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1.
Rev. urug. enferm ; 17(1): 1-15, jun. 2022.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1367881

RESUMEN

Objetivo: compreender as adversidades e habilidades adaptativas vivenciadas por pessoas com diabetes mellitus. Metodologia: estudo de caso único com abordagem qualitativa, realizado com pessoas com diabetes, participantes em um grupo de educação em saúde vinculado a um Hospital Universitário da região sul do Brasil. Para coleta de dados, entre maio e junho de 2019, foi aplicada a Escala Problems Areas in Diabetes, cujos dados foram analisados, conforme recomendação de pontuação do instrumento; entrevista semiestruturada e observação participante submetidas à análise de conteúdo. O suporte teórico deste estudo foi a Teoria da Resiliência Aplicada a Sistemas Socioecológicos e estudos que abordam as práticas de autocuidado. Resultados: o caso único inclui cinco participantes. O score médio segundo a Escala Problems Areas in Diabetes foi de 48,0. O score individual indicou elevado impacto emocional relacionado ao viver com diabetes. Dos cinco participantes, três ultrapassaram o score máximo desejável (40 pontos): 81,25; 65; 57,5, 28,75 e 7,5. Da análise de conteúdo emergiram duas categorias: "Desafios para o autocuidado", com destaque à alimentação, tratamento farmacológico e monitorização do diabetes; "Rede de suporte para o enfrentamento das adversidades", com destaque o apoio dos familiares, amigos e profissionais da saúde. Conclusão: o conhecimento das adversidades e habilidades adaptativas das pessoas com diabetes contribui para compreensão do processo de resiliência, práticas de autocuidado e melhores práticas de saúde.


Objetivo: comprender las adversidades y habilidades adaptativas que experimentan las personas con diabetes mellitus. Metodología: estudio de caso único con abordaje cualitativo, realizado con personas con diabetes, participantes de un grupo de educación en salud vinculado a un Hospital Universitario en el sur de Brasil. Para la recolección de datos, entre mayo y junio de 2019 se aplicó la Escala de Áreas de Problemas en Diabetes, cuyos datos fueron analizados de acuerdo con la recomendación de puntaje del instrumento; entrevista semiestructurada y observación participante sometida a análisis de contenido. El soporte teórico de este estudio fue la Teoría de la Resiliencia Aplicada a Sistemas Socioecológicos y estudios que abordan las prácticas de autocuidado. Resultados: el caso único incluyó a cinco participantes. La puntuación media según la Escala de áreas problemáticas en la diabetes fue de 48,0. La puntuación individual indicó un alto impacto emocional relacionado con vivir con diabetes. De los cinco participantes, tres superaron la puntuación máxima deseable (40 puntos): 81,25; sesenta y cinco; 57,5, 28,75 y 7,5. Del análisis de contenido surgieron dos categorías: "Desafíos para el autocuidado", con énfasis en la nutrición, el tratamiento farmacológico y el seguimiento de la diabetes; "Red de apoyo para afrontar la adversidad", destacando el apoyo de familiares, amigos y profesionales de la salud. Conclusión: el conocimiento de la adversidad y las habilidades de adaptación de las personas con diabetes contribuye a la comprensión del proceso de resiliencia, las prácticas de autocuidado y las mejores prácticas de salud.


Objective: to understand the adversities and adaptive skills experienced by people with diabetes mellitus. Method: single-case study with qualitative approach, carried out with people with diabetes, participating in a health education group linked to a University Hospital in the south of Brazil. For data collection, between May and June 2019, the Problems Areas in Diabetes Scale was applied, with analysis according to the instrument's scoring recommendation; semi-structured interview and participant observation submitted to content analysis. The theoretical support of this study was the Theory of Resilience Applied to Socio-ecological Systems and studies related to self-care practices. Results: the single-case included five participants. The average score according to the Problems Areas in Diabetes Scale was 50.75, the individual score indicated a high emotional impact related to living with diabetes. Of the five participants, three exceeded the maximum desirable score (40 points): 81.25; 67.5; 65; 32.5 and 7.5. From the content analysis, two categories emerged: "Challenges for self-care", with emphasis on food, pharmacological treatment and monitoring of diabetes; "Support network for coping with adversity", with emphasis on the support of family members, friends and health professionals. Conclusion: the knowledge of adversities and adaptive skills of people with diabetes contributes to understanding the resilience process, self-care practices and best health practices.


Asunto(s)
Humanos , Autocuidado , Apoyo Social , Brasil , Diabetes Mellitus , Resiliencia Psicológica
2.
BMC Health Serv Res ; 22(1): 596, 2022 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-35505358

RESUMEN

BACKGROUND: Interventions to increase person-centeredness in hospital care for persons with psychotic illness are needed. Changing care delivery is however a complex venture, requiring staff to reconsider their mindsets and ways of working. A multidisciplinary educational intervention for hospital staff at four wards was launched to increase person-centeredness in the care of patients with schizophrenia and similar psychoses. This study aims to explore staff experiences of working to increase person-centeredness. METHODS: A heterogenic sample of staff (n = 23) from all participating wards were recruited for six focus group interviews. Semi-structured questions covered staff perceptions of person-centered care and the process of increasing person-centeredness. Transcribed data was analyzed using thematic analysis according to Braun and Clarke. RESULTS: Staff viewed person-centered care as an approach rather than a method. They described central aspects of person-centered care, such as recognizing the patient as a capable person who can participate in her/his care. Statements further showed how these core features were put into practice. Changes related to the intervention were presented in terms of evolving patient and staff roles, improved contact with patients, more flexible care routines, and a more positive ward climate. Neither psychotic symptoms nor involuntary status were considered barriers for person-centered care, but organizational factors beyond staff control seemed to impact on implementation. CONCLUSIONS: After implementation, participants displayed good understanding of the core concepts of person-centered care in both thinking and action. They attributed several improvements in the care milieu to an increased level of person-centeredness. Psychotic behavior and involuntary treatment did not present major barriers to person-centered care. Findings suggest person-centered care is feasible in the psychosis inpatient setting and could improve quality of care. TRIAL REGISTRATION: The study is part of a larger study evaluating the intervention Person-Centered Psychosis Care (PCPC). It was registered retrospectively at clinicaltrials.gov , identifier NCT03182283 .


Asunto(s)
Atención Dirigida al Paciente , Trastornos Psicóticos , Femenino , Humanos , Pacientes Internos , Atención Dirigida al Paciente/métodos , Trastornos Psicóticos/terapia , Estudios Retrospectivos , Autocuidado
3.
Rev Med Suisse ; 18(781): 930-933, 2022 May 11.
Artículo en Francés | MEDLINE | ID: mdl-35543683

RESUMEN

Anxiety is a very common problem in primary care consultations. In addition to standard treatments (psychotropic medications and psychotherapy), many self-care techniques can improve patients' anxiety. A few explanations (psychoeducation) about the role of the autonomic nervous system in stress and anxiety can be helpful to motivate patients to experiment techniques that allow their body to relax and unwind, and to thus take care of themselves. Family doctors who have practiced some of these techniques for themselves can easily teach them to their patients, but they can also recommend face-to-face or Internet courses on the subject.


L'anxiété est un problème très courant dans les consultations de médecine générale. En complément aux traitements classiques (psychotropes et psychothérapie), de très nombreux autosoins (selfcare) peuvent amener un grand bénéfice aux patients anxieux. Quelques explications (psychoéducation) sur le rôle du système nerveux autonome dans le stress et l'anxiété aideront le médecin traitant à motiver son patient à expérimenter des techniques permettant le ressourcement de l'organisme et à s'autoriser à prendre soin de lui-même. Dans l'idéal, le médecin traitant sera capable d'enseigner certaines de ces techniques à ses patients, après les avoir expérimentées lui-même. De nombreux cours et démonstrations existent aussi sur internet ou en présentiel.


Asunto(s)
Trastornos de Ansiedad , Autocuidado , Ansiedad/terapia , Humanos , Internet , Atención Primaria de Salud , Psicoterapia/métodos
4.
Rev Med Suisse ; 18(781): 936-939, 2022 May 11.
Artículo en Francés | MEDLINE | ID: mdl-35543684

RESUMEN

Self-management is a process in which the patient actively engages in the management of his or her disease, adapting to the resulting problems, and complying with behavioral changes. Its support will have beneficial effects, as well as an improvement in quality of life, and reasonable use of resources available for health. Exercise plays a central role in the self-management of a range of chronic diseases, including musculoskeletal conditions, one of the most prevalent conditions in Switzerland. However, physical activity and exercise are under-prescribed in chronic disease management. A combination of supervised strategies and digital devices in self-management coaching could maximize the effects of physical activity.


L'autogestion est un processus par lequel le patient s'engage activement dans la gestion de sa maladie, en changeant ses comportements pour faire face aux conséquences physiques et psychiques de celle-ci. Cela aura des effets bénéfiques sur sa qualité de vie et permettra de diminuer ses besoins en soins. L'exercice physique joue un rôle central dans l'autogestion des maladies chroniques parmi lesquelles les pathologies musculo-squelettiques constituent un motif fréquent de consultation en médecine de famille. L'autogestion est toutefois insuffisamment conseillée par les médecins dans le traitement des maladies chroniques, notamment par manque de connaissances. L'essor des dispositifs numériques permettant un coaching des patients pourrait être un levier motivateur supplémentaire pour les patients et les thérapeutes.


Asunto(s)
Dolor Crónico , Dolor Musculoesquelético , Automanejo , Enfermedad Crónica , Dolor Crónico/terapia , Terapia por Ejercicio , Femenino , Humanos , Masculino , Dolor Musculoesquelético/terapia , Calidad de Vida , Autocuidado/métodos
5.
Rev Med Suisse ; 18(781): 940-942, 2022 May 11.
Artículo en Francés | MEDLINE | ID: mdl-35543685

RESUMEN

A recent survey conducted in the French-speaking part of Switzerland ("Romandie") showed that only about half of the primary care physicians (PCP) in Romandie had a personal doctor. Moreover, 37 % of the PCP declared they had foregone consulting a doctor for a health problem or a check-up during the past year. Finally, 29 % of them had chosen to continue working despite being ill. The literature describes multiple origins for these behaviors, both systemic (especially workload) and individual (denial, fear of social and peer judgment, culture of invincibility…). There is room for improvement for this still too often overlooked problem, in order to enhance the PCP's health (or well-being), and consequently the quality of care.


Une récente enquête menée en Suisse romande a montré qu'environ la moitié seulement des médecins de premier recours (MPR) romands avaient un médecin traitant. De plus, 37 % des MPR ont déclaré avoir renoncé à consulter un médecin pour un problème de santé durant l'année écoulée. Enfin, ils étaient aussi 29 % à avoir choisi de continuer à travailler tout en étant malades. La littérature évoque divers facteurs pouvant expliquer ou du moins contribuer à ces comportements, qu'il s'agisse de facteurs systémiques (principalement la charge de travail) ou individuels (déni, peur du jugement de la société et des pairs ou culture de la toute-puissance). Des voies d'amélioration, pour traiter cette problématique souvent méconnue, sont non seulement possibles, mais certainement nécessaires pour le bien de nos médecins et la qualité des soins délivrés aux patients.


Asunto(s)
Médicos , Humanos , Derivación y Consulta , Autocuidado , Encuestas y Cuestionarios , Suiza
6.
Comput Math Methods Med ; 2022: 3637792, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35529261

RESUMEN

Objective: To explore the multidisciplinary collaborative extended care combined with EBN to improve breast cancer liver metastasis patients' psychological status and self-care ability. Background: In the past ten years, the number of breast cancer patients with liver metastases has increased year by year, becoming a global public health problem. Studies have shown that 30% of breast cancer patients with liver metastases show varying degrees of anxiety and depression, and their quality of life is significantly lower than that of the normal population. Multidisciplinary collaborative continuous care can improve the prognosis of breast cancer treatment to a certain extent and is the key to meeting the needs of cancer patients. Materials and Methods: The clinical data of 96 patients with liver metastases from breast cancer were selected as the study subjects and divided into a comparison group and an observation group of 48 cases each according to a random number table. Among them, the comparison group implemented evidence-based nursing (EBN) and the observation group implemented multidisciplinary collaborative extended care based on the comparison group. The effects of psychological status, quality of life, self-care ability, and sleep quality were compared between the two groups before and after nursing care. Results: After nursing, the sleep quality scores, increased awakening scores, sleep quality that shows weakness because important things are not steady or strong scores, and night terrors scores of the two groups of breast cancer patients with liver the spread of diseases through the body were very much improved, and the sleep quality scores of the instance of watching, noticing, or making a statement group were much lower than those of the comparison group (P < 0.05). After nursing, the fear and stress-related score, depression score, tiredness and distress score, and anger score of the two groups of breast cancer patients with liver (the spread of diseases through the body) were very much improved, and the mental state score of the instance of watching, noticing, or making a statement group was much lower than that of the comparison group (P < 0.05). The scores of self-care skills, self-responsibility, health knowledge, and self-idea of patients in the instance of watching, noticing, or making a statement group after nursing were higher than those in the comparison group (P < 0.05). After nursing, the scores of mental energy, social interaction, emotional restriction, and mental status of patients in (instance of watching, noticing, or making a statement) were much higher than those in the comparison group (P < 0.05). Conclusion: Multidisciplinary collaborative continuous nursing combined with EBN can effectively improve the sleep quality and psychological state of patients with breast cancer and liver metastases and improve self-care ability.


Asunto(s)
Neoplasias de la Mama , Neoplasias Hepáticas , Neoplasias de la Mama/terapia , Enfermería Basada en la Evidencia , Femenino , Humanos , Neoplasias Hepáticas/terapia , Calidad de Vida/psicología , Autocuidado
7.
J Med Internet Res ; 24(5): e31810, 2022 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-35536633

RESUMEN

BACKGROUND: Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment. OBJECTIVE: This study aims to revisit the landmark index study to investigate whether and how symptom checkers' capabilities have evolved since 2015 and how they currently compare with laypersons' stand-alone triage appraisal. METHODS: In early 2020, we searched for smartphone and web-based applications providing triage advice. We evaluated these apps on the same 45 case vignettes as the index study. Using descriptive statistics, we compared our findings with those of the index study and with publicly available data on laypersons' triage capability. RESULTS: We retrieved 22 symptom checkers providing triage advice. The median triage accuracy in 2020 (55.8%, IQR 15.1%) was close to that in 2015 (59.1%, IQR 15.5%). The apps in 2020 were less risk averse (odds 1.11:1, the ratio of overtriage errors to undertriage errors) than those in 2015 (odds 2.82:1), missing >40% of emergencies. Few apps outperformed laypersons in either deciding whether emergency care was required or whether self-care was sufficient. No apps outperformed the laypersons on both decisions. CONCLUSIONS: Triage performance of symptom checkers has, on average, not improved over the course of 5 years. It decreased in 2 use cases (advice on when emergency care is required and when no health care is needed for the moment). However, triage capability varies widely within the sample of symptom checkers. Whether it is beneficial to seek advice from symptom checkers depends on the app chosen and on the specific question to be answered. Future research should develop resources (eg, case vignette repositories) to audit the capabilities of symptom checkers continuously and independently and provide guidance on when and to whom they should be recommended.


Asunto(s)
Servicios Médicos de Urgencia , Aplicaciones Móviles , Recolección de Datos , Estudios de Seguimiento , Humanos , Autocuidado , Triaje
8.
Saudi Med J ; 43(5): 465-472, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35537729

RESUMEN

OBJECTIVES: To examine the pathway in which health literacy affects diabetic patients' quality of life (QoL) with self-care management skills and glycemic control levels (hemoglobin A1c [HbA1c]) mediating the relationship. METHODS: A cross-sectional study carried out between April 2019 and September 2019. A convenience sample of participants with type 2 diabetes mellitus were recruited from 3 primary healthcare centers, Al Ahsa, Saudi Arabia. Data were collected using structured interviews and HbA1c levels were collected from medical files. Structural equation modeling was also used. RESULTS: Among the 256 participants, 27.3% had a marginal level of health literacy and 35.5% had an inadequate level of health literacy. Health literacy positively affects self-care management, glycemic control (HbA1c), and QoL directly and indirectly. Self-care management partially mediates this relationship. CONCLUSION: Healthcare providers need to assess health literacy and develop interventions that enhance diabetic patients' health literacy because it influences self-care management skills, glycemic control, and patients' QoL. Health literacy should be considered as a key for health education and healthcare encounter to improve health outcomes.


Asunto(s)
Diabetes Mellitus Tipo 2 , Alfabetización en Salud , Automanejo , Estudios Transversales , Diabetes Mellitus Tipo 2/terapia , Hemoglobina A Glucada/metabolismo , Control Glucémico , Conocimientos, Actitudes y Práctica en Salud , Humanos , Calidad de Vida , Autocuidado
10.
Rev Esc Enferm USP ; 56: e20220022, 2022.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-35510834

RESUMEN

OBJECTIVE: To construct and validate nursing diagnoses statements of the International Classification for Nursing Practice (ICNP®) for the person with diabetic foot ulcer being followed up in primary health care. METHOD: This is a methodological study structured in four stages: identification of terms; cross-mapping of identified terms with ICNP terms®, version 2019/2020; construction of nursing diagnoses statements and organization with Orem's Theory of Self-care; and content validation by expert nurses working in primary care, with those with Content Validity Index (CVI) ≥ 0.80 being considered valid. RESULTS: Eighty-one diagnostic statements were constructed, five of which were positive, 67 negative, and nine risky. Of these, 58 were included in ICNP® and 23 were not, 51% of which were categorized as self-care requirements related to health changes. CONCLUSION: ICNP® subsidized the construction of a technical product, which can be consulted and used by nurses and will allow the strengthening of the standardization of a specific language in the context of care for people with diabetic foot ulcers in primary health care.


Asunto(s)
Diabetes Mellitus , Pie Diabético , Terminología Normalizada de Enfermería , Pie Diabético/diagnóstico , Humanos , Diagnóstico de Enfermería , Autocuidado , Vocabulario Controlado
11.
J Gerontol Nurs ; 48(5): 5-12, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35511062

RESUMEN

In residential care communities (CCs), implementation strategies can improve the use of person-centered approaches for residents' behavioral symptoms of distress. We examined staff perceptions of how well their organizational goals for achieving person-centered care (PCC) were met following implementation of the strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Distress. We also identified organizational characteristics and indicators of staff adoption associated with perceived goal attainment. Goal attainment was evaluated by staff using goal attainment scaling (GAS) at the completion of the implementation trial in 26 CCs. Correlations, t tests, and linear regression were used to determine which factors were associated with goal attainment. Total time spent with the research facilitator, stable staff group membership, and presence of a survey deficiency during the study period explained 63% of the variance in goal attainment. Staff can set achievable organizational goals to improve PCC for residents' behavioral symptoms of distress. [Journal of Gerontological Nursing, 48(5), 5-12.].


Asunto(s)
Enfermería Geriátrica , Casas de Salud , Anciano , Objetivos , Humanos , Autocuidado , Encuestas y Cuestionarios
12.
JAMA ; 327(14): 1344-1355, 2022 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-35412564

RESUMEN

Importance: Home-based walking exercise interventions are recommended for people with peripheral artery disease (PAD), but evidence of their efficacy has been mixed. Objective: To investigate the effect of a home-based, walking exercise behavior change intervention delivered by physical therapists in adults with PAD and intermittent claudication compared with usual care. Design, Setting, and Participants: Multicenter randomized clinical trial including 190 adults with PAD and intermittent claudication in 6 hospitals in the United Kingdom between January 2018 and March 2020; final follow-up was September 8, 2020. Interventions: Participants were randomized to receive a walking exercise behavior change intervention delivered by physical therapists trained to use a motivational approach (n = 95) or usual care (n = 95). Main Outcomes and Measures: The primary outcome was 6-minute walking distance at 3-month follow-up (minimal clinically important difference, 8-20 m). There were 8 secondary outcomes, 3 of which were the Walking Estimated Limitation Calculated by History (WELCH) questionnaire (score range, 0 [best performance] to 100), the Brief Illness Perceptions Questionnaire (score range, 0 to 80 [80 indicates negative perception of illness]), and the Theory of Planned Behavior Questionnaire (score range, 3 to 21 [21 indicates best attitude, subjective norms, perceived behavioral control, or intentions]); a minimal clinically important difference was not defined for these instruments. Results: Among 190 randomized participants (mean age 68 years, 30% women, 79% White race, mean baseline 6-minute walking distance, 361.0 m), 148 (78%) completed 3-month follow-up. The 6-minute walking distance changed from 352.9 m at baseline to 380.6 m at 3 months in the intervention group and from 369.8 m to 372.1 m in the usual care group (adjusted mean between-group difference, 16.7 m [95% CI, 4.2 m to 29.2 m]; P = .009). Of the 8 secondary outcomes, 5 were not statistically significant. At 6-month follow-up, baseline WELCH scores changed from 18.0 to 27.8 in the intervention group and from 20.7 to 20.7 in the usual care group (adjusted mean between-group difference, 7.4 [95% CI, 2.5 to 12.3]; P = .003), scores on the Brief Illness Perceptions Questionnaire changed from 45.7 to 38.9 in the intervention group and from 44.0 to 45.8 in the usual care group (adjusted mean between-group difference, -6.6 [95% CI, -9.9 to -3.4]; P < .001), and scores on the attitude component of the Theory of Planned Behavior Questionnaire changed from 14.7 to 15.4 in the intervention group and from 14.6 to 13.9 in the usual care group (adjusted mean between-group difference, 1.4 [95% CI, 0.3 to 2.5]; P = .02). Thirteen serious adverse events occurred in the intervention group, compared with 3 in the usual care group. All were determined to be unrelated or unlikely to be related to the study. Conclusions and Relevance: Among adults with PAD and intermittent claudication, a home-based, walking exercise behavior change intervention, compared with usual care, resulted in improved walking distance at 3 months. Further research is needed to determine the durability of these findings. Trial Registrations: ISRCTN Identifier: 14501418; ClinicalTrials.gov Identifier: NCT03238222.


Asunto(s)
Claudicación Intermitente , Enfermedad Arterial Periférica , Anciano , Prueba de Esfuerzo , Terapia por Ejercicio/métodos , Femenino , Humanos , Claudicación Intermitente/etiología , Claudicación Intermitente/terapia , Masculino , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/terapia , Autocuidado , Encuestas y Cuestionarios , Caminata
13.
BMC Public Health ; 22(1): 828, 2022 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-35468753

RESUMEN

BACKGROUND: Understanding people's subjective experiences of everyday lives with chronic health conditions such as diabetes is important for appropriate healthcare provisioning and successful self-care. This study explored how individuals with type 2 diabetes in northern Vietnam handle the everyday life work that their disease entails. METHODS: Detailed ethnographic data from 27 extended case studies conducted in northern Vietnam's Thái Bình province in 2018-2020 were analyzed. RESULTS: The research showed that living with type 2 diabetes in this rural area of Vietnam involves comprehensive everyday life work. This work often includes efforts to downplay the significance of the disease in the attempt to stay mentally balanced and ensure social integration in family and community. Individuals with diabetes balance between disease attentiveness, keeping the disease in focus, and disease discretion, keeping the disease out of focus, mentally and socially. To capture this socio-emotional balancing act, we propose the term "everyday disease diplomacy." We show how people's efforts to exercise careful everyday disease diplomacy poses challenges to disease management. CONCLUSIONS: In northern Vietnam, type 2 diabetes demands daily labour, as people strive to enact appropriate self-care while also seeking to maintain stable social connections to family and community. Health care interventions aiming to enhance diabetes care should therefore combine efforts to improve people's technical diabetes self-care skills with attention to the lived significance of stable family and community belonging.


Asunto(s)
Diabetes Mellitus Tipo 2 , Diplomacia , Antropología Cultural , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/psicología , Diabetes Mellitus Tipo 2/terapia , Humanos , Autocuidado/psicología , Vietnam/epidemiología
14.
Curr Pharm Teach Learn ; 14(4): 457-461, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35483811

RESUMEN

INTRODUCTION: Studies have examined the impact of team formation strategies to performance on team assessments and perceptions of team dynamics. This study assessed the impact of intentional vs. randomized team formation strategies on a semester-long self-care pharmacotherapy course taught using team-based learning. METHODS: Students were intentionally assigned to teams in fall 2018 and randomized to teams in fall 2019. Performance on team readiness assessment tests (TRATs) was compared. Student perceptions regarding team dynamics were evaluated using a questionnaire. RESULTS: The were no significant differences in TRAT scores between the intentional (n = 91; average 99.8%) and randomized (n = 68; average 99.9%) cohorts (P = .33). Response rates for the student perception questionnaires for the intentional and randomized cohorts were 85.7% and 77.9%, respectively. No significant differences existed between cohorts for any questionnaire items. CONCLUSIONS: The type and number of criteria used to intentionally develop teams has varied across the literature and has generally failed to show significant differences in performance on team assessments regardless of team formation strategy. There have been varied findings with respect to the impact of team formation criteria on student perceptions related to team dynamics. In this study, intentionally assigning teams in a single semester-long course primarily using community pharmacy experience and significant relationships did not produce significant differences in team performance or student perceptions compared to randomization. For teams in a single semester course, randomization may be an efficient way of assigning students to teams without negatively impacting team performance or perceptions of team dynamics.


Asunto(s)
Educación en Farmacia , Estudiantes de Farmacia , Curriculum , Educación en Farmacia/métodos , Evaluación Educacional/métodos , Humanos , Autocuidado
15.
Rech Soins Infirm ; (147): 82-91, 2022 Feb 10.
Artículo en Francés | MEDLINE | ID: mdl-35485039

RESUMEN

Introduction : Sickle cell disease, while it is the most common genetic disease in France, is little known to caregivers and the general public.Context : Only a few studies have examined the daily lives of people suffering from this disease.Objectives : The purpose of this project was to describe the specific strategies helping adult patients to manage the symptoms of their disease.Method : To reach this objective, a qualitative study was conducted among eight homozygous (SS) people over 30 years old living in the Ile-de-France region of France. The semi-structured interviews took place at the patients' homes, selected from several regional competence centers and on social media. An inductive methodology and a thematic analysis were used to draw the conclusions of this research.Results : They show that pain and suffering are patients' main complaints. Patients suffering from sickle cell disease seek numerous effective self-care strategies to manage their long-term pain : preventive measures and drugs, as well as complementary and alternative medicine.Discussion : A sociological approach shows us the considerable work that patients undertake to manage symptoms daily.Conclusion : The findings support interventions that would increase the feeling of control over the disease through better self-awareness and appropriate physical activity.


Asunto(s)
Anemia de Células Falciformes , Automanejo , Adulto , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/terapia , Humanos , Dolor/etiología , Investigación Cualitativa , Autocuidado
16.
Healthc Manage Forum ; 35(3): 179-184, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35387502

RESUMEN

The implementation of Person-Centred Care (PCC) by primary care teams is complex. Framed through the Quadruple Aim, successful healthcare system redesigns result in improved health outcomes of individuals and populations, reduce costs, and ensure an engaged and productive workforce. However, how can primary care teams achieve the Quadruple Aim? This article provides a learning and performance framework to support PCC through a Team-Based Care (TBC) ecosystem approach. We developed our approach using action research to improve TBC orientations, workshops, and consultations for teams and their leaders in Urgent Primary Care Centres and Primary Care Networks in Canada. This paper provides a synthesis of our experience in the context of the relevant evidence. We aim to share our efforts and acknowledge that our experience is still ongoing and complemented by ongoing improvement activities by others in the TBC ecosystem.


Asunto(s)
Atención a la Salud , Ecosistema , Investigación sobre Servicios de Salud , Humanos , Atención Dirigida al Paciente , Autocuidado
17.
Nat Commun ; 13(1): 2229, 2022 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-35484106

RESUMEN

Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and treatment-resistant IAH and severe hypoglycaemia, with blinded analysis of 12-month recall of severe hypoglycaemia at 12 and/or 24 months the primary outcome. Secondary outcomes included cognitive and emotional measures. Adults with T1D, IAH and severe hypoglycaemia despite structured education in insulin adjustment, +/- diabetes technologies, were randomised to the "Hypoglycaemia Awareness Restoration Programme despite optimised self-care" (HARPdoc, n = 49), a psychoeducation programme uniquely focussing on changing cognitive barriers to avoiding hypoglycaemia, or the evidence-based "Blood Glucose Awareness Training" (BGAT, n = 50), both delivered over six weeks. Median [IQR] severe hypoglycaemia at baseline was 5[2-12] per patient/year, 1[0-5] at 12 months and 0[0-2] at 24 months, with no superiority for HARPdoc (HARPdoc vs BGAT incident rate ratios [95% CI] 1.25[0.51, 3.09], p = 0.62 and 1.26[0.48, 3.35], p = 0.64 respectively), nor for changes in hypoglycaemia awareness scores or fear. Compared to BGAT, HARPdoc significantly reduced endorsement of unhelpful cognitions (Estimated Mean Difference for Attitudes to Awareness scores at 24 months, -2.07 [-3.37,-0.560], p = 0.01) and reduced scores for diabetes distress (-6.70[-12.50,-0.89], p = 0.02); depression (-1.86[-3.30, -0.43], p = 0.01) and anxiety (-1.89[-3.32, -0.47], p = 0.01). Despite positive impact on cognitive barriers around hypoglycaemia avoidance and on diabetes-related and general emotional distress scores, HARPdoc was not more effective than BGAT at reducing severe hypoglycaemia.


Asunto(s)
Diabetes Mellitus Tipo 1 , Hipoglucemia , Adulto , Glucemia , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Humanos , Hipoglucemia/prevención & control , Insulina , Autocuidado
18.
J Nurs Educ ; 61(4): 187-191, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35384757

RESUMEN

BACKGROUND: Advanced practice RNs (APRNs) working in rural primary care provide a spectrum of health care needs that can lead to professional burnout. As a preventative for burnout, the Institute of Medicine developed a strategy focused on self-care. Understanding the importance of self-care as a preventive for building professional resilience to manage workplace stressors during students' academic years may improve retention. METHOD: Twenty-two APRN students participated in a rural primary care immersion course with a specific component on self-care. Preand postsurveys, student journaling, class discussions, and a posttraining focus group were used to assess students' progress. RESULTS: Students reported strengthening patient and team relationships, enhanced interpersonal communication, and increased self-awareness of stressors for managing their emotions. These self-imposed processes improved student confidence, job satisfaction, and workplace resilience. CONCLUSION: Heath-promoting behaviors via self-care during APRN students' formal education may assist them in their clinical practice as rural primary care providers. [J Nurs Educ. 2022;61(4):187-191.].


Asunto(s)
Enfermería de Práctica Avanzada , Agotamiento Profesional , Estudiantes de Enfermería , Humanos , Atención Primaria de Salud , Autocuidado , Estudiantes
19.
BMC Health Serv Res ; 22(1): 442, 2022 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-35379247

RESUMEN

BACKGROUND: Process evaluations are useful in clarifying results obtained from randomised controlled trials (RCTs). Traditionally, the degree of intervention usage in process evaluations is monitored by measuring dose or evaluating implementation fidelity. From a person-centred perspective, such evaluations should be supplemented with patients' experiences of meaningful use, given that intervention use should be agreed upon between interested parties and tailored to each patient. This study aimed to elucidate patients' experiences of a remote person-centred care (PCC) intervention by deepening the understanding of, if, how and for whom the intervention contributed to meaningful use. METHODS: Patients (n = 86) were recruited from the RCT PROTECT intervention group. A convergent mixed-method approach was implemented. Data were collected in parallel with the ongoing RCT via a survey, including ratings and written comments on meaningful or non-meaningful use. Also, interviews were performed with twelve purposefully selected participants. Descriptive statistics, logistic regression and content analysis were employed. Data sources were integrated in the results. RESULTS: Most participants rated the overall intervention as meaningful to use, with the telephone support rated as most meaningful. Interviews and written comments showed that patient ratings on meaningful use were explained by four categories: Not in need, Communication deficiency, Benefits in everyday life and A personal boost. Meaningful use of rating symptoms on the digital platform was predicted by living alone (adjusted odds ratio [aOR] = 2.8 P = .044). A diagnosis of chronic obstructive pulmonary disease (COPD) predicted meaningful use of digital platform direct messaging (aOR = 3.5, P = .045). Moreover, having access to direct-dial telephone contact explained meaningful use among participants with low ratings of technical competence (aOR = 3.6, P = .014). CONCLUSIONS: The combined digital platform and structured telephone support could be helpful in identifying preventive actions to maintain health for people diagnosed with COPD and chronic heart failure but tends to be more meaningful for those diagnosed with COPD. Overall, lower adoption of the digital platform was seen compared to telephone support. Shortcomings were noted in the digital platform's implementation that negatively influences experiences of meaningful use. When used, the intervention proved to be an easily applicable and valued tool to support preventive actions in a person-centred manner.


Asunto(s)
Uso Significativo , Teléfono , Humanos , Atención Dirigida al Paciente/métodos , Proyectos de Investigación , Autocuidado
20.
JAMA Netw Open ; 5(4): e225982, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35380643

RESUMEN

Importance: Strategies that enhance self-care of patients with heart failure reduce mortality and health care use. Objective: To examine whether an empowerment-based self-care education program was more effective and cost-effective to improve self-care, health status, and hospital service use than a didactic education program in patients with heart failure. Design, Setting, and Participants: In this double-blind randomized clinical trial, a consecutive sample of 988 patients with heart failure from the cardiac clinics of 2 regional hospitals underwent eligibility screening from February 1, 2017, to May 31, 2019, using the criteria of age of 55 years or older, heart failure diagnosed 6 months before screening, and New York Heart Association class II to IV. A total of 236 participants were randomized to the empowerment (n = 118) or education (n = 118) group. Interventions: The 12-week, group-based, empowerment-based education program included self-care assessment, goal-orientated actions in symptom recognition and response, fluid and dietary modification, and lifestyle management. Didactic education covered the same topics without empowerment strategies. Main Outcomes and Measures: The primary outcome was self-care measured by the Self-care Heart Failure Index (SCHFI) maintenance, management, and symptom perception subscales at posttest and 3-month end points. Secondary outcomes included measures of knowledge, confidence, health-related quality of life, and health service use. Direct, indirect, and social costs of the 2 programs were collected for cost-effectiveness analysis. Results: A total of 236 Chinese patients (mean [SD] age, 70 [8.0] years; 149 [63.1%] men) were included in the study. The empowerment group reported significantly greater improvement in SCHFI management scores (mean difference, 13.76; 95% CI, 5.89-21.62; Cohen d = 0.46 at posttest and Cohen d = 0.35 at 3 months) and symptom perception scores (mean difference, 20.36; 95% CI, 13.98-26.75; Cohen d = 0.84 at posttest and Cohen d = 0.61 at 3 months). The empowerment group had lower risks of emergency department attendance (incidence rate ratio, 0.55; 95% CI, 0.31-0.95; P = .03) and hospital admission (incidence rate ratio, 0.38; 95% CI, 0.21-0.68; P = .001) and better improved self-care knowledge (change in score [empowerment minus education], 1.29; 95% CI, 0.48-2.09) and confidence (change in score [empowerment minus education], 7.98; 95% CI, 1.91-14.05). Empowerment was cost-saving and cost-effective at T2 compared with the education group for quality-adjusted life-years, with an incremental cost-effectiveness ratio of -114 485. Conclusion and Relevance: In this randomized clinical trial, an empowerment approach led to clinically relevant improvement in symptom perception and self-care management among patients with heart failure. Its cost-effectiveness in improving these prognostic factors also benefits the patient-reported outcome. Trial Registration: Chinese Clinical Trial Registry: ChiCTR-IOR-16008254.


Asunto(s)
Insuficiencia Cardíaca , Autocuidado , Anciano , Análisis Costo-Beneficio , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Calidad de Vida
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