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1.
J Med Syst ; 41(8): 122, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28689310

RESUMO

Poor adherence to medication is a prevalent issue that affects 50-60% of chronically ill patients. We present Medplan, a platform for patients/caregivers and healthcare professionals (HCPs) that aims to enhance adherence, increase patient medication knowledge, and facilitate communication between patients and HCPs. The Medplan platform was designed and developed by a multidisciplinary team composed of primary care and hospital physicians, pharmacists, patients, and developers. We questioned 62 patients in order to know their opinion about the different functions the app would incorporate and other possible features that should be taken into consideration. Medplan comprises a website for HCPs and an application (app) that is installed on the patient's phone. The app is available in Spanish, Catalan, and English. The patient's medication plan was introduced by the HCP and interfaced with the app. Each medicine is represented by an icon showing the indication of the treatment, the trade name, active ingredients, dose, and route of administration. Information about special requirements (e.g., need to take medication on an empty stomach), side effects, or lifestyle recommendations can also be provided. Additional functions include a medication reminder alarm system, by which patients can confirm whether or not they have taken the drug. Patients can self-track their adherence, and all data collected are sent automatically to the website for analysis by the HCP. Weekly motivation messages are sent to encourage adherence. A tool enabling interactive communication between patients and HCPs (primary care or hospital care) is also included. The app contains a feature enabling the HCP to verify the suitability of over-the-counter drugs. Medplan has the potential to significantly improve management of medication in chronically ill patients. A pilot study is being conducted to test whether Medplan is useful and effective.


Assuntos
Telefone Celular , Doença Crônica , Humanos , Internet , Projetos Piloto , Sistemas de Alerta , Gerenciamento do Tempo
2.
Postgrad Med ; 128(4): 427-31, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27007065

RESUMO

OBJECTIVES: Mobile phones have been rapidly adopted by the general population and are now a promising technology with considerable potential in health care. However, refusal rates of 24%-75% have been reported in telemedicine studies. We aimed to report the challenges faced when recruiting patients to use Android and iOS smartphone applications aimed at improving medication management and communication between patients and healthcare professionals. METHODS: The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal. RESULTS: Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00). CONCLUSION: We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology.


Assuntos
Doença Crônica , Adesão à Medicação , Aplicativos Móveis , Seleção de Pacientes , Autocuidado/métodos , Smartphone , Fatores Etários , Idoso , Dislipidemias/tratamento farmacológico , Feminino , Hábitos , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado/instrumentação
3.
J Med Syst ; 40(4): 99, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26872781

RESUMO

OBJECTIVE: The aim of this study was to assess the feasibility and preliminary outcomes of a medication self-management platform for chronically ill patients, Medplan. METHODS: We performed a 6-month single-arm prospective pre-post intervention study of patients receiving treatment for hypertension and/or dyslipidemia and/or heart failure and/or human immunodeficiency virus infection. During the pre-intervention phase, participants were followed according to their usual care; during the intervention phase, they used Medplan. We evaluated adherence, health outcomes, healthcare resources and measured the satisfaction of patients and health care professionals. RESULTS: The study population comprised 42 patients. No differences were found in adherence to medication measured by proportion of days covered with medication (PDC). However, when adherence was measured using the SMAQ, the percentage of adherent patients improved during the intervention phase (p < 0.05), and the number of days with missed doses decreased (p < 0.05). Adherence measured using the Medplan app showed poor concordance with PDC. No differences were found in health outcomes or in the use of health care resources during the study period. The mean satisfaction score for Medplan was 7.2 ± 2.7 out of 10 among patients and 7.3 ± 1.7 among health care professionals. In fact, 71.4 % of participants said they would recommend the app to a friend, and 88.1 % wanted to continue using it. CONCLUSION: The Medplan platform proved to be feasible and was well accepted by its users. However, its impact on adherence differed depending on the assessment method. The lack of effect on PDC is mainly because patients were already good adherers at baseline. The study enabled us to validate the platform in real patients using many different mobile devices and to identify potential barriers to scaling up the platform.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Aplicativos Móveis , Autocuidado/métodos , Adulto , Idoso , Antirretrovirais/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Doença Crônica , Dislipidemias/tratamento farmacológico , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipertensão/tratamento farmacológico , Internet , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Smartphone
4.
Med Clin (Barc) ; 129(13): 501-3, 2007 Oct 13.
Artigo em Espanhol | MEDLINE | ID: mdl-17980119

RESUMO

BACKGROUND AND OBJECTIVE: Rumack's nomogram is usually used to indicate the treatment with N-acetilcysteine in the paracetamol poisoning, but it has several limitations. Paracetamol half-life elimination (t1/2) is approximately of 2 h with therapeutic doses and it increases to more than 4 h in patients with hepatotoxicity. The aim of this study was to determine the usefulness of estimated paracetamol t1/2 as greater than or inferior to 4 h by using a simple ratio in relation to the development of hepatotoxicity. PATIENTS AND METHOD: 21 patients with paracetamol overdose were admitted to Son Dureta Hospital (Palma de Mallorca) and Clínic Hospital (Barcelona) over 13 months. The estimated t1/2 is calculated using the quotient between 2 plasma paracetamol concentrations separated by 2 or more hours. RESULTS: We found a significant difference (p < 0.005) between the group with hepatotoxicity (n = 3; t1/2 = 8,5 h; range: 3,6 - 8,7 h); and without hepatotoxicity (n = 18; t1/2 = 2,4 h; (range: 1,6 - 4,3 h). We observed an agreement between positive ratio and a t1/2 > 4 h, and negative ratio with t1/2 < 4 h, bearing in mind that the quotient is obtained through mathematical equations. CONCLUSIONS: Rumack's nomogram should be complemented with t1/2 estimation in all cases of paracetamol poisoning, especially with those patients for whom we are not able to determine the time of ingestion at presentation or if there has been a multiple-timepoint ingestion.


Assuntos
Acetaminofen/metabolismo , Acetaminofen/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Nomogramas , Adulto , Overdose de Drogas , Feminino , Meia-Vida , Humanos , Masculino , Valor Preditivo dos Testes
5.
Med. clín (Ed. impr.) ; 129(13): 501-503, oct. 2007. tab
Artigo em Espanhol | IBECS | ID: ibc-72205

RESUMO

FUNDAMENTO Y OBJETIVO: El nomograma de Rumack seutiliza para indicar el tratamiento con el antídoto Nacetilcisteínaen la intoxicación por paracetamol, perotiene varias limitaciones de uso. La semivida de eliminación(t1/2) del paracetamol, que con dosis terapéuticases de unas 2 h, se incrementa hasta más de4 h en caso de hepatotoxicidad. El objetivo de estetrabajo ha sido validar la predicción de hepatotoxicidada partir de la estimación de la t1/2 como superior oinferior a 4 h obtenida mediante un simple cociente.PACIENTES Y MÉTODO: Se ha estudiado a 21 pacientescon sobredosificación de paracetamol que acudierona los Hospitales de Son Dureta de Palma de Mallorcay Clínic de Barcelona durante un período de 13meses. La estimación de la t1/2 se realizó medianteun cociente entre 2 determinaciones consecutivasde paracetamol en plasma, separadas por un intervalode tiempo de 2 h o más.RESULTADOS: Se observó una diferencia significativa(p < 0,005) en la t1/2 entre el grupo con hepatotoxicidad(n = 3; t1/2 mediana de 8,5 h; extremos: 3,6-8,7 h) y el grupo sin hepatotoxicidad (n = 18; t1/2mediana de 2,4 h; extremos: 1,6-4,3 h). Se hallóuna coincidencia entre cociente positivo y t1/2 superiora 4 h, y entre cociente negativo y t1/2 inferior a4 h, teniendo en cuenta que el cociente se obtuvoa través de ecuaciones matemáticas.CONCLUSIONES: Se propone que se complemente elnomograma de Rumack con la estimación de la t1/2en todos los casos de intoxicación por paracetamol enque se planteen dudas respecto a la indicación detratamiento con antídoto, y en aquellos en los que sedesconozca el tiempo transcurrido desde la ingestao cuando ésta haya sido fraccionada


Rumack’s nomogram isusually used to indicate the treatment with N-acetilcysteinein the paracetamol poisoning, but it hasseveral limitations. Paracetamol half-life elimination(t1/2) is approximately of 2 h with therapeutic dosesand it increases to more than 4 h in patients with hepatotoxicity.The aim of this study was to determinethe usefulness of estimated paracetamol t1/2 as greaterthan or inferior to 4 h by using a simple ratio inrelation to the development of hepatotoxicity.PATIENTS AND METHOD: 21 patients with paracetamoloverdose were admitted to Son Dureta Hospital (Palmade Mallorca) and Clínic Hospital (Barcelona)over 13 months. The estimated t1/2 is calculatedusing the quotient between 2 plasma paracetamolconcentrations separated by 2 or more hours.RESULTS: We found a significant difference (p < 0.005)between the group with hepatotoxicity (n = 3; t1/2 =8,5 h; range: 3,6 – 8,7 h); and without hepatotoxicity(n = 18; t1/2 = 2,4 h; (range: 1,6 – 4,3 h). Weobserved an agreement between positive ratio and at1/2 > 4 h, and negative ratio with t1/2 < 4 h, bearingin mind that the quotient is obtained through mathematicalequations.CONCLUSIONS: Rumack’s nomogram should be complementedwith t1/2 estimation in all cases of paracetamolpoisoning, especially with those patientsfor whom we are not able to determine the time ofingestion at presentation or if there has been amultiple-timepoint ingestion (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Insuficiência Hepática/induzido quimicamente , Acetaminofen/síntese química , Acetaminofen/farmacologia , Acetaminofen/toxicidade , Acetilcisteína/toxicidade , Acetilcisteína/uso terapêutico , Sensibilidade e Especificidade , Testes de Toxicidade/métodos , /diagnóstico , Antídotos/uso terapêutico
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