents advice on preputial care and are unlikely to offer such advice. When offered, the advice given is highly variable. This study emphasizes the need for improved education of pediatric residents.


Assuntos
Cuidado da Criança , Aconselhamento Diretivo , Internato e Residência , Pais , Pediatria/educação , Pênis , Pré-Escolar , Circuncisão Masculina , Aconselhamento Diretivo/métodos , Aconselhamento Diretivo/normas , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
6.
Urology ; 137: 14-18, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31794813

RESUMO

Artificial urinary sphincters (AUS) are common. Life expectancy at average implantation (71.5 years) is 14 years. During this period patients must still possess manual dexterity and cognitive capabilities needed to operate the AUS, otherwise it is practically unfunctional. Still, available data regarding AUS durability deal with medical and mechanical factors. Issues as age-related deteriorating manual dexterity and cognitive capabilities precluding patients from operating an apparently intact AUS have not been addressed. We set to focus on these aspects. We review the natural history of manual dexterity, physical, and cognitive deterioration of aging men and propose counseling and screening algorithms for evaluating these aspects.


Assuntos
Disfunção Cognitiva/fisiopatologia , Mãos/fisiopatologia , Autocuidado , Esfíncter Urinário Artificial , Fatores Etários , Algoritmos , Aconselhamento Diretivo , Humanos , Masculino
7.
Clin Exp Hypertens ; 42(1): 67-74, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30760048

RESUMO

Objective: To clarify the present situation of home blood pressure (HBP) measurement among Japanese patients.Methods: A nationwide questionnaire survey regarding HBP measurement was conducted on patients aged 20 years or older who had visited 20 community pharmacies to have their prescriptions filled.Results: In total, 76.7% of 1,103 hypertensives and 40.9% of 1,106 normotensives had their own devices for HBP measurement. Compared with normotensives, a higher proportion of hypertensives recognized the guideline-based reference values for HBP and clinic BP. Compared with hypertensives who did not have a physician's recommendation, those who did more often had their own devices, recognized the guideline-based reference values for HBP, and measured HBP every day (70.4%, 1.5%, and 31.6% vs. 91.1%, 6.9%, and 65.4%, respectively). Among 793 hypertensives who measured HBP, a higher proportion of those with a physician's recommendation measured HBP according to optimal guideline-based procedures compared with those without. Among 560 hypertensives who recorded HBP readings, a higher proportion of those with a physician's recommendation (74.6%) showed all HBP readings to their physicians compared with those without (35.3%).Conclusions: Our findings suggest that physicians should recommend measuring HBP in accordance with the Japanese Society of Hypertension guidelines more aggressively, and provide more detailed explanations to patients regarding how to measure HBP.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/estatística & dados numéricos , Pressão Sanguínea , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/fisiopatologia , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Estudos de Casos e Controles , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Esfigmomanômetros/estatística & dados numéricos , Inquéritos e Questionários
8.
J Clin Nurs ; 29(1-2): 85-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31512796

RESUMO

AIMS AND OBJECTIVES: The aim of the study was to examine patients' experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG). BACKGROUND: Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart-healthy diet when the recovery period is over. These needs can be difficult to manage for the patients. DESIGN: Qualitative study. METHODS: Interviews were conducted and analysed within a phenomenological-hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4-5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines. RESULTS: In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, "Different needs-the nutritional jungle", "Food and heart-the lacking attention," and "The force of habits-being under the influence from spouses on dietary habits". CONCLUSION: The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling. RELEVANCE TO CLINICAL PRACTICE: This study provides important and relevant knowledge about patients' lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process-men's health behaviour and spouses' influence on dietary habits in the household.


Assuntos
Ponte de Artéria Coronária/enfermagem , Comportamento Alimentar/psicologia , Educação em Saúde/métodos , Idoso , Ponte de Artéria Coronária/psicologia , Aconselhamento Diretivo/métodos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pesquisa Qualitativa
9.
Am J Surg ; 219(1): 136-139, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31036255

RESUMO

BACKGROUND: Exercise and weight loss are recommended for patients with obesity undergoing elective complex ventral hernia repair (cVHR). METHODS: Weight and BMI trajectory data on 230 obese patients undergoing cVHR from 2012 to 2017 were retrospectively analyzed from 12 months prior to first visit with the hernia surgeon to 12 months after surgery. RESULTS: One year prior to initial visit, 76 (33%) patients had lost > 1kg/m2, 98 (43%) had gained> 1kg/m2, and 56 (24%) had no change in body mass index (BMI). Between initial visit and operation, 53 (23%) lost >1kg/m2, 43 (19%) gained, and 134 (58%) had no change. Post-operative hyperglycemia was associated with BMI> 40kg/m2 at time of operation. Twelve months post-operatively, 69 (35%) had lost >1kg/m2, while 52 (26%) had gained, and 108 (47%) had no change. CONCLUSIONS: Exhortations for pre-operative and post-operative weight management are not often successful or sustainable, implying a need for individualized holistic approaches.


Assuntos
Aconselhamento Diretivo , Hérnia Ventral/complicações , Herniorrafia , Obesidade/complicações , Obesidade/terapia , Perda de Peso , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco
10.
BMJ Case Rep ; 12(12)2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31822528

RESUMO

Each year approximately 20 million low birthweight babies are born globally. Prematurity is a leading cause of neonatal mortality in developing countries and results in 60%-80% of neonatal deaths. Neonatal mortality is the major contributor to under-5 mortality. According to Pakistan Demographic and Health Survey 2017-2018, neonatal mortality in Pakistan is 42 per 1000 live births and under-5 mortality is 74 per 1000 live births. One out of every 22 newborns dies in Pakistan, which is an alarming figure. Majority of these deaths are preventable. They can be prevented by well-trained midwives, safe delivery, early initiation of breast feeding within an hour after birth and skin-to-skin contact. Pakistan is among the top 10 countries with the highest number of preterm births and with limited resources to manage the burden. Kangaroo mother care (KMC) is a safe and economical alternative to provide preterm care in developing countries. In babies at gestational age less than 37 weeks or with neonatal weight less than 2.5 kg, skin-to-skin contact prevents hypothermia and infection. Neonatal mortality and morbidity can be reduced by providing preterm care through KMC. This case report is of a preterm baby who was delivered at 33 weeks of gestation with a weight of 1.3 kg and was saved by KMC in the paediatric department of Services Hospital in Lahore.


Assuntos
Aleitamento Materno/métodos , Recém-Nascido de Baixo Peso/fisiologia , Método Canguru , Gravidez de Trigêmeos , Sobreviventes , Ganho de Peso/fisiologia , Aconselhamento Diretivo , Feminino , Humanos , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Terapia Intensiva Neonatal , Gravidez , Resultado do Tratamento
12.
Presse Med ; 48(12): 1422-1430, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679895

RESUMO

Pulmonary hypertension in pregnant women is associated with high mortality and morbidity despite significant improvement in prognosis. Women with pulmonary arterial hypertension (PAH) should be still advised against pregnancy and advised on effective contraceptive methods. Pregnancy may be manageable in women with well controlled PAH or mild pulmonary hypertension (sPAP<50mmHg). When women with PAH choose to continue their pregnancy, they need: management by a multidisciplinary team in an expert centre; continuation or early introduction of targeted PAH therapy; early planned delivery.


Assuntos
Complicações Cardiovasculares na Gravidez , Hipertensão Arterial Pulmonar , Parto Obstétrico/métodos , Parto Obstétrico/normas , Aconselhamento Diretivo/métodos , Feminino , Humanos , Mortalidade Materna , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Hipertensão Arterial Pulmonar/epidemiologia , Hipertensão Arterial Pulmonar/terapia , Fatores de Risco , Vasodilatadores/uso terapêutico
13.
BMC Pregnancy Childbirth ; 19(1): 448, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775681

RESUMO

BACKGROUND: Preeclampsia (PE) and gestational diabetes mellitus (GDM) are both associated with increased risk of future cardiovascular disease (CVD). Knowledge of the relationship between these pregnancy complications and increased CVD risk enables early prevention through lifestyle changes. This study aimed to explore women's experiences with PE and/or GDM, and their motivation and need for information and support to achieve lifestyle changes. METHODS: Systematic text condensation was used for thematic analysis of meaning and content of data from five focus group interviews with 17 women with PE and/or GDM, with a live birth between January 2015 and October 2017. RESULTS: This study provides new knowledge of how women with GDM and/or PE experience pregnancy complications in a Nordic healthcare model. It reveals the support they want and the important motivating factors for lifestyle change. We identified six themes: Trivialization of the diagnosis during pregnancy; Left to themselves to look after their own health; The need to process the shock before making lifestyle changes (severe PE); A desire for information about future disease risk and partner involvement; Practical solutions in a busy life with a little one, and; Healthcare professionals can reinforce the turning point. The women with GDM wanted healthcare professionals to motivate them to continue the lifestyle changes introduced during pregnancy. Those with severe PE felt a need for individualized care to ensure that they had processed their traumatic labor experiences before making lifestyle changes. Participants wanted their partner to be routinely involved to ensure a joint understanding of the need for lifestyle changes. Motivation for lifestyle changes in pregnancy was linked to early information and seeing concrete results. CONCLUSIONS: Women with PE and GDM have different experiences of diagnosis and treatment, which will affect the follow-up interventions to reduce future CVD risk through lifestyle change. For GDM patients, lifestyle changes in pregnancy should be reinforced and continued postpartum. Women with PE should be informed by their general practitioner after birth, and given a plan for lifestyle change. Those with severe PE will need help in processing the trauma, and stress management should be routinely offered.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Gestacional/psicologia , Estilo de Vida Saudável , Motivação , Pré-Eclâmpsia/psicologia , Adulto , Diabetes Gestacional/etiologia , Aconselhamento Diretivo , Feminino , Grupos Focais , Humanos , Comportamento de Busca de Informação , Entrevistas como Assunto , Pré-Eclâmpsia/etiologia , Gravidez , Relações Profissional-Paciente , Fatores de Risco
14.
BMC Womens Health ; 19(1): 145, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31771557

RESUMO

BACKGROUND: Intimate partner violence (IPV) against women is a global health problem that is a substantial source of human suffering. Within the United States (US), women veterans are at high risk for experiencing IPV. There is an urgent need for feasible, acceptable, and patient-centered IPV counseling interventions for the growing number of women treated in the US's largest integrated healthcare system, the Veterans Health Administration (VHA). Implementation science and user-centered-design (UCD) can play an important role in accelerating the research-to-practice pipeline. Recovering from IPV through Strengths and Empowerment (RISE) is a flexible, patient-centered, modular-based program that holds promise as a brief counseling intervention for women veterans treated in VHA. We utilized a UCD approach to develop and refine RISE (prior to formal effectiveness evaluations) by soliciting early feedback from the providers where the intervention will ultimately be implemented. The current study reports on the feedback from VHA providers that was used to tailor and refine RISE. METHOD: We conducted and analyzed semi-structured, key-informant interviews with VHA providers working in clinics relevant to the delivery of IPV interventions (n = 23) at two large medical centers in the US. Participants' mean age was 42.6 years (SD = 11.6), they were predominately female (91.3%) and from a variety of relevant disciplines (39.1% psychologists, 21.7% social workers, 17.4% physicians, 8.7% registered nurses, 4.3% psychiatrists, 4.3% licensed marriage and family therapists, 4.3% peer specialists). We conducted rapid content analysis using a hybrid inductive-deductive approach. RESULTS: Providers perceived RISE as highly acceptable and feasible, noting strengths including RISE's structure, patient-centered agenda, and facilitation of provider comfort in addressing IPV. Researchers identified themes related to content and context modifications, including requests for additional safety check-ins, structure for goal-setting, and suggestions for how to develop and implement RISE-specific trainings. CONCLUSIONS: These findings have guided refinements to RISE prior to formal effectiveness testing in VHA. We discuss implications for the use of UCD in intervention development and refinement for interventions addressing IPV and other trauma in health care settings globally. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03261700; Date of registration: 8/25/2017, date of enrollment of first participant in trial: 10/22/2018. Unique Protocol ID: IIR 16-062.


Assuntos
Aconselhamento Diretivo/métodos , Violência por Parceiro Íntimo , Veteranos/psicologia , Saúde da Mulher , Adulto , Atitude do Pessoal de Saúde , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Feminino , Humanos , Ciência da Implementação , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estados Unidos , United States Department of Veterans Affairs
15.
Clinics (Sao Paulo) ; 74: e1091, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778428

RESUMO

OBJECTIVES: This is a randomized controlled trial that aims to evaluate the impact of pharmacist-led discharge counseling on reducing pharmacotherapy problems in the 30-day postdischarge period of cardiology patients from a tertiary hospital in Brazil. METHODS: At discharge, two cardiovascular pharmacy residents performed a medication counseling session with the intervention group, and the follow-up was performed by telephone (3 and 15 days after discharge). The number of pharmacotherapy problems was evaluated during a pharmacist-led ambulatory consultation 30 days after discharge. RESULTS: A total of 66 and 67 patients were randomized to the intervention and control groups, respectively, but only 51 patients were analyzed in each group, all with similar baseline characteristics. The intervention group had significantly fewer pharmacotherapy problems compared to the control (p<0.001), and 100% of the patients had at least one problem. We observed five problems significantly more frequently in the control group: "incorrect time of taking" (p=0.003), "use higher dose of medication" (p=0.007), "use lower dose of medication" (p=0.014), "restart discontinued medication" (p=0.011), and "underdosing prescription" (p=0.009). Simvastatin, enalapril, carvedilol, and atorvastatin were the medications more associated with pharmacotherapy problems. CONCLUSIONS: We concluded that pharmacist-led discharge counseling should be an indispensable service, as patients exhibited less pharmacotherapy problems in the 30-day postdischarge period, especially related to drug administration and adherence.


Assuntos
Continuidade da Assistência ao Paciente , Aconselhamento Diretivo/métodos , Prescrições de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Alta do Paciente , Farmacêuticos , Papel Profissional , Adulto , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária
16.
Investig Clin Urol ; 60(5): 373-379, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501800

RESUMO

Purpose: To evaluate de novo and resolved urgency and urgency urinary incontinence (UUI) after midurethral sling operations in patients with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Materials and Methods: Patients who underwent midurethral sling operations because of SUI and MUI between January 2012 and December 2016 were reviewed. Patients were divided into three groups (pure SUI, SUI with urgency, and MUI). Patients with MUI were subcategorized as SUI predominant, equivalent, and UUI predominant. Postoperative de novo, persistent or disappearance of urgency or UUI were compared. Results: A total of 334 patients were included: 76 with pure SUI, 78 with SUI with urgency, and 180 with MUI. In the MUI group, 138 patients were SUI predominant, 12 patients were equivalent, and 30 patients were UUI predominant. De novo urgency developed in 5 patients (6.6%) in the pure SUI group. In the SUI with urgency group, 51 patients (65.4%) became urgency-free, and 3 (3.8%) developed de novo UUI. UUI resolved in 135 patients (75.0%): 110 (79.7%) in the SUI-predominant group, 9 (75.0%) in the equivalent group, and 16 (53.3%) in the UUI-predominant group. The patients' preoperative perception of predominant UUI was the predictive factor for persistent UUI in the multivariate analysis (hazard ratio, 5.722; p=0.001). Conclusions: De novo urgency and UUI developed in a relatively small number of patients after a midurethral sling operation. The resolution rate of UUI was significantly low in patients who had previous pelvic surgery or who preoperatively perceived UUI as a more bothersome symptom.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/epidemiologia , Idoso , Aconselhamento Diretivo , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Urológicos/métodos
19.
Patient Educ Couns ; 102(11): 2073-2080, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31285065

RESUMO

OBJECTIVE: This study explored the feasibility and acceptability of using Motivational Interviewing (MI) in the home setting with families of preschoolers. METHODS: Using mixed-methods pilot data from an MI-based obesity prevention intervention delivered via home visits by health educators (HEs) with 44 families (n = 17 four home visit group; n = 14 two home visit group), we examined: 1) fidelity of MI adherence by HEs; 2) parents' perceptions of the intervention; and 3) HEs insights pertaining to the intervention's delivery. RESULTS: Multiple measures of MI fidelity were deemed to exceed defined proficiency levels. Ninety-three percent of families reported being "satisfied" to "very satisfied" with the intervention. HEs reported building a high level of trust with families and gaining a thorough understanding of familial context. Parents appreciated how HEs' were knowledgeable and provided personalized attention when discussing health goals. Some parents suggested more directive advice and follow-up visits as ways to improve the intervention. CONCLUSION: Home-based MI was conducted with a high level of fidelity, was well accepted by families and practitioners. PRACTICE IMPLICATIONS: Our findings from parents and MI practitioners provide key learnings that can inform future behavior change interventions that propose to use MI within the home setting.


Assuntos
Aconselhamento Diretivo/métodos , Promoção da Saúde/métodos , Visita Domiciliar/estatística & dados numéricos , Entrevista Motivacional/métodos , Obesidade Pediátrica/prevenção & controle , Adulto , Criança , Família/psicologia , Saúde da Família , Estudos de Viabilidade , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Obesidade Pediátrica/psicologia , Gravidez
20.
Arch Dis Child ; 104(11): 1034-1041, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31270094

RESUMO

OBJECTIVE: To study regulatory problems (RPs) of feeding, sleeping and excessive crying in infancy, and explore the influence of maternal mental health problems and parent-child relationship problems. DESIGN AND SETTING: Data were collected in the general child health surveillance delivered to infant families by community health nurses (CHNs). Information on CHNs' assessments and conclusions were obtained on 2598 infants and merged with data from national registers. Descriptive statistics and logistic regression models were used to study RPs in early and late infancy, and the influences due to child, family and parent-child relationship problems. RESULTS: Combined RPs (C-RPs), defined as two or more simultaneous problems of feeding, sleeping or excessive crying, was identified in 2.9% and 8.6% of the population between age 2-6 and 8-11 months, respectively. Low maternal schooling and immigrant parents were associated with an increased risk of late C-RPs, but RPs in early infancy stand out as the main predictor of late C-RPs OR 3.4 (95% CI 1.8 to 6.6), and the effect of early maternal mental health problems and parent-child relationship problems seem to be mediated by early C-RPs. CONCLUSIONS: Combined problems of feeding, sleeping or excessive crying may exist throughout infancy independently of exposures to maternal mental health problems and parent-child relationship problems. The results indicate that infants with RPs exceeding age 2 months need special attention, in clinical as well as community settings. Suggested intervention includes specific guidance to the parents to help them understand and regulate their infant's sensitivity and reactions.


Assuntos
Choro , Depressão Pós-Parto/epidemiologia , Aconselhamento Diretivo/métodos , Transtornos de Alimentação na Infância/diagnóstico , Pais/educação , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Desenvolvimento Infantil , Enfermagem em Saúde Comunitária , Estudos Transversais , Choro/psicologia , Dinamarca/epidemiologia , Transtornos de Alimentação na Infância/etiologia , Transtornos de Alimentação na Infância/enfermagem , Feminino , Humanos , Lactente , Comportamento do Lactente , Recém-Nascido , Masculino , Relações Pais-Filho , Poder Familiar , Pais/psicologia , Vigilância da População , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/enfermagem
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