RESUMO
BACKGROUND: Parkinson's disease progressively limits patients at different levels and as a result family members play a key role in their care. However, studies show lack of an integrative approach in Primary Care to respond to the difficulties and psychosocial changes experienced by them. The aim of this study is to evaluate the effects of a multidisciplinary psychoeducational intervention focusing on improving coping skills, the psychosocial adjustment to Parkinson's disease and the quality of life in patients and family carers in a Primary Care setting. METHODS: This quasi-experimental study with control group and mixed methods was designed to evaluate a multidisciplinary psychoeducational intervention. Based on the study power calculations, 100 people with Parkinson's disease and 100 family carers will be recruited and assigned to two groups. The intervention group will receive the ReNACE psychoeducational intervention. The control group will be given a general educational programme. The study will be carried out in six community-based health centres. The results obtained from the two groups will be collected for evaluation at three time points: at baseline, immediately after the intervention and at 6 months post-intervention. The results will be measured with these instruments: the Quality of Life Scale PDQ-39 for patients and the Scale of Quality of Life of Care-givers SQLC for family carers, and for all participants the Psychosocial Adjustment to Illness scale and the Brief COPE Inventory. Focus groups will be organised with some patients and family carers who will have received the ReNACE psychoeducational intervention and also with the healthcare professionals involved in its development. DISCUSSION: An important gap exists in the knowledge and application of interventions with a psychosocial approach for people with PD and family carers as a whole. This study will promote this comprehensive approach in Primary Care, which will clearly contribute in the existing knowledge and could reduce the burden of PD for patients and family carers, and also in other long-term conditions. TRIAL REGISTRATION: NCT03129425 (ClinicalTrials.gov). Retrospectively registered on April 26, 2017.
Assuntos
Cuidadores/educação , Educação em Saúde/métodos , Doença de Parkinson/terapia , Qualidade de Vida , Adulto , Humanos , Educação de Pacientes como Assunto/métodos , Projetos de Pesquisa , EspanhaRESUMO
BACKGROUND: Parkinson's disease has a considerable impact on people's lives. It is necessary to identify the key elements that influence the process of living with Parkinson's disease so that health professionals can help patients and their relatives to live as well as possible with the changes and limitations produced by the disease. MATERIAL AND METHODS: A qualitative descriptive study was realized. This study corresponded to the first phase of a sequential, exploratory design (mixed method) that in turn included a quantitative phase. A multicentre project was carried out. Convenience sampling was applied to collect data, a semi-structured interview was realized individually with patients and carer-relatives and two questionnaires with patients: the Hoehn & Yahr scale and the PDNMS questionnaire. Content analysis of the interviews and a statistical description of the questionnaires were used. RESULTS: The sample was made up of 46 participants. Three key elements were identified in the process of living with Parkinson's disease: acceptance, adaptation and self-management. These elements conditioned the modes of living with Parkinson's disease: positive living, characterized by feelings of harmony, balance and naturalness; negative living characterized be feelings of frustration, loss of control and self-esteem. CONCLUSIONS: It is essential for health professionals to have a deep understanding of these elements, as well as of the factors that favor or hinder them. To the extent that research in this field progresses and effective interventions are identified, comprehensive patient care will be improved in consonance with the new directives for chronicity.
Assuntos
Cuidadores , Relações Familiares , Doença de Parkinson , Idoso , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
Fundamento: La enfermedad de Parkinson produce un impacto considerable en la vida de las personas. Es necesario identificar los elementos clave que influyen en el proceso de convivencia con la enfermedad de Parkinson para que los profesionales de la salud puedan ayudar a los pacientes y sus familias a convivir lo mejor posible con los cambios y limitaciones producidos por la enfermedad. Material y método: Se llevó a cabo un estudio cualitativo descriptivo. Este estudio se corresponde con la primera fase de un diseño exploratorio secuencial (Mixed-methods) que incluye a su vez una fase cuantitativa. Se realizó un proyecto multicéntrico. Para la recogida de datos se aplicó un muestreo de conveniencia y se utilizó una entrevista semi-estructurada realizada individualmente a pacientes y familiares cuidadores y dos cuestionarios para pacientes: la Escala de Hoehn & Yahry el Cuestionario PDNMS. Se realizó un análisis de contenido de las entrevistas y estadístico descriptivo de los cuestionarios. Resultados: La muestra la constituyeron 46 participantes. Se identificaron tres elementos clave en el proceso de convivencia con la enfermedad de Parkinson: aceptación, adaptación y automanejo. Estos elementos condicionaron dos modos de convivencia con la enfermedad de Parkinson: una convivencia positiva, caracterizada por sentimientos de armonía, equilibrio, y naturalidad; y una convivencia negativa caracterizada por sentimientos de frustración, pérdida de control y autoestima. Conclusiones: Es esencial que los profesionales de la salud conozcan a fondo estos elementos, así como los factores que los favorecen o dificultan. En la medida que se propicie la investigación en este ámbito y se identifiquen intervenciones efectivas se mejorará la atención integral de la personas en consonancia con las nuevas directrices para la cronicidad (AU)
Background: Parkinson's disease has a considerable impact on peoples lives. It is necessary to identify the key elements that influence the process of living with Parkinsons disease so that health professionals can help patients and their relatives to live as well as possible with the changes and limitations produced by the disease. Material and methods: A qualitative descriptive study was realized. This study corresponded to the first phase of a sequential, exploratory design (mixed method) that in turn included a quantitative phase. A multicentre project was carried out. Convenience sampling was applied to collect data, a semi-structured interview was realized individually with patients and carer-relatives and two questionnaires with patients: the Hoehn & Yahr scale and the PDNMS questionnaire. Content analysis of the interviews and a statistical description of the questionnaires were used. Results: The sample was made up of 46 participants. Three key elements were identified in the process of living with Parkinsons disease: acceptance, adaptation and self-management. These elements conditioned the modes of living with Parkinsons disease: positive living, characterized by feelings of harmony, balance and naturalness; negative living characterized be feelings of frustration, loss of control and self-esteem. Conclusions: It is essential for health professionals to have a deep understanding of these elements, as well as of the factors that favor or hinder them. To the extent that research in this field progresses and effective interventions are identified, comprehensive patient care will be improved in consonance with the new directives for chronicity (AU)
Assuntos
Humanos , Doença de Parkinson/psicologia , Cuidadores/psicologia , Relações Familiares , Fatores de Risco , Relações Profissional-Família , Pesquisa Qualitativa , Doença Crônica/psicologiaRESUMO
AIMS: In this study we review the risk factors associated with the formation and progression of an atheroma plaque, the mechanism involved in cerebral ischemia secondary to intracranial atheromatosis and possible medical treatment in primary and secondary prevention. DEVELOPMENT: Medical treatment of intracranial stenoses (ICS) is aimed at stopping the progression of the atheroma plaque and at preventing recurrences in the case of symptomatic stenoses. It is based on the control of vascular risk factors, the use of statins and antithrombotic therapy (antiplatelet or anticoagulation drugs). Although antiplatelet agents have not proved to be beneficial in the primary prevention of stroke, they are recommended in patients with ICS in order to lower the risk of heart attack associated with this pathology. The use of antiplatelet drugs in the secondary prevention of ischemic stroke secondary to an ICS is based on clinical trials which have shown that antiaggregation prevents non-cardioembolic strokes. Nevertheless, several retrospective studies have observed that oral anticoagulation is better than antiaggregation with aspirin. Two prospective clinical trials are currently being conducted which will, in the next few years, help to determine what the first choice medical treatment is for this group of patients. CONCLUSIONS: Medical treatment of ICS patients must include the control of vascular risk factors and the use of statins. New studies are needed to be able to establish the first choice antithrombotic drug in secondary prevention.
Assuntos
Arteriosclerose/complicações , Arteriosclerose/patologia , Isquemia Encefálica , Transtornos Cerebrovasculares , Arteriosclerose/tratamento farmacológico , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Isquemia Encefálica/patologia , Isquemia Encefálica/prevenção & controle , Transtornos Cerebrovasculares/tratamento farmacológico , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/prevenção & controle , Ensaios Clínicos como Assunto , Constrição Patológica/tratamento farmacológico , Constrição Patológica/patologia , Constrição Patológica/prevenção & controle , Progressão da Doença , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Fatores de RiscoRESUMO
Objetivo. En este trabajo se revisan los factores de riesgo asociados a la formación y progresión de la placa de ateroma, el mecanismo de la isquemia cerebral secundaria a la ateromatosis intracraneal y las posibilidades de tratamiento médico en prevención primaria y secundaria. Desarrollo. El tratamiento médico de las estenosis intracraneales (EIC) tiene como objetivos impedir la progresión de la placa de ateroma y evitar las recurrencias en el caso de las estenosis sintomáticas. Se basa en el control de los factores de riesgo vascular, el empleo de estatinas y la terapia antitrombótica (antiagregación o anticoagulación). Aunque los antiagregantes no han demostrado ningún beneficio en la prevención primaria del ictus, en los pacientes con EIC se recomiendan para reducir el riesgo de infarto de miocardio asociado a esta patología. La utilización de antiagregantes plaquetarios en la prevención secundaria del ictus isquémico secundario a una EIC se sustenta en los ensayos clínicos que han demostrado que la antiagregación previene el ictus no cardioembólico. Sin embargo, varios estudios retrospectivos han observado que la anticoagulación oral es superior a la antiagregación con aspirina. Actualmente, están en marcha dos ensayos clínicos prospectivos, que en los próximos años contribuirán a definir cuál es el tratamiento médico de elección de este grupo de pacientes. Conclusión. El tratamiento médico de los pacientes con EIC debe incluir el control de los factores de riesgo vascular y la utilización de estatinas. Se necesitan nuevos estudios para definir cuál es el antitrombótico de elección en la prevención secundaria (AU)
Aims. In this study we review the risk factors associated with the formation and progression of an atheroma plaque, the mechanism involved in cerebral ischemia secondary to intracranial atheromatosis and possible medical treatment in primary and secondary prevention. Development. Medical treatment of intracranial stenoses (ICS) is aimed at stopping the progression of the atheroma plaque and at preventing recurrences in the case of symptomatic stenoses. It is based on the control of vascular risk factors, the use of statins and antithrombotic therapy (antiplatelet or anticoagulation drugs). Although antiplatelet agents have not proved to be beneficial in the primary prevention of stoke, they are recommended in patients with ICS in order to lower the risk of heart attack associated with this pathology. The use of antiplatelet drugs in the secondary prevention of ischemic stroke secondary to an ICS is based on clinical trials which have shown that antiaggregation prevents non-cardioembolic strokes. Nevertheless, several retrospective studies have observed that oral anticoagulation is better than antiaggregation with aspirin. Two prospective clinical trials are currently being conducted which will, in the next few years, help to determine what the first choice medical treatment is for this group of patients. Conclusions. Medical treatment of ICS patients must include the control of vascular risk factors and the use of statins. New studies are needed to be able to establish the first choice antithrombotic drug in secondary prevention (AU)
Assuntos
Humanos , Transtornos Cerebrovasculares , Isquemia Encefálica , Fatores de Risco , Inibidores de Hidroximetilglutaril-CoA Redutases , Progressão da Doença , Inibidores da Agregação Plaquetária , Arteriosclerose , Constrição PatológicaAssuntos
Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Tratos Piramidais/patologia , Adulto , Astrocitoma/metabolismo , Neoplasias Encefálicas/metabolismo , Humanos , Imageamento por Ressonância Magnética , Masculino , Tratos Piramidais/metabolismo , Tomografia Computadorizada de EmissãoRESUMO
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