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1.
West J Emerg Med ; 21(5): 1054-1058, 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32970554

RESUMO

INTRODUCTION: The development and deployment of a web-based, self-triage tool for severe respiratory syndrome coronavirus 2 (COVID-19 disease) aimed at preventing surges in healthcare utilization could provide easily understandable health guidance with the goal of mitigating unnecessary emergency department (ED) and healthcare visits. We describe the iterative development and usability testing of such a tool. We hypothesized that adult users could understand and recall the recommendations provided by a COVID-19 web-based, self-triage tool. METHODS: We convened a multidisciplinary panel of medical experts at two academic medical schools in an iterative redesign process of a previously validated web-based, epidemic screening tool for the current COVID-19 pandemic. We then conducted a cross-sectional usability study over a 24-hour period among faculty, staff, and students at the two participating universities. Participants were randomly assigned a pre-written health script to enter into the self-triage website for testing. The primary outcome was immediate recall of website recommendations. Secondary outcomes included usability measures. We stratified outcomes by demographic characteristics. RESULTS: A final sample of 877 participants (mean age, 32 years [range, 19-84 years]; 65.3% female) was used in the analysis. We found that 79.4% of the participants accurately recalled the recommendations provided by the website. Almost all participants (96.9%) found the website easy to use and navigate. CONCLUSION: Adult users of a COVID-19 self-triage website, recruited from an academic setting, were able to successfully recall self-care instructions from the website and found it user-friendly. This website appears to be a feasible way to provide evidence-based health guidance to adult patients during a pandemic. Website guidance could be used to reduce unnecessary ED and healthcare visits.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Internet , Pandemias , Pneumonia Viral , Autocuidado/métodos , Triagem/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Compreensão , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Interface Usuário-Computador , Adulto Jovem
2.
J Med Internet Res ; 22(9): e19716, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32975521

RESUMO

BACKGROUND: Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. OBJECTIVE: The goal of this study was to assess MIRROR's use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. METHODS: MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR's outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale-21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). RESULTS: In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range -.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. CONCLUSIONS: MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.


Assuntos
Inquéritos Epidemiológicos , Aplicativos Móveis , Encaminhamento e Consulta , Resiliência Psicológica , Autocuidado/métodos , Autocuidado/normas , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Ansiedade/diagnóstico , Lista de Checagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/diagnóstico , Análise Fatorial , Feminino , Humanos , Internet , Masculino , Países Baixos/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Psicometria , Reprodutibilidade dos Testes , Estresse Psicológico/diagnóstico
3.
Cochrane Database Syst Rev ; 8: CD012739, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32748394

RESUMO

BACKGROUND: Regular blood pressure (BP) measurement is crucial for the diagnosis and management of hypertensive disorders in pregnancy, such as pre-eclampsia. BP can be measured in various settings, such as conventional clinics or self-measurement at home, and with different techniques, such as using auscultatory or automated BP devices. It is important to understand the impact of different settings and techniques of BP measurement on important outcomes for pregnant women. OBJECTIVES: To assess the effects of setting and technique of BP measurement for diagnosing hypertensive disorders in pregnancy on subsequent maternal and perinatal outcomes, women's quality of life, or use of health service resources. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 22 April 2020, and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving pregnant women, using validated BP devices in different settings or using different techniques. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data, assessed risk of bias, and used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: Of the 21 identified studies, we included three, and excluded 11; seven were ongoing. Of the three included RCTs (536,607 women), one was a cluster-RCT, with a substantially higher number of participants (536,233 deliveries) than the other two trials, but did not provide data for most of our outcomes. We generally judged the included studies at low risk of bias, however, the certainty of the evidence was low, due to indirectness and imprecision. Meta-analysis was not possible because each study investigated a different comparison. None of the included studies reported our primary outcome of systolic BP greater than or equal to 150 mmHg. None of the studies reported any of these important secondary outcomes: antenatal hospital admissions, neonatal unit length of stay, or neonatal endotracheal intubation and use of mechanical ventilation. Setting of BP measurement: self-measurement versus conventional clinic measurement (one study, 154 women) There were no maternal deaths in either the self-monitoring group or the usual care group. The study did not report perinatal mortality. Self-monitoring may lead to slightly more diagnoses of pre-eclampsia compared with usual care (risk ratio (RR) 1.49, 95% confidence interval (CI) 0.87 to 2.54; 154 women; 1 study; low-certainty evidence) but the wide 95% CI is consistent with possible benefit and possible harm. Self-monitoring may have little to no effect on the likelihood of induction of labour compared with usual care (RR 1.09, 95% CI 0.82 to 1.45; 154 women; 1 study; low-certainty evidence). We are uncertain if self-monitoring BP has any effect on maternal admission to intensive care (RR 1.54, 95% CI 0.06 to 37.25; 154 women; 1 study; low-certainty evidence), stillbirth (RR 2.57, 95% CI 0.13 to 52.63; 154 women; 1 study; low-certainty evidence), neonatal death (RR 1.54, 95% CI 0.06 to 37.25; 154 women; 1 study; low-certainty evidence) or preterm birth (RR 1.15, 95% CI 0.37 to 3.55; 154 women; 1 study; low-certainty evidence), compared with usual care because the certainty of evidence is low and the 95% CI is consistent with appreciable harms and appreciable benefits. Self-monitoring may lead to slightly more neonatal unit admissions compared with usual care (RR 1.53, 95% CI 0.65 to 3.62; 154 women; 1 study; low-certainty evidence) but the wide 95% CI includes the possibility of slightly fewer admissions with self-monitoring. Technique of BP measurement: Korotkoff phase IV (K4, muffling sound) versus Korotkoff phase V (K5, disappearance of sound) to represent diastolic BP (one study, 220 women) There were no maternal deaths in either the K4 or K5 group. There may be little to no difference in the diagnosis of pre-eclampsia between using K4 or K5 for diastolic BP (RR 1.16; 95% CI 0.89 to 1.49; 1 study; 220 women; low-certainty evidence), since the wide 95% CI includes the possibility of more diagnoses with K4. We are uncertain if there is a difference in perinatal mortality between the groups because the quality of evidence is low and the 95% CI is consistent with appreciable harm and appreciable benefit (RR 1.14, 95% CI 0.16 to 7.92; 1 study, 220 women; low-certainty evidence). The trial did not report data on maternal admission to intensive care, induction of labour, stillbirth, neonatal death, preterm birth, or neonatal unit admissions. Technique of BP measurement: CRADLE intervention (CRADLE device, a semi-automated BP monitor with additional features, and an education package) versus usual care (one study, 536,233 deliveries) There may be little to no difference between the use of the CRADLE device and usual care in the number of maternal deaths (adjusted RR 0.80, 95% CI 0.30 to 2.11; 536,233 women; 1 study; low-certainty evidence), but the 95% CI is consistent with appreciable harm and appreciable benefit. The trial did not report pre-eclampsia, induction of labour, perinatal mortality, preterm birth, or neonatal unit admissions. Maternal admission to intensive care and perinatal outcomes (stillbirths and neonatal deaths) were only collected for a small proportion of the women, identified by an outcome not by baseline characteristics, thereby breaking the random allocation. Therefore, any differences between the groups could not be attributed to the intervention, and we did not extract data for these outcomes. AUTHORS' CONCLUSIONS: The benefit, if any, of self-monitoring BP in hypertensive pregnancies remains uncertain, as the evidence is limited to one feasibility study. Current practice of using K5 to measure diastolic BP is supported for women with pregnancy hypertension. The benefit, if any, of using the CRADLE device to measure BP in pregnancy remains uncertain, due to the limitations and instability of the trial study design.


Assuntos
Determinação da Pressão Arterial/métodos , Complicações Cardiovasculares na Gravidez/diagnóstico , Monitorização Ambulatorial da Pressão Arterial/métodos , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Autocuidado/métodos
4.
PLoS One ; 15(8): e0237061, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790718

RESUMO

Stepped-care (SC) models for anxiety disorders are implemented on a large scale and are assumed to be as effective for the greater majority of patients as more intensive treatment schemes. To compare the outcomes of SC and international guideline-based treatment (Treatment as Usual: TAU) for panic disorder, a total of 128 patients were randomized to either SC or TAU (ratio 2: 1, respectively) using a computer generated algorithm. They were treated in four mental health care centres in the Netherlands after therapists had been trained in SC by a senior expert therapist. SC comprised 10-week guided self-help (pen-and-paper version) followed, if indicated, by 13-week manualized face-to-face cognitive behavioural therapy (CBT), with medication- if prescribed- kept constant. TAU consisted of 23-week regular face-to-face CBT (RCBT) with medication -when prescribed- also kept constant. The means of the attended sessions in the SC condition was 5.9 (SD = 4.8) for ITT and 9.6 (SD = 9.6) for the RCBT condition. The difference in the number of attended sessions between the conditions was significant (t(126) = -3.87, p < .001). Remission rates between treatment conditions did not differ significantly (SC: 44.5%; RCBT: 53.3%) and symptom reduction was similar. Stepping up SC treatment to face-to-face CBT showed a minimal additional effect. Importantly, drop-out rates differed significantly for the two conditions (SC: 48.2%; RCBT: 26.7%). SC was effective in the treatment of panic disorder in terms of symptom reduction and remission rate, but dropout rates were twice as high as those seen in RCBT, with the second phase of SC not substantially improving treatment response. However, SC required significantly less therapist contact time compared to RCBT, and more research is needed to explore predictors of success for guided self-help interventions to allow treatment intensity to be tailored to patients' needs and preferences.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno de Pânico/terapia , Autocuidado/métodos , Adulto , Agorafobia/complicações , Agorafobia/tratamento farmacológico , Agorafobia/terapia , Ansiolíticos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Avaliação de Resultados em Cuidados de Saúde , Transtorno de Pânico/complicações , Transtorno de Pânico/tratamento farmacológico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
5.
PLoS One ; 15(8): e0236141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764751

RESUMO

BACKGROUND: Novel interventions are needed to reach young people and adult men with HIV services given the low HIV testing rates in these population sub-groups. We assessed the feasibility and acceptability of a peer-led oral HIV self-testing (HIVST) intervention in Kasensero, a hyperendemic fishing community (HIV prevalence: 37-41%) in Rakai, Uganda. METHODS: This study was conducted among young people (15-24 years) and adult men (25+ years) between May and August 2019. The study entailed distribution of HIVST kits by trained "peer-leaders," who were selected from existing social networks and trained in HIVST distribution processes. Peer-leaders received up to 10 kits to distribute to eligible social network members (i.e. aged 15-24 years if young people or 25+ years if adult man, not tested in the past 3 months, and HIV-negative or of unknown HIV status at enrolment). The intervention was evaluated against the feasibility benchmark of 70% of peer-leaders distributing up to 70% of the kits that they received; and the acceptability benchmark of >80% of the respondents self-testing for HIV. RESULTS: Of 298 enrolled into the study at baseline, 56.4% (n = 168) were young people (15-24 years) and 43.6% (n = 130) were adult males (25+ years). Peer-leaders received 298 kits and distributed 296 (99.3%) kits to their social network members. Of the 282 interviewed at follow-up, 98.2% (n = 277) reported that they used the HIVST kits. HIV prevalence was 7.4% (n = 21). Of the 57.1% (n = 12) first-time HIV-positives, 100% sought confirmatory HIV testing and nine of the ten (90%) respondents who were confirmed as HIV-positive were linked to HIV care within 1 week of HIV diagnosis. CONCLUSION: Our findings show that a social network-based, peer-led HIVST intervention in a hyperendemic fishing community is highly feasible and acceptable, and achieves high linkage to HIV care among newly diagnosed HIV-positive individuals.


Assuntos
Autoavaliação Diagnóstica , Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Infuência dos Pares , Autocuidado/psicologia , Adolescente , Adulto , Doenças Endêmicas , Estudos de Viabilidade , Seguimentos , Anticorpos Anti-HIV/isolamento & purificação , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Liderança , Masculino , Masculinidade , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Mucosa Bucal/imunologia , Projetos Piloto , Prevalência , Kit de Reagentes para Diagnóstico , População Rural/estatística & dados numéricos , Autocuidado/instrumentação , Autocuidado/métodos , Uganda/epidemiologia , Adulto Jovem
6.
PLoS One ; 15(8): e0237585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790752

RESUMO

INTRODUCTION: Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation. METHODS: This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool. RESULTS: Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings. CONCLUSION: This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.


Assuntos
Análise Custo-Benefício , Implementação de Plano de Saúde , Organização para a Cooperação e Desenvolvimento Econômico/organização & administração , Autocuidado/economia , Autocuidado/métodos , Telemedicina/economia , Telemedicina/legislação & jurisprudência , Doença Crônica , Gerenciamento Clínico , Humanos
7.
Am J Pharm Educ ; 84(6): ajpe8156, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32665727

RESUMO

This commentary examines the challenges pharmacy faculty members have faced while working to fulfill their school's tripartite mission of teaching, research, and service during the coronavirus identified in 2019 (COVID-19) pandemic. It also outlines considerations that need to be made before moving forward regarding communication, collaboration, and culture. The pandemic has created opportunities for pharmacy educators to take instructional risks and attempt new didactic and experiential teaching methods and assessment strategies. Working remotely has not only altered pharmacy education, but also scholarship and service. Conducting a broad range of collaborations with accelerated timelines to address COVID-19 has in some instances forged new relationships both between and within universities and focused faculty members on grantsmanship and writing. Faculty governance and administrative leadership have been focused on solving challenges resulting from the COVID-19 pandemic in a collaborative, transparent approach guided by faculty bylaws. Programs have found ways to use these changes to their advantage while advancing the mission of the Academy, which can contribute to changing the culture of how we interact and care about each other with the hope that the positive changes made have an enduring and meaningful impact for years to come.


Assuntos
Comportamento Cooperativo , Infecções por Coronavirus/epidemiologia , Educação em Farmácia/organização & administração , Docentes de Farmácia/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Comunicação , Educação a Distância/organização & administração , Empatia , Docentes de Farmácia/psicologia , Humanos , Liderança , Cultura Organizacional , Pandemias , Autocuidado/métodos
8.
JMIR Mhealth Uhealth ; 8(9): e19796, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32609622

RESUMO

BACKGROUND: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes. OBJECTIVE: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps' assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes. METHODS: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities. RESULTS: Of the 223 COVID-19-related mobile apps, only 30 (19.9%) found in the App Store and 28 (44.4%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function. CONCLUSIONS: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Aplicativos Móveis/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Educação em Saúde/métodos , Humanos , Autocuidado/métodos , Estados Unidos/epidemiologia
9.
Diabetes Res Clin Pract ; 166: 108314, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32653506

RESUMO

AIMS: Diabetes self-care outcomes are positively impacted by social support. Understanding the mechanisms involved can inform more effective interventions. This study tested potential cross-sectional mediation of social support through self-efficacy and diabetes distress for self-care and clinical outcomes (diet, physical activity, blood glucose monitoring, HbA1c). METHOD: We analysed a sub-sample of the Australian Diabetes MILES-2 cross-sectional online survey (N = 1727). Measures were: Diabetes Social Support Scale, Confidence in Diabetes Self-care Scale, Problem Areas In Diabetes scale, diet and physical activity subscales of the Summary of Diabetes Self-Care Activities, and self-reported HbA1c. Separate mediation path models were tested for each of the four self-care/clinical outcomes in groups with type 1 and type 2 (insulin- and non-insulin-treated) diabetes. RESULTS: Social support was associated with more optimal self-care and self-reported HbA1c outcomes. When diabetes-specific self-efficacy and distress were included as mediators, the direct path from social support became non-significant. Conversely, the indirect effects of social support through diabetes-specific self-efficacy and distress were significant across all diabetes groups and outcomes. CONCLUSION: Diabetes-specific self-efficacy and distress may be important mechanisms linking social support with diabetes self-care and clinical outcomes. Social support interventions could explore whether improving diabetes self-efficacy and decreasing diabetes distress could help improve self-care.


Assuntos
Diabetes Mellitus Tipo 2/psicologia , Autocuidado/métodos , Autoeficácia , Apoio Social , Adolescente , Adulto , Idoso , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
Pain Res Manag ; 2020: 5602683, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566061

RESUMO

Background: Hip fractures of elderly patients are a public health problem worldwide, mostly lying in bed for a long time; therefore, the importance of life quality in such patients is an issue beyond question. Orem's self-care model is a nursing pattern which is introduced with the purpose of improving the self-care ability of individuals, especially the patients suffering from diseases with limits on activity. Objective: The aim of this study was to determine the effects of Orem's self-care program on life quality of senile patients with hip fractures. Methods: A randomized clinical trial study was conducted on 130 eligible old patients suffering from hip fractures who were selected using easy sampling methods and allocated randomly into two groups of experiment and control. The data were collected through validated questionnaires including visual analogue scale (VAS) and Barthel index for them. The experiment group was treated according to Orem's self-care model, and the control group was treated on the basis of the traditional care model. The data of complications including pneumonia, deep venous thrombosis, urinary infection, wound problem, and bedsore were also gathered. Results: As revealed, mean scores of VAS and Barthel index one week after operation in the experiment group were significantly different from the control one (P < 0.05, P ≤ 0.001). The changes of VAS and Barthel index six weeks postoperatively of the two groups were also statistically significant (P < 0.05, P ≤ 0.001). Compared with the control group, the difference of complications reduced significantly in the experiment group (P < 0.05). Accordingly, educational intervention according to Orem's self-care model seemed to be effective in promoting self-care ability for these senile patients. Conclusions: According to the obtained results, a self-care program based on Orem's model for elderly patients with hip fractures can improve life quality and reduce perioperative complications significantly. Therefore, it is recommended that this nursing program should be taken into account as a part of treatment measures for these patients.


Assuntos
Fraturas do Quadril/enfermagem , Fraturas do Quadril/psicologia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Autocuidado/métodos , Idoso , Feminino , Humanos , Inquéritos e Questionários
12.
Gerokomos (Madr., Ed. impr.) ; 31(2): 98-106, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193891

RESUMO

OBJETIVO: Determinar la prevalencia hospitalaria de lesiones relacionadas con la dependencia (LRD) en la provincia de Burgos. Determinar las características de las LRD. Identificar las valoraciones del riesgo de padecer lesión por presión (LPP) y el uso de dispositivos de prevención de LPP. Cuantificar los registros de enfermería de LRD. METODOLOGÍA: Estudio observacional, descriptivo, transversal y multicéntrico, realizado mediante observación directa y revisión de la historia clínica de adultos ingresados en unidades de hospitalización. Realizado en tres hospitales de Burgos en 2018. RESULTADOS: La población sumó 511 pacientes; presentaron LRD: 188. Se detectaron 328 LRD: 176 (53,65%) LPP, 48 (14,63%) lesiones por humedad, 81 (24,69%) lesiones por fricción, 11 (3,35%) lesiones combinadas y 12 (3,65%) lesiones multicausales. Las LPP de categoría 1 fueron las más numerosas, sumando un 35,36%. El 78,96% de las LRD se consideraron adquiridas en el hospital. La prevalencia de LRD es del 36,79%. Las prevalencias por tipos de LRD son: LPP 20,93%, lesiones por humedad 9%, fricción 12,72%, combinadas 1,76% y multicausales 1,56%. El 35,61% de los pacientes presentaba algún tipo de dispositivo preventivo; el 60,07% presentaba valoración del riesgo de padecer LPP; el 30,31% presentaba registro de la lesión, y el 18,37% contaba con plan de cuidados específico. CONCLUSIONES: La prevalencia e LRD, obtenida por inspección directa, cuadruplica los resultados nacionales, pero parece reflejar con mayor exactitud la realidad que los datos obtenidos mediante los registros de enfermería. Es aconsejable universalizar la valoración del riesgo de padecer LPP a todos los pacientes, la mejora de los registros de enfermería y reforzar los esfuerzos preventivos


AIM: To determine the hospital prevalence of dependence-related lesions (DRL) in the province of Burgos. Determine the characteristics of the DRL. Identify the risk assessments of pressure ulcer (PU) and the use of PU prevention devices. Quantify the DRL nursing records. METHODOLOGY: Observational, descriptive, cross-sectional and multicenter study, performed through direct observation and review of the health record of adults admitted to hospitalization units. RESULTS: The population totaled 511 patients, of wich 188 presented DRL. 328 DRL were detected: 176 (53.65%) PU, 48 (14.63%) moisture lesions, 81 (24,69%) friction lesions, 11 (3.35%) combined lesions, and 12 (3.65%) multifactorial lesions. The most numerous was PU category 1 totaling 35.36%. 78.96% of the DRL were determined to be hospital acquired. The prevalence of DRL is 36.79%. The prevalences for DRL types are: PU 20.93%, moisture lesions 9%, friction 12.72%, combined 1.76% and multifactorial 1.56%. 35.61% of patients had some type of preventive device, 60.07% had a risk assessment for PU, 30.31% had a record of the lesion and 18.37% had a specific care plan. CONCLUSIONS: The prevalence of DRL, obtained by direct inspection, quadruples national results, but it seems to be more accurate than the data obtained through nursing records. It is advisable to universalize the assessment of the risk of suffering PU to all patients, to improve nursing records and to reinforce preventive efforts


Assuntos
Humanos , Masculino , Feminino , Idoso , Lesão por Pressão/complicações , Úlcera Cutânea/classificação , Úlcera Cutânea/prevenção & controle , Segurança do Paciente , Registros de Enfermagem/normas , Enfermagem Geriátrica , Autocuidado/métodos , Autocuidado/normas , Enfermagem Geriátrica/métodos
13.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194058

RESUMO

BACKGROUND: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction. OBJECTIVE: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes. METHODS: During an 'intervention phase' spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received 'usual care' provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p < 0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p < 0.05. Participants' satisfaction with the intervention was also assessed. RESULTS: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p = 0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p = 0.064), 3 months (r=-0.123, p = 0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention 'beneficial' and suggested it be used long term. CONCLUSIONS: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients' health literacy or numeracy


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus/prevenção & controle , Educação de Pacientes como Assunto , Mídias Sociais , Autocuidado/métodos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Satisfação Pessoal , Hemoglobina A/administração & dosagem , Projetos de Pesquisa , Análise de Dados
14.
J Zhejiang Univ Sci B ; 21(5): 400-404, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-336925

RESUMO

Public health crises, such as the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since Dec. 2019, are widely acknowledged as severe traumatic events that impose threats not only because of physical concerns but also because of the psychological distress of infected patients. We designed an internet-based integrated intervention and evaluated its efficacy on depression and anxiety symptoms in patients infected by SARS-CoV-2.


Assuntos
Ansiedade/terapia , Infecções por Coronavirus/psicologia , Depressão/terapia , Internet , Pneumonia Viral/psicologia , Autocuidado/métodos , Adulto , Betacoronavirus , Telefone Celular , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Plena , Pandemias , Estudos Prospectivos , Angústia Psicológica , Terapia de Relaxamento
15.
Med J Aust ; 212(11): 514-519, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32391611

RESUMO

OBJECTIVES: To investigate the quality of diagnostic and triage advice provided by free website and mobile application symptom checkers (SCs) accessible in Australia. DESIGN: 36 SCs providing medical diagnosis or triage advice were tested with 48 medical condition vignettes (1170 diagnosis vignette tests, 688 triage vignette tests). MAIN OUTCOME MEASURES: Correct diagnosis advice (provided in first, the top three or top ten diagnosis results); correct triage advice (appropriate triage category recommended). RESULTS: The 27 diagnostic SCs listed the correct diagnosis first in 421 of 1170 SC vignette tests (36%; 95% CI, 31-42%), among the top three results in 606 tests (52%; 95% CI, 47-59%), and among the top ten results in 681 tests (58%; 95% CI, 53-65%). SCs using artificial intelligence algorithms listed the correct diagnosis first in 46% of tests (95% CI, 40-57%), compared with 32% (95% CI, 26-38%) for other SCs. The mean rate of first correct results for individual SCs ranged between 12% and 61%. The 19 triage SCs provided correct advice for 338 of 688 vignette tests (49%; 95% CI, 44-54%). Appropriate triage advice was more frequent for emergency care (63%; 95% CI, 52-71%) and urgent care vignette tests (56%; 95% CI, 52-75%) than for non-urgent care (30%; 95% CI, 11-39%) and self-care tests (40%; 95% CI, 26-49%). CONCLUSION: The quality of diagnostic advice varied between SCs, and triage advice was generally risk-averse, often recommending more urgent care than appropriate.


Assuntos
Aplicativos Móveis/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Autocuidado/normas , Avaliação de Sintomas/normas , Triagem/normas , Algoritmos , Inteligência Artificial , Austrália , Humanos , Autocuidado/métodos , Avaliação de Sintomas/métodos , Triagem/métodos
16.
PLoS One ; 15(5): e0233606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442226

RESUMO

HIV self-testing (HIVST), which allows people to test in private, is an innovative testing strategy that has been shown to increase HIV testing among men. Delivering HIVST kits to men via women is one promising assisted partner service strategy. Little research has been conducted on HIVST secondary distribution to men by women living with HIV (WLWH) in the Caribbean and other settings. The purpose of this study was to assess the perspectives of WLWH, their male partners, and healthcare professionals on the perceived advantages and disadvantages of HIVST, and recommendations for implementing HIVST in Haiti, with a focus on secondary distribution of HIVST to men by WLWH. Sixteen key informant interviews and nine focus groups with 44 healthcare workers, 31 Option B+ clients, and 13 men were carried out in Haiti. Key informants were representatives of the Ministry of Health and of a non-governmental agency involved in HIV partner services. Focus group members included program leads and staff members from the HIV care and treatment program, the Option B+ program, the community health service program, and the HIV counseling and testing services from 2 hospitals. Perceived HIVST advantage included an increase in the number of people who would learn their HIV status and start treatment. The perceived disadvantages were lack of support to ensure self-testers initiate treatment, uncertainty about male partner's reaction, risk of violence towards women delivering HIVST kits after receiving an HIVST kit from a woman, and the inability of women to counsel a man in case his self-test result is positive. Recommendations for integrating HIVST and secondary distribution of HIVST by WLWH included coupling HIVST distribution with public information, education, and communication through media and social marketing, relying on community health workers to mediate use of HIVST and ensure linkage to care, piloting HIVST programs on a small scale. HIVST is an appropriate and feasible strategy HIV prevention for men and women; however, more research is needed on how best to implement different strategies for this approach in the Caribbean.


Assuntos
Autoavaliação Diagnóstica , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Autocuidado/métodos , Adulto , Atitude , Feminino , Grupos Focais , HIV-1 , Haiti , Pessoal de Saúde , Humanos , Masculino , Pesquisa Qualitativa , Kit de Reagentes para Diagnóstico
18.
J Zhejiang Univ Sci B ; 21(5): 400-404, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32425006

RESUMO

Public health crises, such as the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since Dec. 2019, are widely acknowledged as severe traumatic events that impose threats not only because of physical concerns but also because of the psychological distress of infected patients. We designed an internet-based integrated intervention and evaluated its efficacy on depression and anxiety symptoms in patients infected by SARS-CoV-2.


Assuntos
Ansiedade/terapia , Infecções por Coronavirus/psicologia , Depressão/terapia , Internet , Pneumonia Viral/psicologia , Autocuidado/métodos , Adulto , Betacoronavirus , Telefone Celular , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Plena , Pandemias , Estudos Prospectivos , Angústia Psicológica , Terapia de Relaxamento
19.
Rev Med Suisse ; 16(694): 1026-1033, 2020 May 20.
Artigo em Francês | MEDLINE | ID: mdl-32432419

RESUMO

Today, there are more and more self-test kits available on the high street. With a few exceptions (HIV, FIT), it is currently unclear whether they are effective, neither beneficial for the consumer, nor useful for the Swiss healthcare system. Is there a favorable impact for the health system? This article tries to help doctors find their way among the many self-test available, providing them a reading grid and recommendations for their patients.


Assuntos
Atitude do Pessoal de Saúde , Testes Diagnósticos de Rotina/normas , Médicos , Autocuidado/métodos , Humanos , Autocuidado/normas , Suíça
20.
Medicine (Baltimore) ; 99(19): e20149, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384502

RESUMO

INTRODUCTION: Chemotherapy-induced peripheral neuropathy (CIPN) is a worldwide concern in patients receiving neurotoxic agents for cancer therapy. High tone external muscle stimulation is a promising therapeutic approach to alleviate symptoms of CIPN. METHODS: This pilot study aims to investigate whether the application of home-based high-tone external muscle stimulation therapy (HTEMS) improves symptoms of CIPN. The trial is planned as a therapist- and assessor-blinded, 1:1 randomized controlled study. A total of 50 patients with chemotherapy-induced peripheral polyneuropathy will be included. All patients will perform therapy at home. Study participants will be allocated randomly to the HTEMS therapy (intervention group) or to the transcutaneous electrical nerve stimulation (TENS, control group), respectively, following a standardized therapy schedule. Compliance of participants can be verified by reading out the tool box. Outcomes will be evaluated at baseline and after 8 weeks of home-based therapy. The primary outcome includes improvement of CIPN according to the patient-reported EORTC QLQ-CIPN 20 questionnaire. Secondary outcomes are the patient-reported change in health-related quality of life and clinician-reported changes of vibration sensibility, tendon reflexes, temperature sensibility, perception of touch, and strength of the lower leg muscles. Further a safety- and process evaluation will be performed. DISCUSSION: This pilot RCT aims to evaluate the impact of home-based HTEMS as compared to TENS in CIPN. There is a need for an effective treatment for CIPN and the results of this study are expected to possibly identify a novel and effective treatment strategy in the future.


Assuntos
Antineoplásicos/efeitos adversos , Polineuropatias/induzido quimicamente , Polineuropatias/terapia , Autocuidado/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Pesos e Medidas Corporais , Fumar Cigarros/epidemiologia , Método Duplo-Cego , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Cooperação do Paciente , Projetos Piloto , Qualidade de Vida , Reflexo de Estiramento , Projetos de Pesquisa , Índice de Gravidade de Doença , Fatores Sexuais , Sensação Térmica , Tato , Adulto Jovem
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