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1.
J Gerontol Nurs ; 47(4): 7-12, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: covidwho-1175623

RESUMO

This process evaluation of the Rural Elder Awareness of Medication Safety (REAMS) program provided identification of successful and unsuccessful elements along with barriers to and facilitators of this home-based pilot program. The REAMS program was developed to assist rural older adults aged >65 years and community health care organizations with strategies to improve health literacy related to medications. Recruitment of older adults, rurality of the program's setting, time constraints, and the onset of the COVID-19 pandemic were the greatest barriers. The collaborative relationship developed with community health care partners was the greatest facilitator. This relationship promoted shared ideas and adjustments in program design to achieve the outcome goals. The lessons learned from process evaluation may benefit future researchers or community health promotion planners with designing community-based programs for older adults in rural areas. Future research should focus on expanding recruitment opportunities in acute care, primary care, and home health with the inclusion of all established health care providers in the community. [Journal of Gerontological Nursing, 47(4), 7-12.].


Assuntos
Idoso Fragilizado , Letramento em Saúde , Serviços de Assistência Domiciliar/organização & administração , Educação de Pacientes como Assunto/métodos , Conhecimento do Paciente sobre a Medicação , Segurança do Paciente , Serviços de Saúde Rural/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Projetos Piloto , População Rural , Estados Unidos
2.
J Nutr Health Aging ; 25(5): 675-678, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1107887

RESUMO

COVID-19 disrupted numerous disciplines which led to widespread misinformation on the virus. Thirteen students from across the USA designed a web-based conference, or "webinar," to minimize the misinformation among student populations. Professionals presented the current and possible future impacts of COVID-19 in their respective fields. Pre- and post-conference surveys were administered to the attendees to gauge the impact of the conference. Survey results demonstrated increased knowledge and a lower degree of feeling overwhelmed by COVID-19 information overall, indicating a niche use for webinars during the COVID-19 pandemic and beyond.


Assuntos
COVID-19/patologia , Disseminação de Informação/métodos , Educação de Pacientes como Assunto/métodos , Comunicação , Escolaridade , Humanos , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
3.
J Gerontol Nurs ; 47(4): 7-12, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34038247

RESUMO

This process evaluation of the Rural Elder Awareness of Medication Safety (REAMS) program provided identification of successful and unsuccessful elements along with barriers to and facilitators of this home-based pilot program. The REAMS program was developed to assist rural older adults aged >65 years and community health care organizations with strategies to improve health literacy related to medications. Recruitment of older adults, rurality of the program's setting, time constraints, and the onset of the COVID-19 pandemic were the greatest barriers. The collaborative relationship developed with community health care partners was the greatest facilitator. This relationship promoted shared ideas and adjustments in program design to achieve the outcome goals. The lessons learned from process evaluation may benefit future researchers or community health promotion planners with designing community-based programs for older adults in rural areas. Future research should focus on expanding recruitment opportunities in acute care, primary care, and home health with the inclusion of all established health care providers in the community. [Journal of Gerontological Nursing, 47(4), 7-12.].


Assuntos
Idoso Fragilizado , Letramento em Saúde , Serviços de Assistência Domiciliar/organização & administração , Educação de Pacientes como Assunto/métodos , Conhecimento do Paciente sobre a Medicação , Segurança do Paciente , Serviços de Saúde Rural/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Projetos Piloto , População Rural , Estados Unidos
4.
J Nutr Health Aging ; 25(5): 675-678, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33949636

RESUMO

COVID-19 disrupted numerous disciplines which led to widespread misinformation on the virus. Thirteen students from across the USA designed a web-based conference, or "webinar," to minimize the misinformation among student populations. Professionals presented the current and possible future impacts of COVID-19 in their respective fields. Pre- and post-conference surveys were administered to the attendees to gauge the impact of the conference. Survey results demonstrated increased knowledge and a lower degree of feeling overwhelmed by COVID-19 information overall, indicating a niche use for webinars during the COVID-19 pandemic and beyond.


Assuntos
COVID-19/patologia , Disseminação de Informação/métodos , Educação de Pacientes como Assunto/métodos , Comunicação , Escolaridade , Humanos , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
5.
Medicine (Baltimore) ; 100(21): e26125, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032758

RESUMO

OBJECTIVES: To assess the feasibility of a patient engagement and medication safety management (PE-MSM) program on medication errors, self-efficacy for appropriate medication and activation among older patients suffering cardiovascular disease (CVD) in Chinese communities. METHODS: A patient engagement and medication safety management (PE-MSM) program intervention study was performed. Older patients suffering CVD in the intervention group (n = 62) received PE-MSM program, while the control group (n = 58) took a 12-week medication safety education alone. RESULTS: Compared with the control group, patients having undergone the individualized PE-MSM program achieved lower incidence of medication errors (P < .001), and a statistically significant interaction was identified between treatment groups and assessment time points in terms of the total score of self-efficacy for appropriate medication use scale and the number of patients with different activation levels (P < .001). CONCLUSIONS: The PE-MSM program is demonstrated to be feasible. Compared with single medication safety education, the PE-MSM program is capable of decreasing the incidence of common medication errors, enhancing the self-efficacy of appropriate medication and the activation of older patients with CVD in a community. PRACTICE IMPLICATIONS: The PE-MSM program is likely to act as a promising medication management model for the routine health care of older patients suffering CVD in communities.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Erros de Medicação/prevenção & controle , Educação de Pacientes como Assunto/métodos , Autoeficácia , Idoso , Idoso de 80 Anos ou mais , China , Estudos de Viabilidade , Humanos , Avaliação de Programas e Projetos de Saúde
6.
Lancet Diabetes Endocrinol ; 9(6): 393-405, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34022157

RESUMO

China has one of the largest populations with obesity in the world, and obesity has become a major challenge for the country's health-care system. Current guidelines for obesity management are not adequately supported by evidence from clinical studies in Chinese populations. Effective lifestyle interventions suitable for Chinese populations are scarce, insufficient weight-loss medications have been approved by regulatory bodies, and there is low acceptance of non-lifestyle interventions (ie, medications and surgery) among both health-care providers and the general public. Large, well designed, and well implemented clinical trials are needed to strengthen the evidence base for the clinical management of obesity in China. Obesity management can be improved through use of a tiered system involving health management centres, integrated lifestyle interventions and medical treatments, strengthened obesity education and training, and use of advanced electronic health technologies. Resource mobilisation, support from major stakeholders for people with overweight or obesity, and education and changes to social norms among the wider public are also needed. National health policies should prioritise both obesity prevention and improvement of the treatment and management of obesity.


Assuntos
Obesidade/terapia , China/epidemiologia , Atenção à Saúde/normas , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Sobrepeso/terapia , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Programas de Redução de Peso/métodos , Programas de Redução de Peso/estatística & dados numéricos , Programas de Redução de Peso/provisão & distribuição
7.
Lancet Diabetes Endocrinol ; 9(6): 336-349, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33933181

RESUMO

BACKGROUND: There are few long-term studies of interventions to reduce in low socioeconomic status children with overweight or obesity. The Stanford GOALS trial evaluated a 3-year, community-based, multi-level, multi-setting, multi-component (MMM) systems intervention, to reduce weight gain among low socioeconomic status, Latinx children with overweight or obesity. METHODS: We did a two-arm, parallel group, randomised, open-label, active placebo-controlled trial with masked assessment over 3 years. Families from low-income, primarily Latinx communities in Northern California, CA, USA, with 7-11-year-old children with overweight or obesity were randomly assigned to a MMM intervention or a Health Education (HE) comparison intervention. The MMM intervention included home environment changes and behavioural counselling, community after school team sports, and reports to primary health-care providers. The primary outcome was child BMI trajectory over three years. Secondary outcomes included one- and two-year changes in BMI. This trial is registered with ClinicalTrials.govNCT01642836. FINDINGS: Between July 13, 2012, and Oct 3, 2013, 241 families were recruited and randomly assigned to MMM (n=120) or HE (n=121). Children's mean age was 9·5 (SD 1·4) years, 134 (56%) were female and 107 (44%) were male, and 236 (98%) were Latinx. 238 (99%) children participated in year 1, 233 (97%) in year 2, and 227 (94%) in year 3 of follow-up assessments. In intention-to-treat analysis, over 3 years, the difference between intervention groups in BMI trajectory was not significant (mean adjusted difference -0·25 [95% CI -0·90 to 0·40] kg/m2; Cohen's d=0.10; p=0·45). Children in the MMM intervention group gained less BMI over 1 year than did children in the HE intervention group (-0·73 [-1·07 to -0·39] kg/m2, d=0.55); the same was true over 2 years (-0·63 [-1·13 to -0·14] kg/m2; d =0.33). No differential adverse events were observed. INTERPRETATION: The MMM intervention did not reduce BMI gain versus HE over 3 years but the effects over 1 and 2 years in this rigorous trial show the promise of this systems intervention approach for reducing weight gain and cardiometabolic risk factors in low socioeconomic status communities. FUNDING: US National Institutes of Health.


Assuntos
Obesidade Pediátrica/etnologia , Obesidade Pediátrica/terapia , Programas de Redução de Peso/métodos , Índice de Massa Corporal , California/epidemiologia , Criança , Participação da Comunidade , Exercício Físico/fisiologia , Feminino , Hispano-Americanos/educação , Humanos , Masculino , Sobrepeso/etnologia , Sobrepeso/prevenção & controle , Sobrepeso/terapia , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto/métodos , Obesidade Pediátrica/prevenção & controle , Pobreza/etnologia , Classe Social , Fatores Socioeconômicos , Esportes , Ganho de Peso/etnologia , Perda de Peso/etnologia
8.
J Med Internet Res ; 23(4): e25773, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: covidwho-1197473

RESUMO

BACKGROUND: As mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools. OBJECTIVE: The specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools. METHODS: The web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document. RESULTS: Based on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers). CONCLUSIONS: The use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways.


Assuntos
Atenção à Saúde/métodos , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Telemedicina/métodos , Recursos em Saúde/provisão & distribuição , Humanos , Transtornos Mentais
9.
Nutrients ; 13(4)2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33917383

RESUMO

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.


Assuntos
Obesidade Pediátrica/terapia , Programas de Redução de Peso/métodos , Terapia Comportamental/métodos , Terapia Comportamental/organização & administração , Terapia Comportamental/tendências , Criança , Redes Comunitárias/organização & administração , Redes Comunitárias/tendências , Humanos , Terapia Nutricional/métodos , Terapia Nutricional/tendências , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/tendências , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etiologia , Modalidades de Fisioterapia/organização & administração , Modalidades de Fisioterapia/tendências , Prevalência , Serviços de Saúde Escolar/organização & administração , Serviços de Saúde Escolar/tendências , Programas de Redução de Peso/organização & administração , Programas de Redução de Peso/tendências
10.
J Med Internet Res ; 23(4): e25773, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-33885374

RESUMO

BACKGROUND: As mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools. OBJECTIVE: The specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools. METHODS: The web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document. RESULTS: Based on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers). CONCLUSIONS: The use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways.


Assuntos
Atenção à Saúde/métodos , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Telemedicina/métodos , Recursos em Saúde/provisão & distribuição , Humanos , Transtornos Mentais
11.
J Orthop Sports Phys Ther ; 51(4): 188-195, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33789433

RESUMO

OBJECTIVE: To assess whether an exercise and education program was more effective than an education booklet for preventing recurrence of low back pain (LBP). DESIGN: Randomized controlled trial. METHODS: Participants aged 18 years or older who had recovered from an episode of LBP within the previous week were recruited from primary care practices and the community. Participants were randomized to receive either 12 weeks of exercise and education (8 supervised exercise sessions and 3 one-on-one sessions) or a control (education booklet). The primary outcome was time to recurrence of LBP during the 1-year follow-up. Times to recurrence of LBP leading to activity limitation, care seeking, and work absence were secondary outcomes. Data were analyzed with Cox regression using intention-to-treat principles. RESULTS: We planned to include 160 participants but included 111 (exercise and education, n = 57; educational booklet, n = 54). At the end of the study period, data completeness was 84.2%. Thirty-six (63%) participants in the exercise and education group and 31 (57%) participants in the control group had a recurrence of LBP. There was no statistically significant difference in time to recurrence of pain between groups (hazard ratio = 1.09; 95% confidence interval: 0.7, 1.8). There was no statistically significant effect for any of the secondary outcomes. CONCLUSION: Among people recently recovered from LBP, exercise and education may not meaningfully reduce risk of recurrence compared to providing an educational booklet. J Orthop Sports Phys Ther 2021;51(4):188-195. doi:10.2519/jospt.2021.10187.


Assuntos
Terapia por Exercício , Dor Lombar/prevenção & controle , Dor Lombar/terapia , Educação de Pacientes como Assunto/métodos , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Prevenção Secundária
12.
Medicine (Baltimore) ; 100(14): e25424, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832143

RESUMO

BACKGROUND: Insulin is an essential therapy for treating diabetes, but many patients lack standard insulin injection skills. PURPOSE: We developed a standard training procedure based on a new simulation tool. Then we conducted a study to investigate the effect of this standard training on the ability of diabetic patients to inject themselves with insulin. METHODS: After follow-up, a total of 120 patients with diabetes mellitus were included. These patients needed insulin therapy depending on their condition and had not previously learned insulin injection. We randomly divided them into the intervention group (60 cases) and the control group (60 cases). The control group was trained on insulin injection before being discharged according to the traditional method, and the intervention group was trained based on an improved simulation tool. All participants were trained as individuals or groups. Finally, we evaluated the learning effects of both groups. RESULTS: The time spent at the training stage in the intervention group was shorter than the control group. We found that after applying simulation devices to mimic operations, the learning time for patients was reduced.The first subcutaneous injection success rate was 73.33% in the intervention group, which was significantly higher than that in the control group by 46.67%. The score of the first subcutaneous injection and pre-discharge score in the test group was significantly higher than that of the control group. One month later, the score for injection skills in the 2 groups was higher than that before discharge, and the score in the trial group was still higher than that in the control group. The incidence of subcutaneous fat hyperplasia in the trial group was lower than that in the control group (3.3% vs 15%, P < .05). Moreover, the incidence of hypoglycemia (16.7% vs. 26.7%) was higher in the control group, but the difference was not statistically significant (P = .184). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: After applying simulation tools plus operating video and guideline as the standard procedure to train diabetic patients on insulin injection, all patients had a good grasp of using the insulin injection technique. This education method is safe, efficient, and worth promoting worldly.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Educação de Pacientes como Assunto/métodos , Treinamento por Simulação/métodos , Materiais de Ensino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Hipoglicemiantes/uso terapêutico , Injeções Subcutâneas , Insulina/uso terapêutico , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Adulto Jovem
13.
Nutrients ; 13(4)2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33800620

RESUMO

BACKGROUND: Elimination of gluten-containing cereals and consumption of ultra-processed gluten-free foods might cause an unbalanced diet, deficient in fiber and rich in sugar and fat, circumstances that may predispose celiac children to chronic constipation. AIM: to evaluate if counseling with a registered dietitian (RD) was capable of improving eating and bowel habits in a celiac pediatric population. METHODS: Dietetic, lipid profile and stool modifications were analyzed, comparing baseline assessments with those twelve months after receiving heathy eating and nutrition education sessions. At both time points, 3-day food records, a bowel habit record and a lipid panel were conducted. Calculated relative intake of macro- and micro-nutrients were compared with current recommendations by the European Food Safety Authority (EFSA). Student's paired t-test, McNemar test, Mandasky test and Pearson correlation tests were used. RESULTS: Seventy-two subjects (58.3% girls) with a mean (standard deviation (SD)) age of 10.2 (3.4) years were included. Baseline diets were imbalanced in macronutrient composition. Significant improvements were observed in their compliance with dietary reference values (DRVs), where 50% of the subjects met fat requirements after the education and 67% and 49% with those of carbohydrates and fiber, respectively (p < 0.001). Celiac children decreased red meat and ultra-processed foods consumption (p < 0.001) and increased fruits and vegetables intake (p < 0.001), leading to a reduction in saturated fat (p < 0.001) and sugar intake (p < 0.001). Furthermore, 92% of the patients achieved a normal bowel habit, including absence of hard stools in 80% of children constipated at baseline (p < 0.001). CONCLUSIONS: RD-led nutrition education is able to improve eating patterns in children with celiac disease (CD).


Assuntos
Doença Celíaca/dietoterapia , Constipação Intestinal/dietoterapia , Aconselhamento/métodos , Dieta Livre de Glúten/métodos , Educação de Pacientes como Assunto/métodos , Adolescente , Doença Celíaca/complicações , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Dieta Livre de Glúten/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Lactente , Masculino , Estado Nutricional , Cooperação do Paciente/psicologia , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos
14.
J Neuroeng Rehabil ; 18(1): 50, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33736656

RESUMO

BACKGROUND: Current commercial prosthetic hand controllers limit patients' ability to fully engage high Degree-of-Freedom (DoF) prosthetic hands. Available feedforward controllers rely on large training data sets for controller setup and a need for recalibration upon prosthesis donning. Recently, an intuitive, proportional, simultaneous, regression-based 3-DoF controller remained stable for several months without retraining by combining chronically implanted electromyography (ciEMG) electrodes with a K-Nearest-Neighbor (KNN) mapping technique. The training dataset requirements for simultaneous KNN controllers increase exponentially with DoF, limiting the realistic development of KNN controllers in more than three DoF. We hypothesize that a controller combining linear interpolation, the muscle synergy framework, and a sufficient number of ciEMG channels (at least two per DoF), can allow stable, high-DoF control. METHODS: Two trans-radial amputee subjects, S6 and S8, were implanted with percutaneously interfaced bipolar intramuscular electrodes. At the time of the study, S6 and S8 had 6 and 8 bipolar EMG electrodes, respectively. A Virtual Reality (VR) system guided users through single and paired training movements in one 3-DoF and four different 4-DoF cases. A linear model of user activity was built by partitioning EMG feature space into regions bounded by vectors of steady state movement EMG patterns. The controller evaluated online EMG signals by linearly interpolating the movement class labels for surrounding trained EMG movements. This yields a simultaneous, continuous, intuitive, and proportional controller. Controllers were evaluated in 3-DoF and 4-DoF through a target-matching task in which subjects controlled a virtual hand to match 80 targets spanning the available movement space. Match Percentage, Time-To-Target, and Path Efficiency were evaluated over a 10-month period based on subject availability. RESULTS AND CONCLUSIONS: In 3-DoF, S6 and S8 matched most targets and demonstrated stable control after 8 and 10 months, respectively. In 4-DoF, both subjects initially found two of four 4-DoF controllers usable, matching most targets. S8 4-DoF controllers were stable, and showed improving trends over 7-9 months without retraining or at-home practice. S6 4-DoF controllers were unstable after 7 months without retraining. These results indicate that the performance of the controller proposed in this study may remain stable, or even improve, provided initial viability and a sufficient number of EMG channels. Overall, this study demonstrates a controller capable of stable, simultaneous, proportional, intuitive, and continuous control in 3-DoF for up to ten months and in 4-DoF for up to nine months without retraining or at-home use with minimal training times.


Assuntos
Amputados/reabilitação , Membros Artificiais , Eletrodos Implantados , Mãos , Movimento , Treinamento por Simulação/métodos , Realidade Virtual , Braço/inervação , Interfaces Cérebro-Computador , Eletromiografia/métodos , Humanos , Modelos Lineares , Masculino , Músculo Esquelético/inervação , Educação de Pacientes como Assunto/métodos , Modalidades de Fisioterapia/instrumentação , Software
15.
J Prim Care Community Health ; 12: 21501327211007026, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1159862

RESUMO

The development of highly efficacious COVID-19 vaccines has brought a feeling of hope to many in the US (United States) and across the globe. However, it is estimated that approximately one-third of the US and international population are hesitant to receive the COVID-19 vaccine. For most Western countries with the economic means to purchase sufficient vaccine for their citizens, the medical community now has the opportunity to lead the vaccination communication campaign. Because frontline clinicians were the first to be vaccinated in the United States (US), they are uniquely positioned to be the most trusted source of vaccine information. Primary care clinicians, more than other groups of clinicians, scientists, government officials, media, etc. have the greatest chance for instilling confidence about the vaccine to their patients, including the most vulnerable and the most distrusting. They are considered credible and trustworthy allies for their patients in the US, however, clinicians receive little to no formal training in communication related to controversial topics, such as vaccine hesitancy. With the increasing worry about highly transmissible COVID-19 viral mutations and possible related vaccine resistance, it becomes even more critical to accelerate vaccination efforts across every community. Educating primary care clinicians regarding the importance of talking to their patients regarding their COVID-19 vaccination plans is essential.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Comunicação em Saúde/métodos , Educação de Pacientes como Assunto/métodos , Médicos de Atenção Primária/educação , Humanos , SARS-CoV-2 , Estados Unidos , Recusa de Vacinação
16.
Transplant Proc ; 53(4): 1105-1111, 2021 May.
Artigo em Inglês | MEDLINE | ID: covidwho-1118702

RESUMO

During the coronavirus 2019 pandemic we converted our liver transplant waitlist candidate education and support program to a virtual format and expanded it to include ongoing engagement sessions aimed to educate and empower patients to maximize opportunity for live donor liver transplantation. Over a period of 6 months from April 2020 to Sept 2020 we included 21 patients in this pilot quality improvement program. We collected data regarding patient response and potential donor referral activity. Overall, patient response was positive, and some patients saw progress toward live donor liver transplantation by fostering inquiry of potential live liver donors. Optimization of logistical aspects of the program including program flow, technology access, and utilization is required to enhance patient experience. Long-term follow-up is needed to assess impact on the outcome of transplantation rates. Future data collection and analysis should focus on assessment of any potential disparity that may result from utilization of virtual programming. Herein we provide a framework for this type of virtual program and describe our experience.


Assuntos
COVID-19 , Transplante de Fígado/educação , Doadores Vivos/educação , Educação de Pacientes como Assunto/métodos , Telemedicina/métodos , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Encaminhamento e Consulta , SARS-CoV-2
17.
J Med Virol ; 93(7): 4342-4350, 2021 07.
Artigo em Inglês | MEDLINE | ID: covidwho-1141364

RESUMO

In this paper, we propose a new susceptible-vaccinated-exposed-infected-recovered with unaware-aware (SEIR/V-UA) model to study the mutual effect between the epidemic spreading and information diffusion. We investigate the dynamic processes of the model with a Kinetic equation and derive the expression for epidemic stability by the eigenvalues of the Jacobian matrix. Then, we validate the model by the Monte Carlo method and numerical simulation on a two-layer scale-free network. With the outbreak of COVID-19, the spread of the epidemic in China prompted drastic measures for transmission containment. We examine the effects of these interventions based on modeling of the information-epidemic and the data of the COVID-19 epidemic case. The results further demonstrate that the epidemic spread can be affected by the effective transmission rate of awareness.


Assuntos
COVID-19/epidemiologia , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , COVID-19/patologia , China/epidemiologia , Humanos , Modelos Estatísticos , SARS-CoV-2
18.
Transplant Proc ; 53(4): 1105-1111, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33676742

RESUMO

During the coronavirus 2019 pandemic we converted our liver transplant waitlist candidate education and support program to a virtual format and expanded it to include ongoing engagement sessions aimed to educate and empower patients to maximize opportunity for live donor liver transplantation. Over a period of 6 months from April 2020 to Sept 2020 we included 21 patients in this pilot quality improvement program. We collected data regarding patient response and potential donor referral activity. Overall, patient response was positive, and some patients saw progress toward live donor liver transplantation by fostering inquiry of potential live liver donors. Optimization of logistical aspects of the program including program flow, technology access, and utilization is required to enhance patient experience. Long-term follow-up is needed to assess impact on the outcome of transplantation rates. Future data collection and analysis should focus on assessment of any potential disparity that may result from utilization of virtual programming. Herein we provide a framework for this type of virtual program and describe our experience.


Assuntos
COVID-19 , Transplante de Fígado/educação , Doadores Vivos/educação , Educação de Pacientes como Assunto/métodos , Telemedicina/métodos , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Encaminhamento e Consulta , SARS-CoV-2
19.
J Med Virol ; 93(7): 4342-4350, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33738825

RESUMO

In this paper, we propose a new susceptible-vaccinated-exposed-infected-recovered with unaware-aware (SEIR/V-UA) model to study the mutual effect between the epidemic spreading and information diffusion. We investigate the dynamic processes of the model with a Kinetic equation and derive the expression for epidemic stability by the eigenvalues of the Jacobian matrix. Then, we validate the model by the Monte Carlo method and numerical simulation on a two-layer scale-free network. With the outbreak of COVID-19, the spread of the epidemic in China prompted drastic measures for transmission containment. We examine the effects of these interventions based on modeling of the information-epidemic and the data of the COVID-19 epidemic case. The results further demonstrate that the epidemic spread can be affected by the effective transmission rate of awareness.


Assuntos
COVID-19/epidemiologia , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , COVID-19/patologia , China/epidemiologia , Humanos , Modelos Estatísticos , SARS-CoV-2
20.
Rev Infirm ; 70(269): 16-17, 2021 Mar.
Artigo em Francês | MEDLINE | ID: mdl-33742584

RESUMO

Today in France, one in three people live with an illness or disability throughout their lives. Due to the successive confinements linked to the health crisis, therapeutic patient education (TPE) programmes have often had to be adapted, notably through telephone follow-up and videoconferences. At the same time, the legislative framework has evolved, with the law of January 1st, 2021, which replaces the authorisation scheme for TPE programmes with a declaration scheme.


Assuntos
Educação de Pacientes como Assunto , França , Humanos , Educação de Pacientes como Assunto/métodos
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