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2.
Bol Med Hosp Infant Mex ; 78(2): 102-109, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33651786

RESUMEN

This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry's recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.


Asunto(s)
/terapia , Cuidadores/organización & administración , Hospitales Pediátricos/organización & administración , Guías de Práctica Clínica como Asunto , Niño , Hospitalización , Humanos , México , Atención Dirigida al Paciente/métodos
3.
J Nurs Adm ; 51(4): 192-199, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33734178

RESUMEN

OBJECTIVE: Objectives were to evaluate patient perceptions of a nurse-led, patient-centered gratitude intervention and if nurses identified actionable items to improve patient's hospitalization experience. BACKGROUND: Research demonstrates positive effects of gratitude and caring interventions on patient health and well-being. Evidence is sparse regarding nurse-led gratitude interventions improving hospitalized patient's experiences. METHODS: In this pilot study, 91 adult medical patients completed gratitude forms twice daily for up to 6 shifts and a study discharge form documenting intervention perceptions. In response to the patients' gratitude-related feedback, RNs recorded patient experience-related actions they and interprofessional teams could implement. RESULTS: On average, patients perceived the nurse-led gratitude intervention as helpful (4.2) (1 = very unhelpful, 5 = very helpful) and improved hospitalization experiences (4.3) (1 = seldom, 5 = never). Most of the time actions were required or to be taken, based on patient gratitude intervention responses. CONCLUSIONS: Patient perceptions of nurse-led gratitude intervention demonstrated helpfulness and improved hospitalization experience.


Asunto(s)
Relaciones Enfermero-Paciente , Satisfacción del Paciente/estadística & datos numéricos , Atención Dirigida al Paciente/métodos , Espiritualidad , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Proyectos Piloto , Lugar de Trabajo/psicología
4.
Patient Educ Couns ; 104(3): 438-451, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33455825

RESUMEN

OBJECTIVE: Communication related to COVID-19 between provider and the patient/family is impacted by isolation requirements, time limitations, and lack of family/partner access. Our goal was to determine the content of provider communication resources and peer-reviewed articles on COVID-19 communication in order to identify opportunities for developing future COVID-19 communication curricula and support tools. METHODS: A systematic review was conducted using the UpToDate clinical decision support resource database, CINAHL, PubMed, PsycInfo, and Web of Science. The grey literature review was conducted in September 2020 and articles published between January-September 2020 written in English were included. RESULTS: A total of 89 sources were included in the review, (n = 36 provider communication resources, n = 53 peer-reviewed articles). Resources were available for all providers, mainly physicians, and consisted of general approaches to COVID-19 communication with care planning as the most common topic. Only four resources met best practices for patient-centered communication. All but three articles described physician communication where a general emphasis on patient communication was the most prevalent topic. Reduced communication channels, absence of family, time, burnout, telemedicine, and reduced patient-centered care were identified as communication barriers. Communication facilitators were team communication, time, patient-centered and family communication, and available training resources. CONCLUSIONS: Overall, resources lack content that address non-physician providers, communication with family, and strategies for telehealth communication to promote family engagement. The gaps identified in this review reveal a need to develop more materials on the following topics: provider moral distress, prevention communication, empathy and compassion, and grief and bereavement. An evidence-base and theoretical grounding in communication theory is also needed. PRACTICE IMPLICATIONS: Future development of COVID-19 communication resources for providers should address members of the interdisciplinary team, communication with family, engagement strategies for culturally-sensitive telehealth interactions, and support for provider moral distress.


Asunto(s)
Comunicación , Atención Dirigida al Paciente/métodos , Telemedicina , Comunicación en Salud , Personal de Salud , Humanos
6.
Cochrane Database Syst Rev ; 1: CD006560, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33448337

RESUMEN

BACKGROUND: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. OBJECTIVES: To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS: We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. SELECTION CRITERIA: Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of the results where possible and carried out a narrative synthesis for the remainder of the results. We present the results in a 'Summary of findings' table and tabular format to show effect sizes across all outcome types. MAIN RESULTS: We identified 17 RCTs examining a range of complex interventions for people with multimorbidity. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people. In 11 studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In six studies, the interventions were predominantly patient-oriented, for example, educational or self-management support-type interventions delivered directly to participants. Overall our confidence in the results regarding the effectiveness of interventions ranged from low to high certainty. There was little or no difference in clinical outcomes (based on moderate certainty evidence). Mental health outcomes improved (based on high certainty evidence) and there were modest reductions in mean depression scores for the comorbidity studies that targeted participants with depression (standardized mean difference (SMD) -0.41, 95% confidence interval (CI) -0.63 to -0.2). There was probably a small improvement in patient-reported outcomes (moderate certainty evidence). The intervention may make little or no difference to health service use (low certainty evidence), may slightly improve medication adherence (low certainty evidence), probably slightly improves patient-related health behaviours (moderate certainty evidence), and probably improves provider behaviour in terms of prescribing behaviour and quality of care (moderate certainty evidence). Cost data were limited. AUTHORS' CONCLUSIONS: This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression in people with co-morbidity.


Asunto(s)
Enfermedad Crónica/terapia , Multimorbilidad , Atención Primaria de Salud , Factores de Edad , Ambliopía , Servicios de Salud Comunitaria , Manejo de la Enfermedad , Trastornos del Crecimiento , Conductas Relacionadas con la Salud , Personal de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Discapacidad Intelectual , Cumplimiento de la Medicación , Medición de Resultados Informados por el Paciente , Atención Dirigida al Paciente/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Resultado del Tratamiento
7.
J Subst Abuse Treat ; 120: 108155, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33298297

RESUMEN

The COVID-19 pandemic and the move to telemedicine for office-based opioid treatment have made the practice of routine urine drug tests (UDT) obsolete. In this commentary we discuss how COVID-19 has demonstrated the limited usefulness and possible harms of routine UDT. We propose that practitioners should stop using routine UDT and instead use targeted UDT, paired with clinical reasoning, as part of a patient-centered approach to care.


Asunto(s)
Trastornos Relacionados con Opioides/diagnóstico , Detección de Abuso de Sustancias/métodos , Humanos , Trastornos Relacionados con Opioides/orina , Atención Dirigida al Paciente/métodos , Telemedicina
10.
Rev Paul Pediatr ; 39: e2020238, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33206843

RESUMEN

OBJECTIVE: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. CASES DESCRIPTION: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. COMMENTS: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.


Asunto(s)
Infecciones por Coronavirus/rehabilitación , Atención Dirigida al Paciente/métodos , Modalidades de Fisioterapia/enfermería , Neumonía Viral/rehabilitación , Brasil , Niño , Infecciones por Coronavirus/enfermería , Femenino , Humanos , Lactante , Masculino , Pandemias , Neumonía Viral/enfermería , Rango del Movimiento Articular
11.
Tog (A Coruña) ; 17(2): 214-224, nov. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-198818

RESUMEN

OBJETIVOS: conocer la efectividad del modelo de atención centrada en la persona en la rehabilitación visual. MÉTODO: se seleccionaron artículos publicados entre 2010 y 2019, recogidos en PUBMED y Web of Science. Se incluyeron aquellos dedicados a la terapia ocupacional y rehabilitación visual de personas con discapacidad visual desde un enfoque de atención centrado en la persona. Finalmente se incluyeron 14 artículos para esta revisión. RESULTADOS: de la búsqueda en PubMed se obtuvieron un total de 490 artículos y de Web of science 40, alcanzando un total de 530 artículos. Después de realizar la lectura del título, se seleccionaron 126 artículos. Tras la lectura de los resúmenes y/o el contenido completo, se excluyeron 112 por no cumplir los objetivos del estudio; resultando elegidos 13 artículos. Las diferentes investigaciones recopiladas justifican que la rehabilitación visual y la terapia ocupacional basadas en el modelo de atención centrada en la persona contribuyen a mejorar la calidad de vida de las personas con baja visión y su autonomía personal. CONCLUSIÓN: son necesarias más investigaciones que evidencien cómo la terapia ocupacional desde una atención centrada en la persona produce resultados positivos en la rehabilitación de personas con baja visión


OBJECTIVE: To know the effectiveness of the person-centered care model in visual rehabilitation. METHOD: Articles published between 2010 and 2019, collected in PUBMED and Web of Science, were selected. Those dedicated to occupational therapy and visual rehabilitation of people with visual disabilities from a person-centered care approach were included. Finally 14 articles were included for this review. RESULTS: A total of 490 articles were obtained from the PubMed search and 40 from Web of science, reaching a total of 530 articles. After reading the title, 126 articles were selected. After reading the abstracts and / or the full content, 112 were excluded because they did not meet the study objectives; resulting in 13 articles chosen. The different studies collected justify that visual rehabilitation and occupational therapy based on the person-centered care model contribute to improving the quality of life of people with low vision and their personal autonomy. CONCLUSION: More research is needed to show how occupational therapy from a person-centered care produces positive results in the rehabilitation of people with low vision


Asunto(s)
Humanos , Autonomía Personal , Evaluación de la Discapacidad , Educación de Personas con Discapacidad Visual/métodos , Resultado del Tratamiento , Atención Dirigida al Paciente/métodos , Trastornos de la Visión/terapia , Servicios de Salud para Personas con Discapacidad , Atención Dirigida al Paciente/organización & administración , Calidad de Vida , Trastornos de la Visión/epidemiología , Trastornos de la Visión/rehabilitación , Actividades Cotidianas
12.
Metas enferm ; 23(8): 19-26, oct. 2020.
Artículo en Español | IBECS | ID: ibc-196930

RESUMEN

Caso clínico inspirado en el Modelo de la Marea de un hombre de 45 años de edad con sufrimiento psíquico severo en seguimiento por los servicios de Salud Mental desde los 25 por brote psicótico. Se identificaron diagnósticos de Enfermería, Resultados esperados e Intervenciones específicas, enunciados mediante la nomenclatura NANDA-NOC-NIC, y clasificados según los dominios que expone el modelo (del yo, del mundo y de los otros), así como según los tres momentos de cuidado que plantean los autores del mismo (inmediatos, de transición y desarrollo). Tras la planificación y ejecución de los cuidados se evaluaron obteniendo la puntuación diana acordada en la mayoría de ellos. Son necesarias intervenciones en personas con sufrimiento psíquico para mejorar su calidad de vida, fortalecer su autonomía y disminuir su aislamiento. Esto supone un desafío para los profesionales de Enfermería para desarrollar y aplicar herramientas de cuidado accesible culturalmente, como el Modelo de la Marea


Case report inspired by the Tidal Model regarding a 45-year-old man with severe psychological suffering on follow-up by Mental Health Services since he was 25 due to a psychotic break. Nursing diagnoses were identified, as well as Expected Outcomes and Specific Interventions, articulated by the NANDA-NOC-NIC terminology, and classified according to the domains stated by the model (self, world, others), as well as according to the three stages of care stated by its authors (immediate, transition and development). After planning and conducting care, there was an assessment and the target score agreed upon was obtained in most of them. Interventions in persons with psychological suffering are necessary in order to improve their quality of life, strengthen their personal autonomy and reduce their isolation. This represents a challenge for Nursing professionals, in order to develop and apply tools of care culturally accessible, such as the Tidal Model


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Modelos de Enfermería , Teoría de Enfermería , Adaptación Psicológica , Trastornos Mentales/enfermería , Atención Dirigida al Paciente/métodos , Atención de Enfermería , Evaluación en Enfermería , Diagnóstico de Enfermería , Estrés Psicológico/enfermería
13.
Artículo en Inglés | MEDLINE | ID: mdl-32933119

RESUMEN

This study examined the effects of a person-centered nursing intervention program for frailty (PNIF) targeting community-dwelling prefrail older people in South Korea. The study participants were 40 community-dwelling older adults (≥65 years) who were classified as prefrail on the Cardiovascular Health Study (CHS) frailty index. The intervention group (n = 20) received group intervention sessions two days/week for twelve weeks and the control group (n = 20) attended lectures about frailty prevention one day/week for four weeks. The evaluation instruments included the CHS Frailty Index, a JAMAR® hydraulic hand dynamometer, the Short Physical Performance Battery (SPPB), the Korean version of the Community Healthy Activities Model Program for Seniors Questionnaire (K-CHAMPS), the Mini Nutritional Assessment (MNA), the Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), the ENRICHD Social Support Instrument (ESSI), and the Goal Attainment Scale (GAS). Significant differences were found in the CHS Frailty Index (p < 0.001), left-hand grip strength (p = 0.022), right-hand grip strength (p = 0.009), SPPB (p = 0.007), K-CHAMPS (p = 0.009), MNA (p = 0.018), and GDSSF-K (p = 0.001) between the two groups after 12 weeks. No significant between-group differences in ESSI scores were observed. The PNIF effectively improved grip strength, physical function, physical activity, and nutritional status, reduced depression, and prevented frailty among community-dwelling older adults.


Asunto(s)
Fragilidad/prevención & control , Evaluación Geriátrica/métodos , Fuerza de la Mano/fisiología , Atención Dirigida al Paciente/métodos , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Humanos , Vida Independiente , Masculino , Dinamómetro de Fuerza Muscular , Evaluación de Programas y Proyectos de Salud , República de Corea
14.
Obstet Gynecol ; 136(4): 859-867, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32976375

RESUMEN

Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine, and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.


Asunto(s)
Aberraciones Cromosómicas , Trastornos de los Cromosomas , Consejo , Enfermedades Fetales , Pruebas Genéticas/métodos , Diagnóstico Prenatal/métodos , Trastornos de los Cromosomas/diagnóstico , Trastornos de los Cromosomas/genética , Consejo/métodos , Consejo/normas , Consejo/provisión & distribución , Femenino , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/genética , Accesibilidad a los Servicios de Salud/normas , Humanos , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Guías de Práctica Clínica como Asunto , Embarazo , Estados Unidos
16.
Obstet Gynecol ; 136(4): e48-e69, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32804883

RESUMEN

Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.


Asunto(s)
Aberraciones Cromosómicas , Trastornos de los Cromosomas , Consejo , Enfermedades Fetales , Pruebas Genéticas/métodos , Diagnóstico Prenatal/métodos , Trastornos de los Cromosomas/diagnóstico , Trastornos de los Cromosomas/genética , Consejo/métodos , Consejo/normas , Consejo/provisión & distribución , Femenino , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/genética , Accesibilidad a los Servicios de Salud/normas , Humanos , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Embarazo , Estados Unidos
17.
Gac Med Mex ; 156(4): 311-316, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32831322

RESUMEN

Medical schools play a central role in the compilation and development of professional knowledge, which is why they have privileges and resources that are justified only to the extent that they use them to serve the community, particularly those who are most in need. Medical schools social accountability focuses on the training, healthcare provision and research services they offer. The principles of medical education and the structure proposed by the Flexner Report are in crisis due to the COVID-19 pandemic, and redefinition of the social contract is required. This document offers a proposal for medical schools social accountability that includes anticipation of the needs of the community, patient-centered inter-professional care, training of people in the area of health and collaboration between institutions. It highlights the need for a conscious institution that finds new training spaces other than hospitals, where each patient is cared for in a personalized way, with inter-professional training models that consider the student as a person who takes care of him/herself in open collaboration with organizations. Leaders must act now because it is their social accountability and because it is the right thing to do.


Asunto(s)
Infecciones por Coronavirus/terapia , Educación Médica/métodos , Neumonía Viral/terapia , Responsabilidad Social , Conducta Cooperativa , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/organización & administración , Humanos , Pandemias , Atención Dirigida al Paciente/métodos , Neumonía Viral/epidemiología , Facultades de Medicina , Estudiantes de Medicina
18.
Health Qual Life Outcomes ; 18(1): 214, 2020 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-32631444

RESUMEN

BACKGROUND: People living with HIV experience burdensome multidimensional symptoms and concerns requiring person-centred care. Routine use of patient reported outcome measures can improve outcomes. There is no brief patient reported outcome measure (PROM) that currently reflects the breadth of concerns for people living with HIV. This study aimed to develop and cognitively test a brief novel patient reported outcome measure for use within routine adult HIV care- the "Positive Outcomes" HIV PROM. METHODS: Development followed the COSMIN taxonomy and guidance for relevance and comprehensiveness, and Rothrock guidance on development of valid patient reported outcome measures. The Positive Outcomes HIV PROM was developed by a steering group (people living with HIV, HIV professionals and health services researchers) using findings from a previously reported qualitative study of priority outcomes for people living with HIV. The prototype measure was cognitively tested with a purposive sample of people living with HIV. RESULTS: The Positive Outcomes HIV PROM consists of 23 questions (22 structured, and one open question) informed by the priorities of key stakeholders (n = 28 people living with HIV, n = 21 HIV professionals and n = 8 HIV commissioners) to ensure face and content validity, and refined through cognitive testing (n = 6 people living with HIV). Cognitive testing demonstrated high levels of acceptability and accessibility. CONCLUSIONS: The Positive Outcomes HIV PROM is the first brief patient reported outcome measure reflecting the diverse needs of people living with HIV designed specifically for use in the clinical setting to support patient assessment and care, and drive service quality improvement. It is derived from primary data on the priority outcomes for people living with HIV and is comprehensive and acceptable. Further psychometric testing is required to ensure reliability and responsiveness.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Cognición/efectos de los fármacos , Infecciones por VIH/tratamiento farmacológico , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Atención Dirigida al Paciente/métodos , Calidad de Vida/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría/métodos , Investigación Cualitativa , Reproducibilidad de los Resultados
19.
Clin Nutr ESPEN ; 38: 196-200, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32690158

RESUMEN

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed. METHODS: The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information. CONCLUSIONS: the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Nutrición Enteral/métodos , Servicios de Atención de Salud a Domicilio , Nutrición Parenteral/métodos , Neumonía Viral/complicaciones , Cuidadores/educación , Técnicas de Laboratorio Clínico , Consenso , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Prestación de Atención de Salud , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias/prevención & control , Grupo de Atención al Paciente , Aislamiento de Pacientes , Atención Dirigida al Paciente/métodos , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Factores de Riesgo
20.
Curr Oncol ; 27(2): 90-99, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32489251

RESUMEN

Background: Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods: The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results: The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions: Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Oncología Médica/estadística & datos numéricos , Neoplasias/terapia , Medición de Resultados Informados por el Paciente , Atención Dirigida al Paciente/estadística & datos numéricos , Canadá , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/normas , Humanos , Oncología Médica/métodos , Oncología Médica/normas , Neoplasias/diagnóstico , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Calidad de Vida
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