Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.135
Filtrar
1.
Medicine (Baltimore) ; 99(1): e18459, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895776

RESUMO

BACKGROUND: The high incidence of Diabetes mellitus (DM) has become a serious challenge for the global epidemic. Increased blood glucose leads to abnormal ocular surface structure and metabolic disorder in patients. DM is a high-risk factor for dry eye disease (DED), with high incidence and increased difficulty in treatment. The disease can cause discomfort, visual impairment, tear film instability and ocular surface damage, and even cause corneal erosion in severe cases, which has a serious impact on people's daily life. Traditional Chinese Medicine (TCM) plays an important role in the evaluation and treatment of DM and its complications. However, whether TCM treatment could improve the treatment efficacy of DM suffering from DED remains poorly understood. OBJECTIVE: To investigate the curative effect of TCM for the alleviation of clinical symptoms in Diabetic patients with DED, and to evaluate its long-term efficacy. METHODS: This trial is a single-case randomized, single-blind, placebo-controlled study. A total of 12 subjects will be recruited in this trial. The trial is divided into three cycles, and one cycle has 2 treatment periods. There is a washout period at each adjacent treatment stage. TCM individualized treatment and placebo will be randomized during the treatment period. The test period will last for 29 weeks, with 4 weeks for each treatment period and 1 week for each washout period to minimize carryover effects. Subjects will be selected by the researcher strictly in accordance with the inclusion and exclusion criteria. The outcomes will evaluate the efficacy of treatment by changes in the various observation indicators. DISCUSSION: This study will realize a patient-centered outcome approach necessary to provide clinical researchers with the evidence that TCM treatment can effectively improve the objective indicators of the eye and systemic symptoms in Diabetic patients with DED. TRIAL REGISTRATION: This study has been registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, No. ChiCTR1900024481), (October, 2019).


Assuntos
Complicações do Diabetes/terapia , Síndromes do Olho Seco/terapia , Medicina Tradicional Chinesa/métodos , Feminino , Humanos , Masculino , Assistência Centrada no Paciente/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
2.
Medicine (Baltimore) ; 99(1): e18470, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895779

RESUMO

The appropriate approach to dental patients, developed during the course of dentists' training, is a prerequisite for the holistic treatment of patients. Empathy is an important component of such an approach. This study aimed to determine the levels of empathy among students of dentistry at different stages in their training.The Jefferson Scale of Empathy - Health Profession Students Version was used to conduct the research, and 100 dental students (66 female and 34 male) ranging from first to fifth year participated in the survey. The scale contained 20 questions, with a possible score interval between 20 and 140. A higher score indicates increased ability to express empathy.The level of empathy among dentistry students increased from the first and second to fourth years, where it reached its maximum. During the fifth year, a decrease in levels of empathy was observed.The increase in empathy during the dental course may be correlated with the growth of clinical practice during the subsequent years of study. A slight decrease in empathy in the fifth-year students may be due to the curricular focus on performing procedures, with students having to meet a set target in order to finish the course.


Assuntos
Atitude do Pessoal de Saúde , Empatia , Estudantes de Odontologia/psicologia , Adulto , Educação em Odontologia , Feminino , Humanos , Masculino , Assistência Centrada no Paciente/métodos , Polônia , Distribuição por Sexo , Inquéritos e Questionários
3.
Anaesthesia ; 75 Suppl 1: e158-e164, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903575

RESUMO

An ageing population and rising healthcare costs are challenging cost-efficient hospital systems wanting to adapt, employing novel organisational structures designed to merge diverse skill sets. This needs not only physician and nursing leadership but also new models of care. Anaesthetists have expanded their role into the broader multidisciplinary field of peri-operative medicine, emphasising collaboration and safety in health teams. A greater focus on patient-centred care and shared decision making, along with validated metrics to quantify quality improvement activities, have emphasised the importance of comfort, patient satisfaction and quality of life after surgery. Shared decision-making is more likely to be manifest in a flat hierarchy in which each member of the team brings their own experience and skills to optimise patient care. Successful surgery is best achieved by a coordinated, multidisciplinary team, embedded in a culture of collaboration and safety.


Assuntos
Equipe de Assistência ao Paciente , Assistência Centrada no Paciente/métodos , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica , Humanos , Período Pós-Operatório
4.
J Clin Nurs ; 29(1-2): e1-e10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31509311

RESUMO

AIMS AND OBJECTIVES: To explore adult general surgical patients' perceptions of, and satisfaction with, discharge education provided by healthcare providers. BACKGROUND: Discharge education is essential for general surgical patients as it equips them with the required knowledge and skills to engage in their care after discharge. Insufficient knowledge to self-manage or assess their symptoms can result in postdischarge complications, unplanned hospital readmission and overall dissatisfaction with the hospital experience. DESIGN: A constructivist-interpretivist paradigm using qualitative interviews. METHODS: Telephone interviews were conducted with 13 patients between August 2018 and November 2018 and analysed using inductive content analysis. COREQ guidelines were adopted for the conduct and reporting of the study. RESULTS: Four themes were uncovered: (a) The quality of discharge information influences patients' postdischarge experience; (b) The negative impact of contextual influences on delivery of discharge education; (c) Patients actively participating in their surgical journey; (d) Patients' preferences with the delivery of discharge education. CONCLUSION: Inadequate discharge education leads to patients' inability to self-manage their recovery process. Information sharing with patients fosters shared understanding towards goals and expectations. RELEVANCE TO CLINICAL PRACTICE: Understanding patients' view may inform the design of patient-centred discharge education interventions for patients to self-manage their recovery postdischarge.


Assuntos
Alta do Paciente/normas , Educação de Pacientes como Assunto/normas , Satisfação do Paciente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/métodos , Período Pós-Operatório , Pesquisa Qualitativa
5.
Adv Exp Med Biol ; 1192: 399-428, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705506

RESUMO

Theoretical psychiatry considers theoretical problems in psychiatry as well as the quality and effectiveness of mental health care. This chapter addresses the idea of predictive, preventive, precision, personalized, and participatory medicine in psychiatry from a theoretical transdisciplinary integrative perspective and systems networking. The aim of the chapter is to bring together some current ideas and concepts such as computational neuroscience, network theory, multi-omics profile, precision medicine, and person-centered psychiatry as a coherent system of theory and practice.


Assuntos
Transtornos Mentais/terapia , Assistência Centrada no Paciente/métodos , Medicina de Precisão , Psiquiatria/métodos , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Modelos Psicológicos
6.
BMJ ; 367: l5887, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690574

RESUMO

Diabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients' goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.


Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Qualidade de Vida , Glicemia/análise , Glicemia/efeitos dos fármacos , Complicações do Diabetes/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Incidência , Metanálise como Assunto , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Revisão Sistemática como Assunto , Resultado do Tratamento
7.
Orv Hetil ; 160(44): 1735-1743, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31657253

RESUMO

Introduction: The most common reason for the adverse events in healthcare is communication. Due to the development of health technologies and the increasing specialization of care, more and more healthcare professionals are involved in the treatment of patients, resulting in an increasingly important role and risk for patient handover. Aim: To present the current state of knowledge of patient handover through the results of an international project. Method: Self-developed, anonymous questionnaires with single and multiple choice questions were used to investigate handover knowledge among healthcare workers in 3 Hungarian and 3 Polish hospitals. The frequency of responses was analyzed according to their correctness. The factors that can influence the knowledge were studied using a regression model in the Hungarian sample. Results: The questionnaire was completed by 63% of the 2963 employees who received the questionnaires. In the two countries, there was no significant difference in the proportion of correct responses. Nearly half of the responders (49.4%-45.7%) gave the right answers to the question about the definition of patient handover. The lowest rate of correct answers (14.4%-11.1%) was given to elements of patient handover techniques. The difficulty of the questions also showed a similar pattern. Conclusion: Based on the results, it can be concluded that knowledge of handover needs to be improved in both countries. Although healthcare providers have some knowledge about handover, it cannot be considered accurate and complete. It is important to promote the knowledge and practice of handover together for the safety of patients and healthcare providers. Orv Hetil. 2019; 160(44): 1735-1743.


Assuntos
Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Transferência da Responsabilidade pelo Paciente/organização & administração , Assistência Centrada no Paciente/métodos , Atitude do Pessoal de Saúde , Humanos , Hungria , Polônia , Inquéritos e Questionários
8.
BMC Health Serv Res ; 19(1): 682, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31581947

RESUMO

BACKGROUND: Person-centred care (PCC) focusing on personalised goals and care plans derived from "What matters to you?" has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by "What matters to you?" with 2) IC and 3) pro-active care is unknown. METHODS: Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014-2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up. RESULTS: The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months. CONCLUSION: Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT02541474 ), registered Sept 2015.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Múltiplas Afecções Crônicas/terapia , Assistência Centrada no Paciente/métodos , Idoso , Serviço Hospitalar de Emergência , Feminino , Idoso Fragilizado/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Morbidade , Noruega , Planejamento de Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Pontuação de Propensão , Estudos Prospectivos , Autocuidado
9.
West Afr J Med ; 36(2): 138-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385600

RESUMO

BACKGROUND: Holistic ward round (HWR) is a polyadic, multiphasic, holistic model of neurosurgical patient care. It is a multidisciplinary ward round where all healthcare providers involved in patients care, the patients, the relations, as well as clergymen (depending on the patients' faith and need) collectively work to review patient's condition and make decisions in the patient's best interest. OBJECTIVES: The study assessed the effectiveness of the holistic model of care and identified the challenges facing this model of healthcare delivery. METHODS: The study was qualitative in design and In-depth Interviews (IDIs) were conducted with eighteen (18) participants who were purposively selected. They include neurosurgeons, nurses, medical social workers and physiotherapists. The data were thematically content analysed with the help of ATLAS.ti (v.7) software. RESULTS: The study found that patients and relations have immensely benefitted from the model of care through psychosocial support. The major challenges facing HWR were logistic, timing and common problems found in the Nigerian healthcare system. CONCLUSION: It was concluded that for HWR to effectively help spinal cord injured patients further, the healthcare providers, patients and their families require support in different forms from outside the hospital.


Assuntos
Saúde Holística , Equipe de Assistência ao Paciente , Assistência ao Paciente , Assistência Centrada no Paciente/métodos , Adulto , Feminino , Hospitais Universitários , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Neurocirurgiões , Neurocirurgia , Nigéria , Fisioterapeutas , Pesquisa Qualitativa , Assistentes Sociais
10.
Artigo em Inglês | MEDLINE | ID: mdl-31398821

RESUMO

The aim of this paper is to describe frail older persons' experiences of hospital care of information and participation when being an inpatient at a hospital. A qualitative method was used. Data were collected at the hospital from 20 interviews with frail older patients, together with observations in the environment at the hospital ward. A content analysis was performed. Patients experienced not receiving information about their care and rehabilitation, or receiving such information in noisy surroundings. They experienced situations of misunderstanding related to their medication, which indicates the need for appropriate discharge calls for frail older patients. They expressed feelings of distress concerning the future, caused by hasty admissions or relatives' problems to handle the situation. The results highlight the need to receive appropriate information and to participate in decision-making. The level of health literacy should be taken notice of when giving information, using peaceful and quiet environments when informing frail older persons. Person-centered care should be recognized to a greater extent in order for healthcare professionals to give information to frail older people in a health literacy-friendly way. This might make it easier for frail older persons to participate in a partnership in care.


Assuntos
Comunicação , Idoso Fragilizado/psicologia , Disseminação de Informação/métodos , Pacientes Internados/psicologia , Participação do Paciente/psicologia , Assistência Centrada no Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Idoso Fragilizado/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Participação do Paciente/estatística & dados numéricos
11.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 509-515, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31370715

RESUMO

Introduction: Sick persons need doctors who understand their pathology, know how to treat their problem, and accompany them through their illness. This study aimed to synthesize the state of knowledge regarding the concept of value-based medicine (VBM) through an integrative literature review, and establish how VBM can be applied in palliative care. Areas covered: An integrative review was conducted with the keywords 'value-based medicine,' 'patient-centered care,' and 'medicina baseada em valor' (Portuguese for VBM) in PubMed and Virtual Health Library, identifying 17,189 articles in total. Of these, 10 articles met the eligibility criteria. VBM combines the highest level of technical-scientific data with patients' values. It is defined as the combination of evidence-based medicine, patient-centered care, and cost-effectiveness. Patients' values are a set of preferences, concerns, and expectations that contribute toward accommodating their needs in the treatment clinic. Expert opinion: Like VBM, palliative care focuses on patients' values and quality of life, respecting natural limits. The early development of a care plan with active participation of the patient in the face of life-threatening diseases should be encouraged and can bring peace and comfort in a person's final moments.


Assuntos
Medicina Baseada em Evidências/métodos , Cuidados Paliativos/métodos , Qualidade de Vida , Análise Custo-Benefício , Tomada de Decisões , Medicina Baseada em Evidências/economia , Humanos , Cuidados Paliativos/economia , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/métodos
13.
Orthop Clin North Am ; 50(4): 471-488, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466663

RESUMO

Juvenile idiopathic arthritis includes conditions characterized by joint inflammation of unknown etiology lasting longer than 6 weeks in patients younger than 16 years. Diagnosis and medical management are complex and best coordinated by a pediatric rheumatologist. The mainstay of therapy is anti-inflammatory and biologic medications to control pain and joint inflammation. Orthopedic surgical treatment may be indicated for deformity, limb length inequality, or end-stage arthritis. Evaluation of the cervical spine and appropriate medication management in consultation with a patient's rheumatologist are essential in perioperative care. Preoperative planning should take into account patient deformity, contracture, small size, osteopenia, and medical comorbidities.


Assuntos
Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/cirurgia , Terapia Combinada/métodos , Assistência Centrada no Paciente/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Cirurgiões Ortopédicos , Planejamento de Assistência ao Paciente , Assistência Perioperatória , Reumatologistas
14.
Artigo em Inglês | MEDLINE | ID: mdl-31408282

RESUMO

Objective: Patients with severe mental illness often lack care coordination between primary care and mental health providers. Siloed patient care across separate health care systems can negatively impact quality and safety of patient care. The purpose of the project discussed in this article is to effectively engage stakeholders from separate primary care and mental health organizations to develop an ideal cross-organization communication system to improve metabolic monitoring for their comanaged patients prescribed second-generation antipsychotics (SGAs). Methods: The mixed method approach of group concept mapping was used to engage stakeholders across a nonaffiliated primary care clinic and a community mental health organization over the time period of March 2018 through May 2018. Results: Three important domains in communication were identified: (1) process/workflow, (2) advocacy, and (3) a patient-centered focus. Seven high priority/easier to implement brainstormed items were identified and resulted in practice changes across both organizations, including developing a standard release of information, identifying a point person from each clinic focused on cross-organization care coordination, endorsing an SGA monitoring protocol across organizations, agreeing that metabolic monitoring of SGAs will be the responsibility of the primary care clinicians, beginning monthly medication reconciliation and cross-organization care conferences, developing standard electronic health record documentation, and providing education. Conclusions: Care coordination across all health systems is critical to optimize patient care for chronic medical and psychiatric conditions. Group concept mapping provides a strategic process to allow shared decision-making among stakeholders to take steps toward solving more complex systematic problems such as poor electronic health record interoperability across health systems.


Assuntos
Antipsicóticos/uso terapêutico , Serviços Comunitários de Saúde Mental/métodos , Monitoramento de Medicamentos/métodos , Transtornos Mentais/tratamento farmacológico , Atenção Primária à Saúde/métodos , Comunicação , Serviços Comunitários de Saúde Mental/organização & administração , Registros Eletrônicos de Saúde/normas , Humanos , Transtornos Mentais/metabolismo , Defesa do Paciente , Assistência Centrada no Paciente/métodos , Papel do Médico , Médicos de Atenção Primária/educação , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade , Fluxo de Trabalho
15.
J Clin Nurs ; 28(21-22): 3734-3746, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31342576

RESUMO

AIM: To describe the nature of care received by patients measured through the Caring Behaviours Inventory. BACKGROUND: Professional nursing practice combines two dimensions of caring: instrumental care and expressive care. Instrumental care focuses on physical health needs, in terms of efficiency and employs interventions based on evidence. Expressive care is patient-centred and based on the interpersonal relationship. It requires caring attitudes that include respect, kindness, sensitivity and patience. The Caring Behaviours Inventory is a tool designed to assess the care expressed through the behaviours nurses perform, contextualised within the Jean Watson's Theory of Human Caring. METHODS: A systematic review following PRISMA recommendations. Scopus, PubMed and CINAHL databases were consulted using the keywords "Caring Behaviours Inventory" AND "Nursing". The Joanna Briggs Institute tool was used for the quality appraisal. A conceptual analysis and a thematic synthesis were performed for data extraction. RESULTS: 11 articles were selected. Three categories were identified: nature of caring, congruence between perceived care by patients and nurses, and factors associated with the expression of care. DISCUSSION: An emphasis on care of an instrumental nature was identified. The perception of patients differs from that of nurses, patients perceive a lower level of expressive caring than the one nurses believe to deliver. Caring behaviours are affected by the working environment, nurses' emotional intelligence and coping skills, and socio-demographic characteristics. CONCLUSION: This paper described the findings of previous research regarding the nature of care that is transmitted and received in clinical practice. Results highlight an emphasis on the instrumental aspect of the nursing care according to the patients' perception. RELEVANCE TO CLINICAL PRACTICE: Findings summarised in this review could contribute to a better understanding of the nursing care. Results reported in this paper could also help to improve the quality of care delivered by nurses as well as patient-centeredness.


Assuntos
Atitude do Pessoal de Saúde , Cuidados de Enfermagem/normas , Competência Clínica , Empatia , Feminino , Humanos , Masculino , Pesquisa Metodológica em Enfermagem/métodos , Assistência Centrada no Paciente/métodos
16.
Complement Ther Med ; 45: 198-204, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331561

RESUMO

INTRODUCTION: Traditional Chinese Medicine (TCM) has become increasingly popular around the world, and has been accepted by people not only in China and Southeast Asia, but also in Western countries. Despite its historic role in the Chinese society, there has been limited research on exploring the nature of TCM practitioner-patient interactions in the Chinese context. As indicated by a major study regarding the Hong Kong context1, there is a need to investigate the role of TCM practitioner and promote interdisciplinary research to ensure safety and synergy of TCM and Western medicine in primary care. This study aims to address this gap by investigating the nature of TCM consultations and their communication patterns in Hong Kong. METHODS: Based on 10 h of conversations (in Cantonese) between TCM practitioners and their patients in the diagnostic interviews, the study explored how the doctor-patient relationship was negotiated in the course of the consultation, while both the TCM practitioners and the patients were constantly trying to manage and maintain common ground. Particular attention had been paid to the identification of specific linguistic and discourse strategies that TCM practitioners had employed to establish doctor-patient rapport, so that a better understanding of patient-centred care in the TCM context could be obtained. The participants were recruited from a local university operated clinic which shared the characteristic of TCM practitioners in Hong Kong. RESULTS: A range of linguistic strategies that TCM practitioners used to deliver patient-centred care have been identified. These strategies are also helpful in shaping a joint decision-making process that will lead to better patient understanding and compliance with the doctors' treatments. CONCLUSIONS: This study demonstrates empirically how TCM practitioners utilize a range of linguistic resources and communication strategies to shape the ongoing discourse so that their patients can have a better understanding of their illnesses. For an example, it is found that TCM practitioners and their patients were constantly trying to manage and maintain common ground by using a range of grammatical markers, including sentence-final particles (SFPs) and discourse markers (DMs), to negotiate the epistemic commitment so that the patient would have good compliance with the practitioner's suggested treatment. It is also observed that various types of interrogatives have been used by the TCM practitioners to elicit information from the patients as well as to encourage them to talk and make a response. Furthermore, it is found that TCM practitioners would deliberately enquire about the patients' everyday experiences because what they eat, do, and encounter all have an important impact on their body conditions. By exploring into the patients' daily routines in the social talk, the practitioner can help maintain and promote the overall balance of the patient's body, and help them monitor and enhance their health conditions by modifying their daily habits and behaviours. With the adoption of these linguistic and communication strategies, the TCM practitioners are shown to have placed the patients' needs as their top priority. Previous studies in the field have already proved that co-construction of the treatment plan between the doctor and the patient is extremely important, and that a patient-centred approach can largely reduce adverse events leading to avoidable patient harm. The specific strategies identified in the current study can enhance the TCM practitioners' communication with patients, creating an environment that will surely optimise safety for both patients and clinicians.


Assuntos
Terapias Complementares/psicologia , Pessoal de Saúde/psicologia , Medicina Tradicional Chinesa/psicologia , Cooperação do Paciente/psicologia , Adulto , China , Comunicação , Tomada de Decisões , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta , Adulto Jovem
17.
Diabetes Metab Syndr ; 13(2): 1321-1323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336485

RESUMO

The objective of the present article was to evaluate the glycemic control of patients with diabetes mellitus (DM) after discharge from a pharmacotherapeutic empowerment program. The results suggest that the strategy is effective for short-term glycemic control, but the benefits are not maintained after discharge, indicating the need for the pharmacist's continuous role.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Alta do Paciente , Educação de Pacientes como Assunto , Autocuidado/métodos , Adulto , Diabetes Mellitus/psicologia , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/métodos , Assistência Farmacêutica , Prognóstico
18.
JMIR Mhealth Uhealth ; 7(7): e13194, 2019 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-31278732

RESUMO

BACKGROUND: A personal health record (PHR) system encourages patients to engage with their own health care by giving them the ability to manage and keep track of their own health data. Of the numerous PHR systems available in the market, many are Web-based patient portals and a few are mobile apps. They have mainly been created by hospitals and electronic health record (EHR) vendors. One major limitation of these hospital-created PHR systems is that patients can only view specific health data extracted from their EHR. Patients do not have the freedom to add important personal health data they collect in their daily lives into their PHR. Therefore, there is an information gap between clinical visits. OBJECTIVE: The aim of this study was to develop and evaluate a new mobile PHR app that can be easily used to manage various types of personal health data to fill the information gap. METHODS: A user-centered approach was used to guide the development and evaluation of the new mobile PHR app. There were three steps in this study: needs assessment, app design and development, and conducting a usability study. First, a large-scale questionnaire study was conducted with the general population to gain an understanding of their needs and expectations with regard to a mobile PHR app. A mobile PHR app for personal medical data tracking and management was then created based on the results of the questionnaire study. End users were actively involved in all stages of the app development. Finally, a usability study was performed with participants to evaluate the usability of the mobile PHR app, which involved asking participants to finish a set of tasks and to respond to a usability questionnaire. RESULTS: In the questionnaire study for needs assessment, there were 609 participants in total. The answers from these participants revealed that they wanted to manage various types of personal health data in a mobile PHR app. Participants also reported some features they desired to have in the app. On the basis of the needs assessment findings, a new mobile PHR app (PittPHR) was created with 6 major modules: health records, history, trackers, contacts, appointments, and resources. This app allows users to customize the trackers according to their needs. In the usability study, there were 15 participants. The usability study participants expressed satisfaction with the app and provided comments and suggestions for further development. CONCLUSIONS: This new mobile PHR app provides options for users to manage a wide range of personal health data conveniently in one place. The app fills the information gap between clinical visits. The study results indicated that this new mobile PHR app meets the need of users and that users welcome this app.


Assuntos
Registros Eletrônicos de Saúde/instrumentação , Aplicativos Móveis/normas , Assistência Centrada no Paciente/métodos , Adolescente , Adulto , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/normas , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Desenho de Programas de Computador , Inquéritos e Questionários
19.
Rev Esp Cardiol (Engl Ed) ; 72(8): 658-663, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31262700

RESUMO

The percutaneous treatment of coronary artery disease and some structural cardiovascular diseases has undergone spectacular changes. More and more patients with different types of heart disease are being treated by percutaneous or transcatheter interventions, with no such increase in patients undergoing cardiac surgery. This situation has led to different types of approach, requiring an objective analysis that includes all the factors possibly influencing these changes. This document assesses the 2 scenarios where this problem is most evident: coronary revascularization and the treatment of aortic stenosis. The document analyzes the situation of coronary revascularization in Spain, and the causes that may explain the differences between the number of patients who currently undergo percutaneous revascularization and those who undergo coronary surgery. In contrast, treatment of aortic stenosis through transcatheter aortic valve implantation will lead to a foreseeable reduction in the number of candidates for surgical replacement. Several international scientific societies have published the requirements on training and experience and the necessary operator and center volumes to implement a transcatheter aortic valve implantation program, conditions that the Spanish Society of Cardiology, adopting a patient-centered approach, considers absolutely essential. Given that the 2 forms of intervention (percutaneous and surgical) are complementary, multidisciplinary patient assessment (Heart Team) remains crucial to offer the best treatment option. In this scenario of diverse approaches, a key figure is the clinical cardiologist. Finally, the changes currently occurring in the treatment of structural heart disease will, in future, lead to the performance of procedures requiring the participation of professionals from both specialties. This approach will require a redesign of current training programs.


Assuntos
Cardiologia/métodos , Consenso , Assistência Centrada no Paciente/métodos , Intervenção Coronária Percutânea/métodos , Sociedades Médicas , Substituição da Valva Aórtica Transcateter/métodos , Humanos , Espanha
20.
J Drugs Dermatol ; 18(7): 608-612, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329380

RESUMO

Rosacea is among the most common facial skin conditions diagnosed by dermatologists. Typical clinical features include erythema, flushing, telangiectasia, papules, and pustules distributed on the central face. While the prevalence of rosacea is highest among white populations of Northern European descent, recent reports have found that rosacea frequently occurs in people from a broad range of racial/ethnic backgrounds and skin types. When rosacea presents in darker skin types, the diagnosis is often more challenging due to masking of features by increased epidermal melanin. As such, under-diagnosis and underreporting may contribute to misconceptions about the prevalence of rosacea in populations with skin of color. Recognizing the unique presentations and complications associated with darker skin types is necessary to reduce the disparities in rosacea treatment, especially as the American population continues to become increasingly heterogeneous. Although rosacea is most common in middle-aged females, patients of other demographics may have more negative impacts on quality of life due to their disease. In this article, we review rosacea management with a focus on special patient groups: people with skin of color, and less common forms of rosacea, in order to diminish the physical and psychosocial burden of rosacea in all patient groups. Due to the variability inherent to rosacea, we advocate for an individualized, patient-centered approach to disease management.


Assuntos
Dermatologia/organização & administração , Carga Global da Doença , Assistência Centrada no Paciente/métodos , Rosácea/diagnóstico , Pigmentação da Pele , Adolescente , Adulto , Idade de Início , Dermatologistas/educação , Dermatologia/educação , Diagnóstico Diferencial , Medicina Baseada em Evidências/educação , Medicina Baseada em Evidências/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Guias de Prática Clínica como Assunto , Prevalência , Qualidade de Vida , Rosácea/epidemiologia , Rosácea/terapia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA