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1.
Medicine (Baltimore) ; 100(2): e23972, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466136

RESUMO

BACKGROUND: The purpose of this experiment is to evaluate the impact of the care of Parkinson disease nurse specialist on improving motor symptoms and life quality for patients with Parkinson disease (PD). METHOD: This is a randomized controlled research, and it will be conducted from April 2021 to October 2021 at Sichuan Provincial People's Hospital. The experiment was granted through the Research Ethics Committee of Sichuan Provincial People's Hospital (004510293). All the patients suffer from PD, age 18 years or older, both female and male, regardless of the duration or severity of this disease are eligible. The exclusion criteria contains: lack sufficient knowledge to complete questionnaires, serious physical comorbidities or refuse to take part in the program. In our experiment, the major result measures are motor symptoms and life quality. For the measurement of life quality, we will utilize Parkinson disease Questionnaire-39, the most extensively utilized the scale of life quality in PD. The evaluation of motor symptoms severity is carried out with the revision of Unified Parkinson Disease Rating Scale sponsored by Movement Disorder Society. RESULTS: Table 1 indicates clinical outcomes at different time points. CONCLUSION: The Parkinson's disease nurse specialist care may promote the life quality in the PD patients. TRIAL REGISTRATION NUMBER: researchregistry 6284.


Assuntos
Doença de Parkinson/enfermagem , Doença de Parkinson/psicologia , Qualidade de Vida/psicologia , Humanos , Planejamento de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/organização & administração , Autogestão/métodos , Índice de Gravidade de Doença
2.
Support Care Cancer ; 29(1): 67-78, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32747989

RESUMO

PURPOSE: Despite wide acknowledgement of differences in levels of support and health outcomes between urban and rural areas, there is a lack of research that explicitly examines these differences in relation to self-management in people affected by cancer following treatment. This scoping review aimed to map the existing literature that examines self-management in people affected by cancer who were post-treatment from rural and urban areas. METHODS: Arksey and O'Malley's framework for conducting a scoping review was utilised. Keyword searches were performed in the following: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. Supplementary searching activities were also conducted. RESULTS: A total of 438 articles were initially retrieved and 249 duplicates removed leaving 192 articles that were screened by title, abstract and full text. Nine met the eligibility criteria and were included in the review. They were published from 2011 to 2018 and conducted in the USA (n = 6), Australia (n = 2) and Canada (n = 1). None of the studies offered insight into self-managing cancer within a rural-urban context in the UK. Studies used qualitative (n = 4), mixed methods (n = 4) and quantitative designs (n = 1). CONCLUSION: If rural and urban populations define their health in different ways as some of the extant literature suggests, then efforts to support self-management in both populations will need to be better informed by robust evidence given the increasing focus on patient-centred care. It is important to consider if residency can be a predictor of as well as a barrier or facilitator to self-management.


Assuntos
Assistência à Saúde/métodos , Neoplasias/terapia , População Rural , Autocuidado/métodos , Autogestão/métodos , População Urbana , Austrália , Canadá , Humanos , Sobrevivência
3.
Epilepsy Behav ; 115: 107658, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33341393

RESUMO

The COVID-19 pandemic has caused global anguish unparalleled in recent times. As cases rise, increased pressure on health services, combined with severe disruption to people's everyday lives, can adversely affect individuals living with chronic illnesses, including people with epilepsy. Stressors related to disruption to healthcare, finances, mental well-being, relationships, schooling, physical activity, and increased isolation could increase seizures and impair epilepsy self-management. We aim to understand the impact that COVID-19 has had on the health and well-being of people with epilepsy focusing on exposure to increased risk of seizures, associated comorbidity, and mortality. We designed two online surveys with one addressing people with epilepsy directly and the second for caregivers to report on behalf of a person with epilepsy. The survey is ongoing and has yielded 463 UK-based responses by the end of September 2020. Forty percent of respondents reported health changes during the pandemic (n = 185). Respondents cited a change in seizures (19%, n = 88), mental health difficulties (34%, n = 161), and sleep disruption (26%, n = 121) as the main reasons. Thirteen percent found it difficult to take medication on time. A third had difficulty accessing medical services (n = 154), with 8% having had an appointment canceled (n = 39). Only a small proportion reported having had discussions about epilepsy-related risks, such as safety precautions (16%, n = 74); mental health (29%, n = 134); sleep (30%, n = 140); and Sudden Unexpected Death in Epilepsy (SUDEP; 15%, n = 69) in the previous 12 months. These findings suggest that people with epilepsy are currently experiencing health changes, coupled with inadequate access to services. Also, there seems to be a history of poor risk communication in the months preceding the pandemic. As the UK witnesses a second COVID-19 wave, those involved in healthcare delivery must ensure optimal care is provided for people with chronic conditions, such as epilepsy, to ensure that avoidable morbidity and mortality is prevented during the pandemic, and beyond.


Assuntos
/epidemiologia , Assistência à Saúde/normas , Epilepsia/epidemiologia , Pandemias , Inquéritos e Questionários , Adolescente , Adulto , Cuidadores/normas , Assistência à Saúde/métodos , Epilepsia/terapia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Projetos Piloto , Fatores de Risco , Autogestão/métodos , Morte Súbita Inesperada na Epilepsia/epidemiologia , Morte Súbita Inesperada na Epilepsia/prevenção & controle , Reino Unido/epidemiologia , Adulto Jovem
4.
Medicine (Baltimore) ; 99(51): e23867, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371172

RESUMO

OBJECTIVE: To explore the effect of modular transitional nursing intervention on the improvement of self-management of the patients with cancer pain. METHOD: This study will be conducted from March 2021 to May 2022 at Affiliated Hospital of Beihua University. The experiment was granted through the Research Ethics Committee of Affiliated Hospital of Beihua University (4348-019). Eighty patients are analyzed in our study. The patients will be included if they are between 18 and 70 years old and are diagnosed with cancer, the pain intensity score on moderate level, the pain lasts for more than 3 days, and the patients who have signed the written informed consent. While the patients will be excluded if they have a documented history of drug or alcohol abuse, and patients with limited performance, and patients have a surgery in the past 3 days. The primary result mainly expresses as intergroup differences in self-management disorders (Barriers Questionnaire-II) associated with the cancer pain. And the secondary results include the quality of life (QOL) and pain intensity. All the analyses are implemented with SPSS for Windows Version 20.0. RESULTS: Table 1 will show the clinical outcomes between the 2 groups. CONCLUSION: A modular transitional nursing intervention appears to reduce pain in cancer patients. TRIAL REGISTRATION NUMBER: researchregistry6262.


Assuntos
Neoplasias/enfermagem , Cuidados de Enfermagem/normas , Manejo da Dor/normas , Autogestão/psicologia , Protocolos Clínicos , Humanos , Neoplasias/psicologia , Cuidados de Enfermagem/métodos , Manejo da Dor/métodos , Manejo da Dor/psicologia , Autogestão/métodos , Resultado do Tratamento
5.
JAMA Netw Open ; 3(12): e2029245, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337493

RESUMO

Importance: Increasing evidence indicates that people are attempting their own abortions outside the formal health care system. However, population-based estimates of experience with self-managed abortion (SMA) are lacking. Objective: To estimate the prevalence of SMA attempts among the general US population. Design, Setting, and Participants: This cross-sectional survey study was fielded August 2 to 17, 2017 among English- and Spanish- speaking, self-identified female panel members from the GfK web-based KnowledgePanel. Women ages 18 to 49 years were approached to complete a 1-time survey. Data were analyzed from September 22, 2017, to March 26, 2020. Main Outcomes and Measures: SMA was defined as "some women may do something on their own to try to end a pregnancy without medical assistance. For example, they may get information from the internet, a friend, or family member about pills, medicine, or herbs they can take on their own, or they may do something else to try to end the pregnancy." SMA was assessed using the question, "Have you ever taken or used something on your own, without medical assistance, to try to end an unwanted pregnancy?" Participants reporting SMA were asked about methods used, reasons, and outcomes. Factors associated with SMA experience, including age, race/ethnicity, socioeconomic status, nativity, reproductive health history, and geography, were assessed. Projected lifetime SMA prevalence was estimated using discrete-time event history models, adjusting for abortion underreporting. Results: Among 14 151 participants invited to participate, 7022 women (49.6%) (mean [SE] age, 33.9 [9.0] years) agreed to participate. Among these, 57.4% (95% CI, 55.8%-59.0%) were non-Hispanic White, 20.2% (95% CI, 18.9%-21.5%) were Hispanic, and 13.3% (95% CI, 12.1%-14.5%) were non-Hispanic Black; and 15.1% (95% CI, 14.1%-16.3%) reported living at less than 100% federal poverty level (FPL). A total of 1.4% (95% CI, 1.0%-1.8%) of participants reported a history of attempting SMA while in the US. Projected lifetime prevalence of SMA adjusting for underreporting of abortion was 7.0% (95% CI, 5.5%-8.4%). In bivariable analyses, non-Hispanic Black (prevalence ratio [PR], 3.16; 95% CI, 1.48-6.75) and Hispanic women surveyed in English (PR, 3.74; 95% CI, 1.78-7.87) were more likely than non-Hispanic White women to have attempted SMA. Women living below 100% of the FPL were also more likely to have attempted SMA compared with those at 200% FPL or greater (PR, 3.43; 95% CI, 1.83-6.42). At most recent SMA attempt, 20.0% (95% CI, 10.9%-33.8%) of respondents used misoprostol, 29.2% (95% CI, 17.5%-44.5%) used another medication or drug, 38.4% (95% CI, 25.3%-53.4%) used herbs, and 19.8% (95% CI, 10.0%-35.5%) used physical methods. The most common reasons for SMA included that it seemed faster or easier (47.2% [95% CI, 33.0%-61.8%]) and the clinic was too expensive (25.2% [95% CI, 15.7%-37.7%]). Of all attempts, 27.8% (95% CI, 16.6%-42.7%) of respondents reported they were successful; the remainder reported they had subsequent facility-based abortions (33.6% [95% CI, 21.0%-49.0%]), continued the pregnancy (13.4% [95% CI, 7.4%-23.1%]), had a miscarriage (11.4% [95% CI, 4.2%-27.5%]), or were unsure (13.3% [95% CI, 6.8%-24.7%]). A total of 11.0% (95% CI, 5.5%-21.0%) of respondents reported a complication. Conclusions and Relevance: This cross-sectional study found that approximately 7% of US women reported having attempted SMA in their lifetime, commonly with ineffective methods. These findings suggest that surveys of SMA experience among patients at abortion clinics may capture only one-third of SMA attempts. People's reasons for attempting SMA indicate that as abortion becomes more restricted, SMA may become more common.


Assuntos
Aborto Induzido , Gravidez não Desejada/psicologia , Autogestão , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Adulto , Estudos Transversais , Tomada de Decisões , Grupos Étnicos , Feminino , Humanos , Gravidez , Prevalência , História Reprodutiva , Autogestão/métodos , Autogestão/psicologia , Autogestão/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos/epidemiologia
6.
Medicine (Baltimore) ; 99(44): e22862, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126330

RESUMO

The aim of this study was to assess the levels of self-perceived burden (SPB) and self-management behavior in elderly stroke survivors during the first 3 months after acute stroke, and to explore the correlation between them.A total of 203 consecutive hospitalized elderly patients diagnosed with stroke were recruited. Self-perceived Burden Scale and Stroke Self-management Scale in 1 month (T1) and 3 months (T2) post-stroke were assessed and compared.The score of SPB in elderly stroke survivors was 28.96 ±â€Š5.50 and 27.25 ±â€Š6.17 at T1 and T2, respectively. Stroke self-management scale scored 165.93 ±â€Š9.82 at T1 and 167.29 ±â€Š10.60 at T2. In the first 3 months post-stroke, the physical burden was dominant (T1 14.73 ±â€Š3.07, T2 14.40 ±â€Š3.13), and the behavior of stroke symptoms and signs monitoring (T1 27.58 ±â€Š6.56, T2 28.64 ±â€Š6.43) and rehabilitation exercise management (T1 21.40 ±â€Š3.28, T2 20.74 ±â€Š3.15) was the worst. SPB was negatively correlated with self-management behavior (T1 r = -.202, T2 r = -.511).Elderly stroke survivors experienced a medium level of SPB and self-management behavior in the first 3 months post-stroke. There is a positive relationship between reduced SPB and improved self-management behavior. Addressing the characteristics and correlations as well as development of targeted interventions for SPB decreasing is beneficial to improving self-management behavior for elderly survivors.


Assuntos
Efeitos Psicossociais da Doença , Autoimagem , Autogestão/psicologia , Reabilitação do Acidente Vascular Cerebral/psicologia , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Autogestão/métodos , Autogestão/estatística & dados numéricos , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos
8.
Can Fam Physician ; 66(10): 745-747, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33077454
9.
J Diabetes Sci Technol ; 14(6): 1107-1110, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33050727

RESUMO

With the recent pivot to telehealth as a direct result of the COVID-19 pandemic, there is an imperative to ensure that access to affordable devices and technologies with remote monitoring capabilities for people with diabetes becomes equitable. In addition, expanding the use of remote Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy (MNT) services will require new strategies for achieving long-term, effective, continuous, data-driven care. The current COVID-19 pandemic has especially impacted underserved US communities that were already disproportionately impacted by diabetes. Historically, these same communities have faced barriers in accessing timely and effective diabetes care including access to DSMES and MNT services, and diabetes technologies. Our call to action encourages all involved to urge US Federal representatives to widen access to the array of technologies necessary for successful telehealth-delivered care beyond COVID-19.


Assuntos
Computação em Nuvem/tendências , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Assistência de Saúde Universal , Infecções por Coronavirus/terapia , Democracia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Diabetes Mellitus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/tendências , Humanos , Invenções/tendências , Área Carente de Assistência Médica , Pandemias , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/tendências , Pneumonia Viral/terapia , Autogestão/métodos , Autogestão/tendências , Telemedicina/métodos , Telemedicina/organização & administração
10.
Eur J Endocrinol ; 183(6): 551-559, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33055299

RESUMO

Introduction: The low prevalence of pituitary diseases makes patient autonomy crucial, and self-management programs should be more common. Objectives: To assess the efficacy of an education program for patients with pituitary diseases in terms of patients' quality of life, satisfaction and goal attainment. Design and methods: Adult patients with pituitary disorders were recruited in a tertiary referral center and chose at least three of eight possible sessions on various topics, from disease management to psychosocial issues. Patients were included if they attended at least three sessions between 2012 and 2016 and completed the initial, final, and follow-up questionnaires. Data on quality of life (SF36), satisfaction and goal attainment were analyzed. Results: Fifty-three patients were included (33 women; mean age, 53.5 years). There were a significant quality of life improvements in terms of physical and psychic limitation scores at the final assessment that persisted at follow-up evaluation. Most patients reached their objectives, especially those on sharing experiences and improving autonomy and self-confidence. More than half set new objectives at the end of the program, the most popular one being to reinforce their knowledge of their pituitary disease, its evolution and treatment (17.1% of patients). The mean overall satisfaction score was 3.75/4. At follow-up evaluation, patients reported improved self-management of pituitary disease (3.6/5) and improved self-efficacy (3.8/5). Conclusion: Individualizing the educational objectives of patients with pituitary disease improves the way they live with their disease. If confirmed in other cohorts, this approach could become the gold standard for education programs in rare endocrine diseases.


Assuntos
Educação de Pacientes como Assunto/normas , Doenças da Hipófise/psicologia , Doenças da Hipófise/terapia , Autogestão/psicologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Projetos Piloto , Doenças da Hipófise/diagnóstico , Qualidade de Vida/psicologia , Autogestão/métodos , Inquéritos e Questionários/normas
11.
Int J Chron Obstruct Pulmon Dis ; 15: 2127-2133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982205

RESUMO

Pulmonary rehabilitation (PR) is an important, evidence-based treatment that improves outcomes for people with COPD. Individualized exercise programmes aim to improve exercise capacity; self-management education and psychological support are also provided. Translating increased exercise capacity into sustained behavioural change of increased physical activity is difficult. Other unresolved problems with PR programmes include improving uptake, completion, response and sustaining long-term benefit. We offer a different perspective drawn from clinical experience of PR, quantitative and qualitative studies of singing groups for people with COPD, and stroke rehabilitation research that gives psychological factors a more central role in determining outcomes after PR. We discuss Take Charge; a simple but effective psychological intervention promoting self-management--that could be used as part of a PR programme or in situations where PR was declined or unavailable. This may be particularly relevant now when traditional face-to-face group programmes have been disrupted by COVID-19 precautions.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Pesquisa de Reabilitação , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Terapia por Exercício/métodos , Terapia por Exercício/organização & administração , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Sistemas de Apoio Psicossocial , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Projetos de Pesquisa , Autogestão/métodos , Autogestão/psicologia , Resultado do Tratamento
12.
J Pediatr Psychol ; 45(9): 977-982, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32929482

RESUMO

The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.


Assuntos
Betacoronavirus , Doença Crônica/terapia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Autogestão/estatística & dados numéricos , Telemedicina/métodos , Adolescente , Criança , Doença Crônica/psicologia , Infecções por Coronavirus/psicologia , Humanos , Aplicativos Móveis , Pneumonia Viral/psicologia , Autogestão/métodos
13.
BMJ Open ; 10(9): e040951, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32912958

RESUMO

OBJECTIVES: To assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19. DESIGN: Analysis of data (n=9515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1 and 8 April 2020. SETTING: Community. PARTICIPANTS: 9515 people with self-reported long-term respiratory conditions. 81% female, age ranges from ≤17 years to 80 years and above, from all nations of the UK. Long-term respiratory conditions reported included asthma (83%), chronic obstructive pulmonary disease (10%), bronchiectasis (4%), interstitial lung disease (2%) and 'other' (<1%) (eg, lung cancer and pulmonary endometriosis). OUTCOME MEASURES: Study responses related to impacts on key elements of healthcare, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures. RESULTS: 45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues and getting basic necessities such as food were also common. 36% did not use online prescriptions, and 54% had not accessed online inhaler technique videos. Psychosocial impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19. CONCLUSIONS: COVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group.


Assuntos
Infecções por Coronavirus , Exercício Físico , Pandemias , Pneumonia Viral , Saúde Pública , Doenças Respiratórias , Autogestão , Isolamento Social/psicologia , Adolescente , Adulto , Idoso de 80 Anos ou mais , Ansiedade/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Estudos Transversais , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Solidão/psicologia , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Saúde Pública/métodos , Saúde Pública/normas , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/fisiopatologia , Doenças Respiratórias/psicologia , Comportamento de Redução do Risco , Autogestão/métodos , Autogestão/psicologia , Autogestão/tendências , Reino Unido
14.
Transplantation ; 104(8): e224-e235, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732828

RESUMO

BACKGROUND: Lack of support for self-management may contribute to adverse health outcomes. eHealth has the potential to support self-management, but evidence in solid organ transplantation remains unclear. This review aims to evaluate the benefits and harms of eHealth interventions to support self-management in solid organ transplant recipients. METHODS: We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases for randomized trials of eHealth interventions in solid organ transplant recipients. We calculated the risk ratios or standardized mean difference of outcomes, and summary estimates were determined using random-effects models. The Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess trial quality. RESULTS: Twenty-one trials from 6 countries involving 2114 participants were included. Compared with standard care, eHealth interventions improved medication adherence (risk ratio, 1.34; CI, 1.12-2.56; I = 75%) and self-monitoring behavior (risk ratio, 2.58; CI, 1.56-4.27; I = 0%) up to 12 mo posttransplant. The treatment effects were largely consistent across different subgroups except for intervention functionality and mode of delivery. The effects on other outcomes were uncertain. Nine trials reported harms. The overall risk of bias was considered high or unclear, and the quality of evidence was low to very low for all outcomes. CONCLUSIONS: eHealth interventions may improve medication adherence and self-monitoring behavior in the short term, but high-quality intervention studies are needed to determine whether eHealth will improve long-term patient-relevant outcomes.


Assuntos
Rejeição de Enxerto/prevenção & controle , Transplante de Órgãos/efeitos adversos , Autogestão/métodos , Telemedicina/métodos , Transplantados , Rejeição de Enxerto/imunologia , Humanos , Imunossupressores/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistemas de Alerta , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(31): e20972, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756084

RESUMO

BACKGROUND: Home-based cardiac rehabilitation is considered as an alternative strategy of cardiac rehabilitation, aims to enhance patients participation rate. Since it emphasizes patients subjective initiative, patients require a better understanding of their illness and manage their conditions. We perform this systematic review and meta-analysis to identify the role and effectiveness of the self-management program in home-based cardiac rehabilitation. METHOD: We conduct the search strategy from an online database: PubMed, web of science, CINAL, EMBASE, OVID/Medline, and google scholar. Studies meet the inclusion criterion and published in the English language in recent 10 years will be screened by 2 independent reviewers. Then they extract data and assess the risk of bias. The disagreement between them will be resolved by the third reviewer. Data analysis is performed by Review Manager (Version 5.3). RESULT: This is systematic review and meta-analysis will identify the role of self-management in home-based cardiac rehabilitation program and evaluate its effectiveness. CONCLUSION: The findings of this study will be published in a related peer-reviewed journal.Protocol registration number: INPLASY202050093.


Assuntos
Reabilitação Cardíaca , Serviços de Assistência Domiciliar , Autogestão , Reabilitação Cardíaca/métodos , Humanos , Avaliação de Programas e Projetos de Saúde , Autogestão/métodos
16.
J Natl Black Nurses Assoc ; 31(1): 52-59, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853497

RESUMO

African-Americans with hypertension continue to demonstrate poor blood pressure (BP) control and have markedly lower rates of hypertension self-management compared to non-African-Americans. Innovative and practical solutions such as mHealth technology are promising and can be leveraged to promote self-management of hypertension. Substantial evidence has demonstrated the importance of community support in improving patients' management of chronic illnesses. Unfortunately, such programs do not offer technology-based interventions (TBI) as a delivery method. Thus, this paper describes the design and rationale of an ongoing pilot study that incorporates TBI using a community-based participatory approach.


Assuntos
Afro-Americanos , Hipertensão/etnologia , Hipertensão/terapia , Autogestão/métodos , Pesquisa Participativa Baseada na Comunidade , Disparidades nos Níveis de Saúde , Humanos , Projetos Piloto , Telemedicina
17.
Med Care ; 58 Suppl 2 9S: S88-S93, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826777

RESUMO

OBJECTIVES: Nonpharmacological options to treat pain are in demand, in part to address the opioid crisis. One such option is acupuncture. Battlefield acupuncture (BFA) is an auricular needling protocol currently used to treat pain in the Veterans Health Administration. We aimed to identify the advantages and disadvantages of BFA from providers' perspectives. METHODS: We rely on an inductive qualitative approach to explore provider perceptions through thematic analysis of semistructured interviews with 43 BFA providers across the nation. RESULTS: We identified the following themes. Disadvantages included: (1) clinical guidelines are insufficient; (2) patients often request multiple BFA visits from providers; (3) BFA can be uncomfortable; (4) BFA may not be an effective treatment option unless it can be provided "on demand"; and (5) BFA can promote euphoria, which can have deleterious consequences for patient self-care. Perceived advantages included: (1) BFA can simultaneously effectively control pain while reducing opioid use; (2) BFA may alleviate the pain that has been unsuccessfully treated by conventional methods; (3) BFA gives providers a treatment option to offer patients with substance use disorder; (4) BFA helps build a trusting patient-provider relationship; (5) BFA can create the opportunity for hope. CONCLUSIONS: Providers perceive BFA to have many benefits, both clinical and relational, including ways in which it may have utility in addressing the current opioid crisis. BFA is easy to deliver and has potential clinical and relational utility. Efforts to better understand effectiveness are warranted.


Assuntos
Acupuntura Auricular/métodos , Atitude do Pessoal de Saúde , Manejo da Dor/métodos , Acupuntura Auricular/efeitos adversos , Analgésicos Opioides/administração & dosagem , Protocolos Clínicos , Euforia/fisiologia , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa , Qualidade de Vida , Autogestão/métodos , Autogestão/psicologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Fatores de Tempo , Saúde dos Veteranos
18.
Value Health ; 23(8): 1012-1019, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828212

RESUMO

OBJECTIVE: Patient-centered care (PCC) could reduce gender inequities in quality of care. Little is known about how to implement patient-centered care for women (PCCW). We aimed to generate consensus recommendations for achieving PCCW. METHODS: We used a 2-round Delphi technique. Panelists included 21 women of varied age, ethnicity, education, and urban/rural residence; and 21 health professionals with PCC or women's health expertise. Panelists rated recommendations, derived from prior research and organized by a 6-domain PCC framework, on a 7-point Likert scale in an online survey. We used summary statistics to report response frequencies and defined consensus as when ≥85% panelists chose 5 to 7. RESULTS: The response rate was 100%. In round 1, women and professionals retained 46 (97.9%) and 42 (89.4%) of 47 initial recommendations, respectively. The round 2 survey included 6 recommendations for women and 5 recommendations for professionals (did not achieve consensus in round 1 or were newly suggested). In round 2, women retained 2 of 6 recommendations and professionals retained 3 of 5 recommendations. Overall, 49 recommendations were generated. Both groups agreed on 44 (94.0%) recommendations (13 retained by 100% of both women and clinicians): fostering patient-physician relationship (n = 11), exchanging information (n = 10), responding to emotions (n = 4), managing uncertainty (n = 5), making decisions (n = 8), and enabling patient self-management (n = 6). CONCLUSION: The recommendations represent the range of PCC domains, are based on evidence from primary research, and reflect high concordance between women and professional panelists. They can inform the development of policies, guidelines, programs, and performance measures that foster PCCW.


Assuntos
Assistência Centrada no Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Saúde da Mulher , Adulto , Fatores Etários , Comunicação , Técnica Delfos , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/métodos , Relações Médico-Paciente , Autogestão/métodos , Fatores Socioeconômicos
19.
Aging (Albany NY) ; 12(13): 12468-12478, 2020 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-32628131

RESUMO

OBJECTIVE: This study aimed to assess the disease conditions of patients with inflammatory bowel disease (IBD) in Hubei Province during the outbreak of Coronavirus Disease 2019 (COVID-19) by questionnaire online and guide their self-management during this epidemic. RESULTS: A total of 102 eligible questionnaires were included. No patient we surveyed reported a diagnosis of COVID-19. Our result showed that 67.86% of patients with ulcerative colitis (UC) and 80.43% of patients with Crohn's disease (CD) were in remission, 85.29%of patients had a good quality of life. Part of the patients (21.57%) reported their disease conditions worsening. The reduction in physical exercise was a risk factor for worsening conditions (OR=17.593, p=0.009). Some patients reported an alteration of medication regimens during the epidemic. CONCLUSIONS: The epidemic of COVID-19 might have a certain impact on many aspects of Hubei IBD patients within four weeks after the traffic control. Doctors could utilize the results from our questionnaire to guide IBD patients' self-management. METHODS: A questionnaire was designed containing the Harvey-Bradshaw Index (HBI), the 6-point Mayo Score, the short inflammatory bowel disease questionnaire (SIBDQ) and distributed to Hubei IBD patients online within four weeks of traffic control after the outbreak, it also included questions about patients' self-reported disease conditions and their epidemiological features of COVID-19.


Assuntos
Infecções por Coronavirus , Doenças Inflamatórias Intestinais , Pandemias , Pneumonia Viral , Autogestão/métodos , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Quarentena , Adulto Jovem
20.
Transl Behav Med ; 10(4): 819-826, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710626

RESUMO

COVID-19 has led to substantial challenges in continuing to deliver behavioral health care to all patients, including children with chronic diseases. In the case of diabetes, maintaining strong connections among children, their families, and their care team is essential to promote and sustain daily adherence to a complex medical regimen. The purpose of this paper is to describe COVID-19 pandemic-related practices and policies affecting the continuity of behavioral health care among children with diabetes. Challenges and opportunities were encountered at the provider, patient, and family levels throughout the rapid transition period from in-person to online care to ensure continuity of services. Institutional, regional, and national policies that impacted the care team's capacity to respond swiftly to patients' changing needs were counterbalanced by those related to standards of care, education and training, and resource constraints. At the policy level, COVID-19 re-exposed a number of long-standing and complicated issues about professional licensure among behavioral health providers at the local and state levels and national long-distance practice restrictions during times of crisis. Issues of insurance reimbursement and regulations intended to protect the public may need to adapt and evolve as the practice of behavioral medicine increasingly takes place remotely, online, and over great distances. The sudden transition to telehealth instigated by COVID-19, in addition to the increasing recognition of the benefits of telehealth to favorably affect the reach and impact of traditional behavioral medicine services, offers an unprecedented opportunity to reimagine the medical home and continuity of care for children with diabetes.


Assuntos
Controle de Doenças Transmissíveis/métodos , Serviços Comunitários de Saúde Mental , Infecções por Coronavirus , Diabetes Mellitus , Pandemias , Pneumonia Viral , Autogestão , Telemedicina , Betacoronavirus , Criança , Comportamento Infantil , Serviços Comunitários de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Diabetes Mellitus/terapia , Humanos , Determinação de Necessidades de Cuidados de Saúde , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Formulação de Políticas , Sistemas de Apoio Psicossocial , Medição de Risco , Comportamento de Redução do Risco , Autogestão/métodos , Autogestão/tendências , Telemedicina/organização & administração , Telemedicina/tendências
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