Rating Scales for Medication Adherence in Parkinson's Disease: A Systematic Review for Critique and Recommendations.

Background: Behaviors interfering with medication adherence (MA) are common and often complex in Parkinson's disease (PD), negatively affecting quality of life and undermining the value of clinical trials. The Clinical Outcome Assessments (COA) Scientific Evaluation Committee of the International Parkinson and Movement Disorder Society (MDS) commissioned the assessment of MA rating scales to recommend the use in PD. Objective: Critically review the measurement properties of rating scales used to assess MA in PD and to issue recommendations. Methods: We conducted systematic review across seven databases to identify structured scales to assess MA in PD. Eligible studies were critically appraised for methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias checklist. Standards for good measurement properties of the selected scales were summarized narratively using the COSMIN, the MDS-COA Committee methodology, the World Health Organization concepts, and the Ascertaining Barriers to Compliance taxonomy. The certainty of the evidence was determined using the modified Grades of Recommendation, Assessment, Development and Evaluation approach with final assessments (highest to lowest) of "Recommended," "Suggested" and "Listed". Results: Of the nine reviewed scales, none met the designation "Recommended". The Morisky Medication Adherence Scale (MMAS-8); Beliefs Related to Medications Adherence questionnaire, Beliefs about Medication Questionnaire, Medication Adherence Rating Scale, and Satisfaction with Information on Medicines Scale were rated "Suggested". Conclusions: We suggest further work focusing on resolving the problems of the suggested scales or developing a new scale meeting all required criteria.

Parkinson's Disease Medication Adherence Scale: Conceptualization, Scale Development, and Clinimetric Testing Plan.

Background: Medication adherence is a crucial component in the management of patients with chronic diseases needing a long-term pharmacotherapy. Parkinson's disease (PD) is a chronic, degenerative disease with complex drug treatment that poses challenging barriers to patient adherence. The adoption of best practices of scale development can contribute to generate solid concepts and, in the long run, a more stable knowledge base on the underlying constructs of medication adherence in PD measured by the items of the first scale to be created for this purpose. Purpose: To present the development process and clinimetric testing plan of the Parkinson's Disease Medication Adherence Scale (PD-MAS). Method: We adopted a hybrid approach plan based on the United States Food and Drug Administration and Benson and Clark Guide that will create a patient-reported outcome instrument. We presented an overview of consecutive and interrelated steps, containing a concise description of each one. International research centers from Brazil and United States were initially involved in the planning and implementation of the methodological steps of this study. Results: We developed a four-phase multimethod approach for the conceptualization and the clinimetric testing plan of the PD-MAS. First, we describe the development process of the conceptual framework of the PD-MAS underpinning the scale construct; second, we formalized the development process of the first version of the PD-MAS from the generation of item pools to the content validation and pre-testing; third, we established the steps for the first pilot testing and revision; fourth, we describe the steps plan for the first pilot testing and revision, to finally describe its clinimetric testing plan and validation. Conclusion: The overview presentation of the development phases and the clinimetric testing plan of the PD-MAS demonstrate the feasibility of creating an instrument to measure the multidimensional and multifactorial components of the medication adherence process in people with PD.

Nursing and Parkinson's Disease: A Scoping Review of Worldwide Studies.

This scoping review aims to evaluate the characteristics of worldwide studies evolving the scope of nursing practice in Parkinson's disease (PD). We conducted a three-step search strategy using 11 databases and reference lists. Of the 4,174 screened studies we included 324 (8%). Most were published during 1978 to 2020, with significant increasing in publications from 2002 onwards and a forecast to double in the next 10 years (total expected = 614, ±62.2, R2 = .998). We identified studies involving nine contexts of nursing practice in PD, in four continents and 31 countries, most of them of observational design (47.2%), funded (52.2%), authored by nurses (70.1%), and related to Nursing care/Guidelines (32.1%), Educational/Research content (16.4%), Symptom management/Medication adherence (14.5%), and Family caregiving (11.1%). The worldwide studies evolving the scope of nursing practice in PD is growing in several health context. These results can guide future research and evidence-based practice involving the role of nurses in PD.

Rating scales for medication adherence in people living with Parkinson's disease: a systematic review protocol.

OBJECTIVE: The objective of the review is to evaluate the measurement properties of rating scales that have been used to assess the components of medication adherence in patients with Parkinson's disease. INTRODUCTION: Drug therapy is a central strategy in the control of Parkinson's disease symptoms. Measuring behaviors related to medication adherence in patients with Parkinson's disease is vital to understanding the therapeutic response. Consequently, it is necessary to define which instrument offers the most reliable and valid screening. INCLUSION CRITERIA: This review will consider studies in English and Portuguese using structured rating scales to assess medication adherence in people with Parkinson's disease. Studies including data from patients with different diseases in addition to Parkinson's disease will be included only if data are clearly available for each disorder covered. Study protocols, letters to the editors, reviews, and studies with clinical judgment scales but no operationally defined anchor points will be excluded. METHODS: A three-step search strategy will be utilized. Databases will include MEDLINE (PubMed), LILACS (BVS Portal), PsycINFO (APA PsycNet), CINAHL (EBSCO), Web of Science (Clarivate Analytics), Embase, and Scopus (Elsevier). The search strategy will be presented using a PRISMA flow diagram. Eligible studies will be critically appraised for methodological quality using the COSMIN Risk of Bias checklist. Criteria for good measurement properties of the selected scales will be summarized narratively using COSMIN, the Movement Disorder Society Rating Scale Program Committee methodology, the World Health Organization concepts, and the ABC taxonomy of medication adherence. The certainty of the evidence will be determined using the modified GRADE recommendations. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42021211099).

Measuring Medication Adherence in Parkinson's Disease: A Systematic Review of Contributing Components in Rating Scales.

BACKGROUND: Poor medication adherence in chronic illnesses such as Parkinson's disease (PD) is a significant but potentially addressable issue if core components are systematically measured. OBJECTIVE: To assess whether rating scales used in PD adequately cover essential components of medication adherence. METHODS: We accessed 5 databases targeting articles published before October 2019 and using rating scales to measure medication adherence in PD. The ABC Taxonomy from the European Ascertaining Barriers to Compliance Consortium and World Health Organization recommendations were used as the evaluation standard of 5 essential adherence dimensions (patient-based, health system-based, social-based, therapy-based, and health condition-based), 3 phases (initiation, implementation, and discontinuation), and 2 factors (intentional and nonintentional). RESULTS: We screened 192 and selected 16 studies, collectively using 5 medication adherence rating scales. No scale covered all essential components of medication adherence (dimensions, phases, factors). The Morisky Medication Adherence Scales were the most frequently used (11 studies), but they measure only 2 dimensions and phases. The Stendal Adherence to Medication Score (used in 1 study) measured all phases but only 2 dimensions, and the Brief Medication Questionnaire (used in 3 studies) measured 3 dimensions and 2 phases. Distinctions between intentional and nonintentional factors were not completely considered in any scale. CONCLUSIONS: Although multiple studies target medication adherence in PD, the used scales did not measure all recommended components, highlighting the need to develop a sensitive, specific, and comprehensive tool for measuring medication adherence among patients with PD.

Quality of life of elderly patients with leg ulcers / Calidad de vida de pacientes ancianos con úlceras en las piernas / Qualidade de vida de idosos com úlceras de perna

Abstract Objectives: To identify compromised domains of the 36-Item Short Form Survey (SF-36) for elderly individuals with leg ulcers and correlate their clinical and sociodemographic variables with the SF-36's components. Method: Exploratory and cross-sectional study conducted with 50 elderly individuals with leg ulcers. The instruments were the sociodemographic and clinical form and the SF-36. The Statistical Package for the Social Sciences was used to analyze data. Results: Most were married, retired, and received one times the minimum wage, were Caucasians or of mixed race, and had hypertension. In regard to the SF-36, the most compromised domain was physical limitations, while social aspects and general health status were the less compromised domains. The SF-36 domains were not correlated with age, income, duration or size of the lesion or pain. Conclusion: The ulcer-related biopsychosocial aspects need to be considered in order to devise more effective nursing interventions.

Resumen Objetivos: Identificar las zonas afectadas de la Escala de Calidad de Vida (SF-36) en ancianos con úlceras en las piernas y correlacionar las variables clínicas y sociodemográficas de los ancianos con los componentes del SF-36. Método: Investigación exploratoria y transversal realizado con 50 ancianos con úlceras en las piernas. Los instrumentos utilizados fueron: datos forman sociodemográfico y clínico y SF-36. Para el análisis de datos se utilizó el paquete estadístico para las Ciencias Sociales. Resultados: Se observó un predominio de ancianos casados, se retiró con el salario mínimo, blanco y marrón, hipertenso. En relación a SF-36, los pacientes fueron los más afectados cuanto a la Limitación de los Aspectos Físicos y menos perjudicados los Aspectos Sociales y de Salud. Los dominios del SF-36 no se correlacionaron con edad, ingresos, tiempo y tamaño de la lesión y dolor. Conclusión: Es necesario tener en cuenta los aspectos biopsicosociales relacionados con lesiones para el desarrollo de intervenciones de enfermería más eficaces.

Resumo Objetivos: Identificar os domínios da Escala de Qualidade de Vida (SF-36) prejudicados nos idosos com úlceras de perna e correlacionar as variáveis clínicas e sociodemográficas dos idosos com os componentes da SF-36. Método: Pesquisa quantitativa, exploratória, transversal realizada com 50 idosos com úlceras de perna. Os instrumentos utilizados foram: formulário de dados sociodemográficos e clínicos e a SF-36. Para análise dos dados, foi utilizado o Statistical Package for the Social Science. Resultados: Predomínio de idosos casados, aposentados com salário mínimo, brancos e pardos, hipertensos. Em relação à SF-36, os participantes estiveram mais prejudicados, no que se refere à limitação por aspectos físicos e menos prejudicados, nos aspectos sociais e no Estado Geral da Saúde. Os domínios da SF-36 não estiveram correlacionados a idade, renda, tempo e tamanho da lesão e dor. Conclusão: É necessário considerar os aspectos biopsicossociais relacionados à lesão para a elaboração de intervenções de enfermagem mais efetivas.

Perfil sócio demográfico e clínico de clientes portadores de lesões cutâneas / The sociodemographic and clinical profile of clients with cutaneous wounds. A descriptive study

O objetivo do trabalho é traçar o perfil social, demográfico e clínico da clientela portadora de lesões cutâneas (aguda e crônica) que é atendida no ambulatório de um hospital universitário. Trata-se de um estudo prospectivo, descritivo com abordagem quantitativa realizado com pacientes portadores de feridas, atendidos no período de fevereiro a setembro de 2006. Os dados registrados no protocolo I, referem-se à identificação, história clínica, doenças prévias e tipo da lesão. Sendo depois categorizados, tabulados com o auxílio de gráficos e analisados com a literatura. Foram atendidos 38 pacientes em 121 consultas. Os resultados apontam que a população do estudo é majoritariamente do sexo masculino (74%), com idade entre 40 e 59 anos (44,5%), tem primeiro grau incompleto (42%) e residem na cidade de Niterói (49%). Em relação aos aspectos clínicos, os pacientes apresentam Diabetes Mellitus (28%) e lesões cirúrgicas (31%). Quanto à localização 39% das lesões encontra-se nos membros inferiores e tem como causa traumas diversos (37%), levando em média de 4 a 8 meses para cicatrizar. O acompanhamento sistemático do paciente com lesão é fundamental para que se estabeleça não só o tratamento da ferida, mas o controle das doenças de base e prevenção de complicações.

This research aims to outline the social, demographic and clinical profile of clients with cutaneous wounds (active and chronic) who received assistance from the outpatient service of a university hospital. The study is prospective and descriptive, with a quantitative approach, involving patients with wounds admitted between February and September 2006. The data registered in protocol I refer to identification, clinical history, previous illnesses and type of wound. These are sorted into categories with the help of graphs and analyzed in the light of the applicable literature. The study encompassed 38 patients with 121 consultations. The results show that the population of the study is mostly male (74%), aged from 40 to 59 years (44.5%), with incomplete middle (junior high) school (42%) and lives in the city of Niterói (49%). With relation to clinical aspects, the patients present Diabetes Mellitus (28%) and surgical injuries (31%). As to location, 39% of wounds are to lower members caused by diverse traumas (37%) and take between 4 and 8 months to heal on average. The systematic monitoring of wounded patients is fundamental not only to treat the wound but also to control basic illnesses and prevent complications.

Metaplasia óssea associada ao retardo da cicatrização de ulcera em paciente diabético / Bony Metaplasia associated with the delay in the ulcer healing in diabetic patient. A case study

O objetivo do trabalho é descrever a metaplasia óssea encontrada na análise histopatológica de ulcera em paciente acompanhado no ambulatório de Reparo de Feridas do hospital universitário. O estudo faz parte do projeto de pesquisa "Retardo na cicatrização das úlceras cutâneas: avaliação clínica e morfológica setorial", sendo que durante a análise das lâminas foram descobertas células que se diferenciaram em osteoblastos. Trata-se de um estudo de caso, de paciente diabético, renal crônico, com mal perfurante plantar. A coleta de dados foi baseada no instrumento de pesquisa com dados de identificação, clínicos e descritivos da lesão, além de material para estudo histopatológico. O resultado morfológico aponta para a diferenciação de células mesenquimais em osteoblastos na lesão, ao invés de fibroblastos. Conclui-se que a cronicidade da lesão fez com que células de um tipo celular fossem substituídas por outro tipo celular impedindo a cicatrização.

This search aims to describe the bony metaplasia found in the histopathological analysis of ulcer in patients observed at the Wound Repair Aid Center at the university hospital. The study is part of a search project applied in CNPq entitled "Delay in the cutaneous ulcers healing: clinical and morphological sectional evaluation", being that during the blades analysis we found out cells that performed different from the osteoblasts. It is about a study of case of a diabetes and chronic renal patient with bad piercing planting. The data collect was based on the instrument of search with clinical and descriptive identification data about the hurt, besides the material for the pathological study histopathological. The morphological result indicates the difference of mesenchymals cells in osteoblasts in the injury, instead of fibroblasts. It can be concluded that the chronicity in the wound made one type of cell to be replaced by another type impairing the scarring.

Técnicas para avaliação do processo cicatricial de feridas / Techniques to the assessment of wounds healing process

Este trabalho tem como objetivo descrever as técnicas de avaliação de lesões tissulares agudas e crônicas apresentando suas vantagens e desvantagens. Os dados foram descritos a partir da experiência de professores, enfermeiros e alunos no Ambulatório de Cirurgia do Hospital Universitário Antonio Pedro, com clientes portadores de úlceras. Destacam-se as facilidades e dificuldades encontradas no desenvolvimento de cada técnica. A observação sistematizada, minuciosa das úlceras através do decalque, da medida simples, da fotografia e dos registros de enfermagem possibilitam avaliar o processo cicatricial de feridas de várias etiologias.

Cicatrização de feridas cirúrgicas e crônicas: um atendimento ambulatorial de enfermagem / Healing of chronic and surgical wounds: an ambulatory care of nursing / Cicatrización de heridas quirúrgicas y crónicas Una atención ambulatorial de enfermería

Este estudo está sendo desenvolvido no Ambulatório de Cirurgia Geral do Hospital Universitáio Antonio Pedro (HUAP/UFF), campo de ensino teórico-prático da disciplina Semiologia e Semiotécnica I, onde alunos e professores realizam a consulta de enfermagem desenvolvendo cuidados fundamentais a clientes portadores de lesões cutâneas. O projeto tem como objetivo realizar uma avaliação diagnóstica da clientela portadora de lesões tissulares que é atendida pelos professores e estudantes de enfermagem no ambulatório. ....