Alleviating Pregastroscopy Anxiety Using Mobile Social Media Application.

Aim: The research aimed to study the effect of using WeChat (a mobile social media application) on pregastroscopy anxiety and the cooperation of patients with different coping styles. Methods: In order to decrease patients' pregastroscopy anxiety and improve the tolerance of unsedated gastroscopy, WeChat, a widely used mobile social media application, was applied to provide information prior to their endoscopic procedure. Two hundred and thirty patients who underwent initial unsedated gastroscopy in a large teaching hospital in China were classified into two groups based on their coping style: information seekers or information avoiders, using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). Each of the two groups was prospectively randomly assigned to either receiving the brochure information or conjunctive interactive WeChat-delivered information of gastroscopy. To measure the level of state anxiety, the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory questionnaire was used. State anxiety, blood pressure and heart rate were measured at enrollment, upon arrival, and before gastroscopy. Results: Information seekers and avoiders who received information from the brochure and the WeChat platform experienced significantly less state anxiety upon arrival and before gastroscopy. Furthermore, information seekers who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of nausea and bloating, and better tolerance. Information avoiders who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of discomfort while swallowing the scope and nausea, and better tolerance. However, we found the percentage of information seekers who preferred no WeChat-delivered pregastroscopy information is greater than WeChat-delivered information at the initial questionnaire. No significant difference was found in blood pressure or heart rate upon arrival and before gastroscopy. Conclusions: Although people preferred no WeChat-delivered pregastroscopy information, the provision of gastroscopy information through a mobile social media application, such as WeChat, could significantly reduce patients' pregastroscopy anxiety, lower the frequency of retching, reduce the scores of nausea and bloating, and improve tolerance for information seekers. In addition, it could lower the frequency of retching, reduce the scores of discomfort while swallowing the scope and its concurrent nausea, and improve tolerance for information avoiders.

Effect of Video Counselling Versus Verbal Counselling on Patient's experience during phacoemulsification under topical anaesthesia.

Purpose: To evaluate the impact of video and verbal counselling on patients' undergoing phacoemulsification under topical anaesthesia. Methods: This is a prospective randomized controlled trial conducted at Aravind Eye Care System, Pondicherry, India. All patients had a 15 â€‹min one-on-one verbal counselling covering surgical technique, implant options, anaesthesia and payment options one day prior to surgery. On the day of surgery, patients were randomized into two groups; in the first group, patients were provided with video counselling and in the second group, patients were given verbal counselling prior to undergoing phacoemulsification under topical anaesthesia. Measurements of blood pressure, heart rate, respiration rate, and the Likert-scale anxiety rating were collected at preoperative, perioperative, and postoperative time points. Results: A group of 186 patients (aged 45-70 years) were provided video counselling via portable iPad before first-time phacoemulsification, and a second group of 186 patients underwent surgery with verbal counselling. Systolic and diastolic blood pressure measurements were lower in both the video and verbally counselled groups during the intraoperative time point. Furthermore, during the intraoperative period, 123 (66.1%) video counselled patients felt relaxed compared to 119 (64%) patients who were provided verbal counselling (P â€‹= â€‹0.6636). Patient cooperation during surgery was excellent in 76(40.9%) video counselled patients and 67(36%) verbally counselled patients (P â€‹= â€‹0.3374). 25.8% and 21% (P â€‹= â€‹0.2703) of patients experienced no pain during surgery in the video and verbal counselled groups respectively. Conclusions: Although measures such as pulse rate, respiratory rate and feelings of relaxation did not show significant differences among the two groups of video and verbal counselling, patients marked cooperation during surgery and furthermore, the level of anxiety is most reassuring.

Efecto del uso de mensajes de texto en dispositivos de telefonía móvil en la adherencia al tratamiento de hipertensión arterial / Effect of mobile phone text messaging on adherence to hypertension treatment

La hipertensión arterial es una de las enfermedades crónicas de mayor incidencia a nivel mundial, produce una importante mortalidad y discapacidad. Este trabajo tuvo por objetivo evaluar el efecto del uso de mensajes de texto en dispositivos de telefonía móvil en la adherencia al tratamiento de hipertensión arterial. Se efectuó un estudio de intervención cuasiexperimental, de antes y después, en el cual se entrevistó a pacientes que pertenecían a un programa ambulatorio de enfermedades crónicas. Se formaron 4 grupos, uno de ellos, el grupo control. A los grupos intervenidos se les remitieron mensajes de texto (educativos/motivadores), con diferentes frecuencias de envío, por un período de 2 meses. Al término de la intervención, se pidió llenar el cuestionario Martín-Bayarre-Grau para determinar su adherencia al tratamiento antihipertensivo antes y después de la intervención. Se realizó un análisis bivariado, en el cual se comparó la variable adherencia al tratamiento, antes y después de la intervención, de los cuatro grupos del estudio. Se encontró solo una diferencia significativa en el grupo 3 (p = 0,011), al cual se le enviaron 8 mensajes al mes (2 por semana). También se comparó, después de los 2 meses, a los grupos sometidos a intervención versus el grupo control; se halló una diferencia significativa en el grupo 3 (p = 0,022). La intervención ha demostrado ser útil para mejorar la adherencia en esta población de estudio. Se obtuvo una respuesta positiva en el grupo 3, que recibió 8 mensajes al mes(AU)

Hypertension is one of the chronic diseases with the highest incidence worldwide and a cause of considerable mortality and disability. This paper aims to evaluate the effect of mobile phone text messaging on adherence to hypertension treatment. A quasi-experimental before-after intervention was conducted based on interviews with patients from a chronic disease outpatient program. Four groups were formed, one of which was the control group. The groups intervened were sent encouraging educational text messages at varying frequencies for a period of two months. At the close of the intervention, participants were asked to fill in the Martín Bayarre Grau questionnaire to determine their adherence to antihypertensive treatment before and after the intervention. A bivariate analysis was performed comparing the variable adherence to treatment before and after the intervention in the four study groups. A significant difference was only found in Group 3 (p = 0.011). This group was sent eight messages per month (two messages per week). Additionally, a comparison between the intervention groups and the control group conducted at two months found a significant difference in Group 3 (p = 0.022). The intervention proved was useful to improve adherence in the study population. A positive response was obtained in Group 3, who received eight messages per month(AU)

Factors influencing treatment efficiency.

OBJECTIVES: The purpose of this cohort study was to evaluate the effect of self-ligating brackets (SB) and other related factors that influence orthodontic treatment time. MATERIALS AND METHODS: This was a two-armed prospective study. Consecutively treated patients who were recruited from a private practice were enrolled and asked to choose between SB and conventional brackets (CB). If the patient did not have a preference, that patient was randomly allocated. An identical archwire sequence was used, and all patients were treated by a single orthodontist. Treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, whether or not to orthodontic mini-implants (OMI) were used, OMI failure, extraction, American Board of Orthodontics Discrepancy Index, and arch length discrepancy were measured and statistically analyzed using t-tests, correlation analysis, and analysis of covariance (ANCOVA). Stepwise regression analysis was conducted to generate an equation to predict treatment duration. RESULTS: A total of 134 patients with an average age of 22.73 years were included. The average treatment duration was 28.63 months. ANCOVA showed no significant difference in treatment duration between CB and SB. Stepwise regression analysis could explain 64.6% of the variance in treatment duration using five variables. CONCLUSIONS: SB did not exhibit a significant reduction in treatment time as compared with CB. Patient cooperation, extractions, and malocclusion severity had a significant impact on treatment duration.

Percepções de enfermeiros e doentes sobre a adesão ao tratamento diretamente observado em tuberculose / Percepciones de enfermeros y pacientes sobre la adhesión al tratamiento diretamente observado en tuberculosis / Perceptions of nurses and patients on adherence to the directly observed treatment in tuberculosis

RESUMO Objetivo: analisar os fatores intervenientes na adesão ao tratamento diretamente observado em tuberculose, na percepção de doentes e de enfermeiros de unidades básicas de saúde. Método: pesquisa qualitativa descritiva com participação de 13 enfermeiros e 52 doentes de 12 Unidades Básicas de Saúde de Belém-Pará, Brasil. Para produção dos dados, realizaramse entrevistas individuais, complementadas por observação não participativa. Os dados foram submetidos à análise de conteúdo temática. Resultados: da análise emergiram duas categorias: Percepções sobre o tratamento diretamente observado de doentes e enfermeiros e Operacionalização do tratamento diretamente observado: aspectos positivos e limitantes. Conclusão: mesmo com as fragilidades apontadas, as unidades apresentam potencial para desenvolver a estratégia. Os enfermeiros são sensíveis à sua importância, mas necessitam de maior apoio institucional, e os doentes, quando bem esclarecidos, conseguem fazer uma boa adesão. Esse conhecimento pode proporcionar maior segurança para os enfermeiros na condução do acompanhamento aos pacientes.

RESUMEN: Objetivo: analizar los factores intervinientes en la adhesión al tratamiento directamente observado en tuberculosis, según la percepción de pacientes y enfermeros de unidades básicas de salud. Método: investigación cualitativa y descriptiva con la participación de 13 enfermeros y 52 pacientes de 12 Unidades Básicas de Salud de Belém-Pará, Brasil. Para la producción de los datos, se realizaron entrevistas individuales, complementadas con observación no participativa. Los datos se sometieron a análisis de contenido temático. Resultados: surgieron dos categorías del análisis: Percepciones de pacientes y enfermeros sobre el tratamiento directamente observado, y Operacionalización del tratamiento directamente observado: aspectos positivos y limitantes. Conclusión: incluso con las debilidades señaladas, las unidades tienen potencial para desarrollar la estrategia. Los enfermeros reconocen su importancia, pero necesitan más apoyo institucional; y los pacientes, cuando están bien informados, logran buenos índices de adhesión al tratamiento. Este conocimiento puede proporcionar mayor seguridad a los enfermeros al realizar el seguimiento de los pacientes.

ABSTRACT Objective: to analyze the intervening factors in adherence to the directly observed treatment in tuberculosis, in the perception of patients and nurses of basic health units. Method: a descriptive and qualitative research study with the participation of 13 nurses and 52 patients of 12 Basic Health Units of Belém-Pará, Brazil. For data production, individual interviews were conducted, complemented by non-participant observation. The data were submitted to thematic content analysis. Results: two categories emerged from the analysis: Perceptions of patients and nurses on the directly observed treatment, and Operationalization of the directly observed treatment: positive and limiting factors. Conclusion: even with the weaknesses pointed out, the units have potential to develop the strategy. The nurses are aware of their importance, but need greater institutional support, and the patients, when well informed, show good adherence. This knowledge can provide greater safety for the nurses in the conduction of patient follow-up.

Health control for celiac patients: an analysis according to the Pender Health Promotion model / Control de la salud en celíacos: un análisis según el modelo de Promoción de la Salud de Pender / Controle de saúde de celíacos: análise segundo o modelo de Promoção da Saúde de Pender

ABSTRACT Objectives: to describe the health control habits that influence the daily life of celiac patients and to analyze the practice of actions related to health control and its determinants, from the perspective of the first component of the Pender Health Promotion Model. Method: a cross-sectional study conducted through interviews with instrument with 83 individuals from Ceará and diagnosed with celiac disease. Data was analyzed using the characteristics and individual experiences component of Pender's theoretical model. Results: of the celiac patients, 96.4% did not follow the gluten-free diet; 80.7% had inappropriate behaviors to reduce risk factors; 72.3% made ineffective choices in daily life to achieve health goals and; and 25.3% could not keep the gluten free diet in their daily life. Conclusion: according to the theoretical model, celiac patients did not adhere to the proper diet and presented factors inherent to daily life and social issues, characterized as barriers to an effective health control.

RESUMEN Objetivos: describir los hábitos de control de la salud que influyen sobre la vida diaria de los celíacos y analizar la práctica de acciones relacionados con el control de la salud y sus factores determinantes, bajo la óptica del primer componente del Modelo de Promoción de la Salud de Pender. Método: estudio transversal realizado a través de entrevistas con instrumento con 83 individuos del estado de Ceará diagnosticados con la enfermedad celíaca. Los datos se analizaron mediante el componente de características y experiencias individuales del modelo teórico de Pender. Resultados: de los celíacos, el 96,4% no seguía la dienta sin gluten; el 80,7% presentaba comportamiento inadecuados para reducir factores de riesgo; el 72,3% realizaba elecciones ineficaces en la vida diaria para alcanzar las metas de salud y el 25,3% no lograba mantener la dieta sin gluten en su vida diaria. Conclusión: de acuerdo con el modelo teórico, los celíacos no respetaban la dieta adecuada y presentaron factores inherentes a la vida diaria y a las cuestiones sociales, caracterizados como obstáculos para un control eficaz de la salud.

RESUMO Objetivos: descrever os hábitos de controle de saúde que influenciam no cotidiano dos celíacos e analisar a prática de ações relacionadas ao controle da saúde e seus determinantes, sob o prisma do primeiro componente do Modelo de Promoção da Saúde de Pender. Método: estudo transversal, realizado com 83 indivíduos com diagnóstico de doença celíaca, do Estado do Ceará, através de entrevistas com instrumento. Os dados foram analisados mediante o componente características e experiências individuais do modelo teórico de Pender. Resultados: dos celíacos, 96,4% não seguiam a dieta isenta de glúten; 80,7% possuíam comportamentos inadequados para reduzir fatores de risco; 72,3% faziam escolhas na vida diária ineficazes para atingir as metas de saúde; e 25,3% não conseguiam manter a dieta isenta de glúten na sua vida diária. Conclusão: de acordo com o modelo teórico, os celíacos não aderiam à dieta adequada e apresentaram fatores inerentes ao cotidiano e às questões sociais, caracterizados como barreiras para o controle eficaz da saúde.

Satisfacción de beneficiarios con la Cooperación Universitaria al desarrollo en seguridad del paciente. Riobamba, 2017 / Satisfaction of patients beneficiated with university cooperation for the development of patient safety in Riobamba, 2017

Introducción: La cooperación universitaria al desarrollo en seguridad del paciente mediante modelos de acreditación y formación sanitaria genera una cultura sanitaria de cuidado que evoluciona hacia mejoras de la atención. Objetivo: Determinar la satisfacción de los beneficiarios directos e indirectos con las acciones instrumentales, técnicas y educativas desarrolladas en el marco del proyecto en Más-Ecuador, cantón Riobamba, 2017. Métodos: Se realizó un estudio descriptivo, transversal, con enfoque mixto. La población fue la totalidad de beneficiarios directos e indirectos que participaron en las actividades de capacitación (348). Se realizó un muestreo no probabilístico que incluyó a aquellos individuos (96) que estuvieron de acuerdo en participar, con edades iguales o superiores a los 20 años, óptimo estado de salud mental y que se encontraban en su ubicación laboral o domiciliar en el momento de aplicación de los instrumentos. Como técnica para la recolección de los datos se empleó un cuestionario diseñado por el equipo investigador, validado durante el proceso investigativo mediante criterio de especialistas. Resultados: Los beneficiaros directos e indirectos del proyecto Más-Ecuador, refirieron un alto nivel de satisfacción general con las acciones instrumentales, técnicas y educativas desarrolladas en el marco de esa intervención; predominando el sexo femenino y la categoría profesional de la salud. Conclusión: Intervenciones como el proyecto Manos Seguras Ecuador (MaS-Ecuador), contribuyen al desarrollo de los procesos formativos en el ámbito académico y comunitario y ayudan a prevenir enfermedades, reducir riesgos en la atención sanitaria, garantizando la seguridad del paciente(AU)

Introduction: University cooperation for the development of patient safety through models of accreditation and health training generates a health culture of care that evolves towards improvements in care. Objective: Determine the satisfaction of direct and indirect beneficiaries with instrumental, technical and educational actions developed within the framework of the MaS-Ecuador project, in Riobamba canton, 2017. Methods: A descriptive, cross-sectional, mixed-focused study was conducted. The population was the total of direct and indirect beneficiaries who participated in the training activities (348). A non-probabilistic sampling was carried out that included those individuals (96) who agreed to participate, at ages equal to or over 20 years, with optimal mental health state and who were in their job or home location at the time of the tools´ application. As a technique for data collection, a questionnaire designed by the research team was used, and it was validated during the research process at the discretion of specialists. Results: The direct and indirect beneficiaries of the MaS-Ecuador project referred to have a high level of general satisfaction with the instrumental, technical and educational actions developed in the framework of this intervention. There was a predominance of the female sex and the category of health professional. Conclusion: Interventions such as the project Manos Seguras Ecuador (MaS-Ecuador) contribute to the development of training processes in the academic and community fields and help to prevent diseases and reduce risks in health care, guaranteeing patient safety(AU)

Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work.

Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how "factual" and "normative" orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors "manage" frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.

Estudo da não adesão ao tratamento da doença falciforme: o caso de uma família / Estudio de la no adhesión al tratamiento de la enfermedad falciforme: caso de una familia / Study of non-adherence to the treatment of sickle cell disease: a family case study

RESUMO Objetivo: compreender os aspectos que influenciam a não adesão ao tratamento da doença falciforme em uma família com vários membros adoecidos. Método: estudo de caso único realizado com quatro irmãos com doença falciforme acompanhados em um Centro de Referência no estado da Bahia, Brasil. Os dados foram colhidos por questionário, entrevista aberta e desenho-estória com tema. Resultados: os temas emergidos foram: Preconceito e discriminação promovem o autoisolamento; Dificuldade para deslocamento impede as idas ao serviço; A unidade de saúde é um espaço que amplia dúvidas e incertezas; Desesperança leva à desistência do tratamento. Conclusão: amparo social, suporte emocional, instrumental e educacional são essenciais para reduzir a vulnerabilidade da família que vivencia a doença falciforme. Conteúdos abordados nas unidades de saúde necessitam incluir perspectivas de experiências positivas, fomentando esperança e construção de sentidos para a vida no processo de adoecimento crônico, a fim de aumentar a adesão ao tratamento.

RESUMEN Objetivo: comprender los aspectos que influyen en la no adhesión al tratamiento de la enfermedad falciforme en una familia con varios miembros enfermos. Método: estudio de caso único que se realizó con cuatro hermanos con enfermedad falciforme asistidos en un Centro de Referencia en el estado de Bahia, Brasil. Se obtuvieron los datos por medio de cuestionario, entrevista abierta y dibujo historia con tema. Resultados: los temas que resultaron del proceso fueron: Prejuicio y discriminación promueven el auto aislamiento; Dificultad para desplazarse imposibilita ir al trabajo; La unidad de salud es un espacio que aumenta dudas e incertidumbres; Desesperanza lleva a desistimiento del tratamiento. Conclusión: ayuda social, apoyo emocional, instrumental y educacional son esenciales para reducir la vulnerabilidad de la familia que vive la enfermedad falciforme. Es necesario añadir perspectivas de experiencias positivas en los contenidos que se abordaron en las unidades de salud, fomentando esperanza y construcción de sentidos para la vida en el proceso crónico de la enfermedad, para aumentar la adhesión al tratamiento.

ABSTRACT Objective: To gain insight on the aspects that impact non-adherence to sickle cell disease treatment in a family with several sick members. Method: Single case study of four siblings with sickle cell disease monitored at a Referral Center in the state of Bahia, Brazil. Data was collected with the use of a questionnaire, open interviews and themed story-drawing. Results: The following themes emerged: Prejudice and discrimination promote self-isolation; Transportation problems prevent patients to get to health services; The health unit is a space that amplifies doubts and uncertainty; Hopelessness leads to treatment withdrawal. Conclusion: Social assistance, emotional, instrumental and educational support are essential to reduce the vulnerability of families experiencing sickle cell disease. The contents addressed in health facilities must include perspectives on positive experiences, encouraging hope and the construction of meanings during life in the process of chronic illness, in order to increase treatment adherence.

The effect of eye dominancy on patients' cooperation and perceived pain during photorefractive keratectomy.

PURPOSE: To find a possible association between patients' cooperation, perceived pain, and ocular dominance in patients who undergo photorefractive keratectomy (PRK). METHODS: One hundred-one eligible candidates for PRK refractive surgery were recruited. Preoperative exams were performed for all patients, and the dominant eye was specified. The surgeon was unaware about which eye was dominant. After surgery, the surgeon completed a cooperation score form for each patient. Ocular cyclotorsion, cooperation, and perceived pain scores were compared between the first-second eye surgeries and between dominant-non-dominant eyes surgeries. RESULTS: The dominant eye was the right eye in 68 patients and the left eye in 33 patients. First, eye surgery was performed on the dominant eye in 56 patients and on the non-dominant eye in 45 patients. Cooperation score and perceived pain were not significantly different between the first and second eye surgeries (P = 0.902 and P = 0.223, respectively), but cyclotorsion was more in the second eye (P = 0.031). Cooperation score, pain score, and cyclotorsion were not significantly different between dominant and non-dominant eye surgeries (P = 0.538, P = 0.581, and P = 0.193, respectively). Also, there was no correlation between cooperation score and duration of the surgery for the first or second eye (P = 0.12 and P = 0.78). CONCLUSION: During PRK surgery, the patients' cooperation and perceived pain did not seem to be associated with eye laterality or dominancy.

Influence of Risk of Drug⁻Drug Interactions and Time Availability on Patient Trust, Satisfaction, and Cooperation with Clinical Pharmacists.

Patients with multiple diseases requiring several medications often face the risk of drug-drug interactions (DDIs). Such patients need more care and services from clinical pharmacists. Given the importance of this issue in clinical medicine, the present study aims to investigate how DDIs and time availability affect patient trust in clinical pharmacists and how patient trust influences patient satisfaction and cooperation between patients and clinical pharmacists. Sample data of 741 patients in central Taiwan hospitals were analyzed, and the results of structural equation modeling showed that DDIs and time availability positively affect patient trust, which, in turn, positively influenced patient satisfaction and cooperation between patients and clinical pharmacists. Overall, the results indicated that patient satisfaction is an important predictor of cooperation between patients and clinical pharmacists.

The influence of text messages on the cooperation of Class II patients regarding the use of intermaxillary elastics.

OBJECTIVES: To evaluate the influence of text messages on cooperation of Class II patients with the use of intermaxillary elastics. MATERIALS AND METHODS: The sample consisted of 42 orthodontic patients (20 males and 22 females) aged between 14 and 34 years. They were randomly divided into one of the following two groups: a control group with 21 patients who did not receive messages and an experimental group with 21 patients who received motivational and reminder text messages. Messages were sent twice a week for a period of 3 months. The patients were instructed to wear the elastics all day, removing them only during meals and replacing them daily. All patients were instructed regarding the importance of cooperation. Measurements were performed with a digital caliper on plaster models at the beginning of elastics wear (T1) and 3 months later (T2). For intragroup and intergroup comparisons between T1 and T2, paired and unpaired t-tests, respectively, were used with a significance level of 5%. RESULTS: Statistically significant differences were observed in the intra- and intergroup comparisons between T1 and T2. Both groups showed a decrease in the sagittal distance between upper and lower arches from T1 to T2, demonstrating the effective use of elastics. However, the experimental group showed a Class II correction that was 3.7 times greater than the control group ( P = .001). CONCLUSIONS: Text messages had a positive influence on the cooperation of patients regarding the use of intermaxillary elastics in the orthodontic treatment of Class II malocclusion.

A New Technique for Retracting the Protrusive Premaxilla With Fewer Patient Visits.

Bilateral cleft lip and palate with premaxillary protrusion is a great challenge due to a large defect area. Retraction of the premaxilla before surgery can be done with numerous orthopedic treatment options. In patients who have cleft lip and alveolus, but not cleft palate, it is quite difficult to get to the place where the premaxilla should be. To effectively reach the location where the premaxilla should be, new appliances with expansion and retraction screws were designed. This new design aims to treat the patient with fewer visits. Our study presents the treatment of a case with excessive premaxillary growth and no palatal defect treated with our new design.

Dimensões que interferem na adesão à medicação nos transtornos relacionados às substâncias: revisão integrativa / Dimensionees que inlfuyen en la adhesión a la medicación en los trastornos asociados a sustancias: revisión integrativa / Dimensions that interfere with adherence to medication in substance-related disorders: integrative review

RESUMO Objetivo Analisar a produção científica acerca das dimensões que interferem na adesão à terapêutica medicamentosa de pessoas com transtornos mentais relacionados ao uso de substância, no período de 2006 a abril de 2017. Método Revisão Integrativa da Literatura a partir de três bancos de dados, LILACS, CINAHL e PUBMED, realizada em abril de 2017. Resultados Foram analisados 43 estudos que atendiam aos critérios de elegibilidade. A análise dos estudos possibilitou identificar fatores que impactam positiva ou negativamente a adesão à terapêutica medicamentosa, agrupados de acordo com as cinco dimensões determinantes para a adesão proposta pela Organização Mundial da Saúde, sendo elas: socioeconômica, equipe/sistema de saúde, doença, tratamento, e indivíduo/paciente. Conclusão Embora a terapêutica medicamentosa seja imprescindível no gerenciamento da pessoa com transtorno relacionado a substâncias, muitas vezes representa um desafio devido às diferentes dimensões interativas que influenciam diretamente no processo de adesão.

RESUMEN Objetivo Analizar la producción científica acerca de las dimensiones que influyen en la adhesión a la terapéutica medicamentosa de personas con trastornos mentales asociados al uso de sustancia, en el periodo de 2006 a abril de 2017. Método Revisión Integrativa de la Literatura a partir de tres bancos de datos, LILACS, CINAHL y PUBMED, hecha en abril de 2017. Resultados Se evaluaron 43 estudios que atendían a los criterios de elegibilidad. El análisis de los estudios posibilitó identificar factores que tienen impacto positivo o negativo en la adhesión a la terapéutica medicamentosa. Esos factores se organizaron de acuerdo con las cinco dimensiones determinantes para la adhesión que propuso la Organización Mundial de la Salud: socioeconómica, equipo/sistema de salud, enfermedad, tratamiento, e individuo/paciente. Conclusión A pesar de que la terapéutica medicamentosa es imprescindible en la administración de la persona con trastorno asociado a substancias, muchas veces representa un desafío a causa de las distintas dimensiones interactivas que influencian directamente en el proceso de adhesión.

ABSTRACT Objective To analyze the scientific production about the dimensions that interfere in the adherence to pharmacological therapy of individuals with mental disorders related to substance abuse from 2006 to April 2017. Method Integrative literature review of publications indexed in the following three databases LILACS, CINAHL and PUBMED, performed in April 2017. Results The 43 studies that met the eligibility criteria were analyzed. Such analysis made it possible to identify factors that have positive or negative impact on adherence to pharmacological therapy, grouped according to the five dimensions that determine the adherence proposed by the World Health Organization, namely: socioeconomic, health team/system, disease, treatment, and individual/patient. Conclusion Although pharmacological therapy is crucial in the management of individuals with substance-related disorders, implementing the treatment is challenging because of the different interactive dimensions that directly impact the process of treatment adherence.

Valoración de la adherencia del paciente diabético al consejo nutricional y evaluación de mejoras tras su reeducación: una investigación-acción en la costa mediterránea / Adherence to nutritional advice and improvement evaluation after reeducation among diabetic patients: an investigation-action on the Mediterranean coast

RESUMEN Objetivo: Valorar la adherencia del paciente diabético tipo 2 a las recomendaciones dietéticas profesionales, posteriormente educar en hábitos nutricionales saludables y evaluar las mejoras implementadas. Método: Investigación-Acción Evaluativa a 32 residentes diabéticos tipo 2 en la costa mediterránea española elegidos aleatoriamente en 2016 durante ingreso hospitalario. El diseño constó de 3 fases: exploratoria, educativa y evaluativa. Las técnicas empleadas fueron: la entrevista semiestructurada y métodos mixtos educativos. Los instrumentos fueron: el cuestionario MUST y el marco evaluativo de mejoras ISTEW. Resultados: Los entrevistados de ambos sexos (19 hombres y 13 mujeres) y media de edad de 74 años, no se sentían responsables de la elección y elaboración de la dieta diaria. Tampoco se sentían bien informados ni creían tener herramientas para abordar su salud nutricional correctamente. Se detectó un consumo excesivo de dulces y de grasas saturadas, no correspondiéndose con el tipo de dieta mediterránea esperable propia de la zona. Tras la intervención educativa se corroboró un alto grado de satisfacción y mejoras en su desempeño. Conclusiones: La no adherencia dietética se puede explicar por la ausencia de un canal de información eficaz paciente-familia-profesional y la ausencia del vínculo terapéutico al disminuir el empoderamiento y el nivel de gravedad percibida por la persona. La adherencia a la dieta mediterránea fue baja. El conocimiento de su patología no se explica por el nivel académico y socioeconómico.

ABSTRACT Objective: To assess adherence to professional dietary recommendations among type 2 diabetic patients and then evaluate improvements after education on healthy nutritional habits. Methods: In 2016, thirty-two type 2 diabetics who resided on the Mediterranean Coast of Spain were randomly selected and invited to participate at hospital admission. The design consisted of 3 phases: exploration, education and evaluation. The techniques used were: semi-structured interviews and mixed educational methods. The instruments were: the MUST questionnaire and the ISTEW improvement evaluation framework. Results: The interviewees of both sexes (19 men and 13 women) with an average age of 74 years did not feel responsible for the choice and elaboration of their daily diet. They also did not feel well informed, nor did they believe they had the tools to address their nutritional needs correctly. Excessive consumption of sweets and saturated fats was detected, not corresponding to the type of Mediterranean diet expected in the area. After the educational intervention, a high degree of satisfaction and improvements in performance were corroborated. Conclusions: Dietary nonadherence can be explained by the absence of an effective patient-family-professional information channel and the absence of a therapeutic link reduced patient empowerment and level of severity perceived by the person. Adherence to the Mediterranean diet was low and the adherence to the Mediterranean diet was low. The knowledge of his pathology is not explained by the academic and socioeconomic level.

Evaluación del efecto sedativo del Midazolam con y sin Ketamina, por vía subcutánea, en pacientes dentales pediátricos / Evaluation of the Sedative Effect of Midazolam with and Without Ketamine, by Subcutaneous Via in Pediatric Dental Patients

Resumen El miedo y la ansiedad de los niños por el tratamiento dental pueden conducir a dificultades en el manejo de la conducta por parte del profesional, lo cual puede ser una barrera para el éxito del tratamiento dental. Los niños no cooperadores pueden necesitar recibir tratamiento dental bajo sedación, la que se indica cuando la guía de comportamiento no farmacológico no tiene éxito. Existen ensayos controlados aleatorios que comparan diferentes protocolos sedantes para procedimientos dentales; sin embargo, la evidencia de superioridad de una forma sobre otra es débil. El objetivo del presente estudio es evaluar el efecto sedativo de Midazolam por vía subcutánea, con y sin ketamina, en procedimientos odontológicos realizados en pacientes pediátricos no cooperadores. Se llevó a cabo un ensayo clínico aleatorizado, cruzado, con cegamiento simple, en 13 niños (10 del género masculino y 3 del femenino) de 19 a 48 meses de edad, ASA I y comportamiento Frankl I. Los dos métodos se aplicaron en el mismo paciente, y el orden de los mismos fue asignado aleatoriamente, para las dos citas de tratamiento. En cada sesión se evaluaron: el comportamiento general del paciente, los movimientos corporales y el llanto, por medio de la escala de Houpt modificada. Además, se monitorearon la frecuencia cardíaca y la saturación de oxígeno por medio de un oxímetro de pulso.

Abstract Children's fear and anxiety about dental treatment can lead to difficulties in the behavior management by the practitioner, which can be a barrier to successful dental treatment. Non cooperative children may need dental treatment under sedation, which is indicated when the non-pharmacological behavioral guidance is unsuccessful. There are randomized controlled trials comparing different sedative protocols for dental procedures; however, evidence of superiority from one form over another is weak. The aim of the present study was to evaluate the sedative effect of midazolam subcutaneously, with and without ketamine, on dental procedures performed in non-cooperative pediatric patients. A randomized, crossover clinical trial with single blinding was performed in 13 children (10 males and 3 females) from 19 to 48 months of age, ASA I and Frankl I behavior. The two methods were applied in the same patient, and the order of the same was assigned randomly, for the two treatment appointments. In each session were evaluated the patient's general behavior, body movements and crying through the modified Houpt scale. In addition, heart rate and oxygen saturation were monitored by means of a pulse oximeter.

Cultural adaptation of The End-Stage Renal Disease Adherence Questionnaire for hemodialysis patients / Adaptación cultural del cuestionario de adhesión del paciente renal crónico en hemodiálisis / Adaptação cultural do questionário de adesão do paciente renal crônico em hemodiálise

ABSTRACT Objective: To describe the stages in the cultural adaptation of "The End-Stage Renal Disease Adherence Questionnaire" for use in Brazil. Method: A descriptive, transversal study with a quantitative approach. The cultural adaptation followed the steps of translation, professional committee, back translation, panel of patients and pretest. Results: the translation stage created a version in Portuguese that was analyzed by specialists, who suggested alterations in the title, seven sentences in the questions and three sets of answers. In the panel of patients phase, two questions were altered. The back translation considered the original characteristics of the instrument were maintained, likewise there were no modifications in the pretest phase. The third version written in Portuguese was considered to be the final version of the questionnaire. Conclusion: this instrument should facilitate nursing care management in hemodialysis, enabling the monitoring of adherence among these patients and also contribute to improving the indicators of morbidity and mortality.

RESUMEN Objetivo: Describir las etapas de la adaptación cultural de The End-Stage Renal DiseaseAdherenceQuestionnaire para uso en Brasil. Método: Estudio descriptivo, transversal, con abordaje cuantitativa. La adaptación cultural siguió las etapas de traducción, comité de especialistas, retrotraducción, panel de pacientes y pre pruesta. Resultados: La etapa de traducción generó una versión en portugués, analizada por especialistas, que sugirieron alteraciones en eltítulo, en siete sentencias de preguntas y en tres conjuntos de respuestas. En la fase de panel de pacientes, dos preguntas sufrieron alteraciones. La retrotraducción consideró la manutención de las características originales del instrumento, así como no hubo modificaciones en la fase de pre prueba. La tercera versión producida en portugués fue considerada la versión final del cuestionario. Conclusión: Este instrumento deberá facilitar la gestión de cuidado de enfermería en la hemodiálisis, permitiendo la monitoreo de la práctica de adhesión de los pacientes y todavía contribuyendo para la mejoría de indicadores de morbilidad y mortalidad.

RESUMO Objetivo: Descrever as etapas da adaptação cultural do The End-Stage Renal Disease Adherence Questionnaire para uso no Brasil. Método: Estudo descritivo, transversal, com abordagem quantitativa. A adaptação cultural seguiu as etapas de tradução, comitê de especialistas, retrotradução, painel de pacientes e pré-teste. Resultados: A etapa de tradução gerou uma versão em português, analisada por especialistas, que sugeriram alterações no título, em sete sentenças de perguntas e em três conjuntos de respostas. Na fase de painel de pacientes, duas perguntas sofreram alterações. A retrotradução considerou a manutenção das características originais do instrumento, assim como não houve modificação na fase de pré-teste. A terceira versão produzida em português foi considerada a versão final do questionário. Conclusão: Este instrumento deverá facilitar o gerenciamento do cuidado de enfermagem na hemodiálise, permitindo a monitorização da prática de adesão dos pacientes e ainda contribuindo para a melhoria de indicadores de morbidade e mortalidade.

Validation of the adherence questionnaire for Brazilian chronic kidney disease patients under hemodialysis / Validez del cuestionario de adhesión del paciente renal crónico en hemodiálisis para Brasil / Validação do questionário de adesão do paciente renal crônico brasileiro em hemodiálise

ABSTRACT Objective: To validate the evaluation questionnaire on adherence of chronic kidney disease (CKD) patients under hemodialysis. Method: We verified the following psychometric properties of the instrument: reliability (stability and internal consistency) and validity (face, content, and construct). Results: The intraclass correlation coefficient reached a value of 0.98 for the adherence questions and 0.91 for the perception questions. Regarding the kappa of the 14 questions examined, 12 had a value > 0.8, whereas the Cronbach's alpha had a value of 0.57. Experts ensured the face and content validity of the instrument, giving it an overall content validity index of 0.96. Construct validity, analyzed by Mann-Whitney test, was achieved as all domains showed a significant association with p<0.01. Conclusion: We verified, by the presented results, that the instrument has been validated for use in Brazil.

RESUMEN Objetivo: Comprobar la validez del cuestionario de adhesión del paciente con enfermedad renal crónica en hemodiálisis para Brasil. Método: Se evaluaron las siguientes propiedades psicométricas del instrumento: confiabilidad (estabilidad y consistencia interna) y validez (predictiva, de contenido y de constructo). Resultados: Los valores de la correlación intraclase fueron de 0,98 para las cuestiones de adhesión y de 0,91 para las de percepción. En relación a la kappa de las 14 cuestiones evaluadas, 12 resultaron un valor mayor que 0,8. Mientras que el Alfa de Cronbach fue de 0,57. Los expertos pudieron garantizar la validez predictiva y de contenido del instrumento, en la que el puntaje de validez de contenido global fue de 0,96. Se obtuvo la validez de constructo, evaluada a través de la prueba de Mann-Whitney, cuando todos los dominios presentaron una asociación significativa con p < 0,01. Conclusión: Desde los resultados observados es posible afirmar que el instrumento todavía no tiene validez para emplearse en Brasil.

RESUMO Objetivo: Validar o questionário de avaliação sobre a adesão do portador de doença renal crônica em hemodiálise. Método: Foram verificadas as seguintes propriedades psicométricas do instrumento: confiabilidade (estabilidade e consistência interna) e validade (de face, de conteúdo e de construto). Resultados: O coeficiente de correlação intraclasse atingiu valor de 0,98 para as questões de adesão e 0,91 para as questões de percepção. Quanto ao kappa das 14 questões analisadas, 12 obtiveram um valor > 0,8. Já o alfa de Cronbach obteve valor de 0,57. Os especialistas asseguraram a validade de face e de conteúdo do instrumento, conferindo-lhe um índice de validade de conteúdo global de 0,96. A validade de construto, analisada por meio do teste de Mann-Whitney, foi alcançada na medida em que todos os domínios apresentaram uma associação significativa com p < 0,01. Conclusão: Verifica-se, pelos resultados apresentados, que o instrumento foi validado para uso no Brasil.

Adesão ao tratamento de pessoas com úlceras venosas atendidas na atenção primária à saúde / Adherencia al tratamiento de personas con úlceras venosas atendidas en la atención primaria a la salud / Adherence to Venous Ulcer Treatment among Patients in Primary Health Care

RESUMO Objetivo: verificar a adesão ao tratamento de pessoas com úlceras venosas (UV) e sua associação com as características sociodemográficas, de saúde e assistenciais. Materiais e métodos: trata-se de um estudo analítico, transversal, realizado com 101 pessoas com UV. Utilizaram-se dois instrumentos: um formulário para caracterizar os aspectos sociodemográficos, de saúde e da assistência, e a Escala Multidimensional de Adesão Terapêutica. Resultados: verificou-se pior adesão ao tratamento na dimensão terapia compressiva. Identificou-se associação entre o domínio estilo de vida saudável e estado civil, e entre o domínio vigilância neurovascular e faixa etária, estado civil, profissão e etilismo. Foram encontradas associações entre as dimensões de adesão e as caraterísticas da assistência: adesão à terapia compressiva, orientação para uso de terapia compressiva e orientação para exercícios regulares e quem realiza o curativo fora das unidades. Conclusões: há maior dificuldade de adesão ao tratamento quanto à terapia compressiva, além disso a assistência prestada está associada à adesão à terapia compressiva, à orientação para uso de terapia compressiva e à orientação para exercícios regulares.

RESUMEN Objetivo: estudiar la adherencia al tratamiento de personas con úlceras venosas (UV) y su asociación con las características sociodemográficas, de salud y asistenciales. Materiales y métodos: se trata de un estudio analítico, transversal, realizado con 101 personas con UV. Se emplearon dos instrumentos: un cuestionario para caracterizar los aspectos sociodemográficos, de salud y de asistencia, y la Escala Multidimensional de Adherencia Terapéutica. Resultados: se halló peor adherencia al tratamiento en la dimensión terapia compresiva. Se identificó asociación entre el dominio estilo de vida saludable y estado civil, y entre el dominio vigilancia neurovascular y rango de edades, estado civil, profesión y etilismo. Se encontraron asociaciones entre las dimensiones de adherencia y las características de asistencia: adherencia a terapia compresiva, orientación para uso de terapia compresiva y orientación para ejercicios regulares y quien realiza la curación fuera de las unidades. Conclusiones: hay mayor dificultad de adherencia al tratamiento en cuanto a terapia compresiva; la asistencia prestada está asociada a la adherencia a terapia compresiva, a orientación para uso de terapia compresiva y a orientación para ejercicios regulares.

Objective: Adherence to treatment by patients with venous ulcers (VU) and how it that adherence is associated with sociodemographic characteristics and features of health and care. Materials and methods: This is an analytical, cross-sectional study of 101 patients with venous ulcers. Two instruments were used: a questionnaire designed to characterize sociodemographic aspects, health and care, and the Multidimensional Therapeutic Adherence Scale. Results: The poorest adhesion to treatment was found with respect to compression therapy. The study identified an association between the domain of a healthy lifestyle and marital status, and between the domain of neurovascular surveillance and age range, marital status, profession and alcoholism. Associations also were found between the dimensions of adherence and the characteristics of care: adherence to compression therapy, guidance on the use of compression therapy, guidance on regular exercises, and who applies treatment outside the primary care units. Conclusions: There is greater difficulty in adhering to treatment in terms of compression therapy. The assistance given is associated with adherence to compression therapy, guidance on the use of compression therapy and guidance on exercises to be performed regularly.

Conceptual and Operational Definitions of the Defining Characteristics and Related Factors of the Diagnosis Ineffective Health Management in People With Heart Failure.

OBJECTIVE: To construct conceptual and operational definitions for the defining characteristics (DCs) and related factors (RFs) of the nursing diagnosis (ND) ineffective health management for people with chronic heart failure. METHOD: Conceptual and operational definitions for the DC and RF were based on studies found in an integrative literature review in the databases Latin American Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE by using the key words Nursing diagnosis, Heart Failure, and Patient Cooperation in different combinations. RESULTS: Conceptual and operational definitions for all the DCs and RFs were constructed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The definitions will facilitate in the identification of ND in clinical practice in patients with heart failure, future research on ND validation, and education in undergraduate courses.