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1.
Medicine (Baltimore) ; 99(8): e19219, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080116

RESUMO

The aim of this study was to ascertain the status quo of perceived readiness for hospital discharge in colorectal cancer patients who underwent enhanced recovery pathway and identify the variables that affect patients' perceptions about their readiness for discharge.A cross-sectional survey was conducted in West China Hospital, Sichuan University. The Readiness for Hospital Discharge Scale and the Quality of Discharge Teaching Scale were delivered to 130 colorectal cancer (CRC) patients who underwent enhanced recovery pathway. Data collection was carried out 4 hours before discharge.The total score of readiness for hospital discharge was 149.86 ±â€Š33.65. The multiple linear regression analysis revealed that the quality of discharge teaching, discharge to a rehabilitative institution were associated with the readiness for hospital discharge.The level of CRC patients' readiness for hospital discharge needs to be improved. Medical staff should improve the quality of discharge guidance and pay more attention to patients transferred to rehabilitation institutions when they leave hospital.


Assuntos
Neoplasias Colorretais/cirurgia , Alta do Paciente/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , China , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/organização & administração , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
2.
Adv Exp Med Biol ; 1171: 85-103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31823242

RESUMO

Pancreatic cancer is a leading cause of cancer related deaths in the UK. However, public knowledge and understanding of the pancreas is generally poor, therefore pancreatic cancer patients often have to contend with understanding large quantities of new information at a pivotal time in their lives.Despite utilisation of digital visualisation techniques in medical education, very rarely are they being used to help clinicians communicate information to their patients. Specifically, there is no literature describing use of an interactive digital application for use by healthcare professionals to aid discussions specific to pancreatic cancer.Therefore, we developed a workflow methodology, and created an interactive application, thus creating a tool that could help clinicians explain pancreatic cancer anatomy, and staging, to their patients. Three-dimensional (3D) digital models were created using ZBrush and Autodesk 3DS Max, and exported into the Unity game engine. Within Unity, the interactivity of models was maximally utilised, and a simple user interface created.The application centres on anatomically accurate, visually simple, 3D digital models, demonstrating a variety of common scenarios that arise in pancreatic cancer. The design of the application is such that the clinician can select which model is relevant to the patient, and can give an explanation of the anatomy and disease process at a speed and level appropriate to that person. This simple, robust and effective workflow methodology for the development of an application could be useful in any clinical setting that needs visual and interactive tools to enhance patient understanding of a clinical condition.


Assuntos
Neoplasias Pancreáticas , Educação de Pacientes como Assunto , Fluxo de Trabalho , Pessoal de Saúde , Humanos , Imagem Tridimensional , Neoplasias Pancreáticas/psicologia , Neoplasias Pancreáticas/terapia , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração
4.
Artigo em Inglês | MEDLINE | ID: mdl-31635047

RESUMO

BACKGROUND: The aim of this study was to examine the effect of dietary education on glycemic control in patients with any type of diabetes at four-week and two-year follow-ups. METHODS: A two-year prospective study was conducted in three phases: before, four weeks after, and two years after an educational program. The participants were patients diagnosed with diabetes who were receiving insulin or oral hypoglycemics and who attended the Diabetes Clinic of the General County Hospital Nasice, Croatia to receive their treatment. The questionnaire and educational program were created for the purpose of this study. Measurements were made (fasting blood glucose, glycated hemoglobin, body mass index, blood pressure, knowledge test) at baseline, four weeks and two years after education. RESULTS: A total of 109 participants took part in the study, of which 56 (51.4%) were on insulin therapy and 53 (48.6%) were on oral therapy, after two years, 78 (72%) subjects were followed up with. There was no control group. At the two-year follow-up, participants with insulin therapy had significantly higher glycated hemoglobin (Mann-Whitney U test, p = 0.035). Significant differences were observed in fasted blood glucose (Friedman's test, p = 0.001), diastolic pressure (Friedman's test, P = 0.018), and glycated hemoglobin (Wilcoxon test, p < 0.001) between Phase 1 and Phase 3. CONCLUSIONS: Education has a positive effect on adherence to recommended diet and glycemia regulation in diabetes patients after four-week follow-ups. However, after two years, participants showed a decrease in adherence to recommended diet and increased glycemia.


Assuntos
Diabetes Mellitus/terapia , Dieta/psicologia , Educação de Pacientes como Assunto/organização & administração , Idoso , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Croácia , Diabetes Mellitus/sangue , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
5.
Curr Med Sci ; 39(5): 690-693, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612384

RESUMO

The occurrence of major emergencies often leads to environmental damage, property damage, health challenges and life threats. Despite the tremendous progress we have made in responding to the many challenges posed by disasters in recent years, there are still many shortcomings. As an emerging technology widely used in recent years, virtual reality (VR) technology is very suitable for many fields of disaster medicine, such as basic education, professional training, psychotherapy, etc. The purpose of this review article is to introduce the application of VR technology in the disaster medical field and prospect its trend in the future.


Assuntos
Medicina de Desastres/métodos , Medicina de Emergência/métodos , Conhecimentos, Atitudes e Prática em Saúde , Realidade Virtual , Medicina de Desastres/educação , Desastres , Medicina de Emergência/educação , Primeiros Socorros/métodos , Humanos , Educação de Pacientes como Assunto/organização & administração
6.
South Med J ; 112(10): 512-519, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31583410

RESUMO

OBJECTIVES: To determine the comparative impact of the standard Parents as Teachers (PAT) to the nutrition and physical activity enhanced version (PATE) of the perinatal educational curriculum on compliance with infant feeding recommendations and changes in maternal infant feeding knowledge and beliefs. METHODS: Women at least 18 years of age, <19 weeks pregnant, and residing in three Mississippi counties were randomized to the standard PAT or the PATE version of the perinatal educational curriculum. Infant diets were assessed via 24-hour diet recall at postnatal months 1 to 12. Maternal knowledge and beliefs about infant feeding were assessed via survey at baseline and postnatal month 12. Compliance with infant feeding recommendations and differences in compliance between treatment arms were assessed using Kaplan-Meier survival curves. Longitudinal changes in maternal knowledge and beliefs were assessed with McNemar tests of symmetry. RESULTS: Postnatal retention for the PAT and PATE arms were 83% (25/30) and 88% (21/24). Compliance with feeding recommendations for PAT and PATE participants, respectively, was 40% and 63% for no solid food before 6 months; 23% and 21% for no sugar-sweetened beverages before 12 months; 100% (both) for no fruit juice before 6 months; and 43% and 46% for no snack chips, French fries, and other fried food and candy before 12 months. Median times to feeding sugar-sweetened beverages were 10.1 and 9.6 months in PAT and PATE arms. Significant differences in compliance between arms were not found (P > 0.05). Participants' knowledge and beliefs about infant feeding were generally in agreement with expert recommendations at baseline, with few changes over time or between arms. CONCLUSIONS: Findings suggest the need for further intervention focused on translating knowledge into action to improve diets of weaning infants in this region of the United States.


Assuntos
Afro-Americanos , Aleitamento Materno/etnologia , Currículo , Exercício/fisiologia , Promoção da Saúde/organização & administração , Saúde Materna , Mães/educação , Educação de Pacientes como Assunto/organização & administração , Adulto , Feminino , Humanos , Gravidez , Estados Unidos , Adulto Jovem
7.
Sante Publique ; Vol. 31(3): 405-415, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640328

RESUMO

INTRODUCTION: Poor oral health in persons with schizophrenia is a major public health issue affecting 600,000 people in France. The aim of this article was to present the different stages in the development of a specific oral health educational program for persons with schizophrenia. It takes into account experimental knowledge of these persons and presents the results of the feasibility study. PATIENTS AND METHOD: The focus group method was applied to a group of health professionals and users to highlight an exploratory corpus in order to develop an oral health educational program. An expert group including persons with schizophrenia among others validated the fields and tools of this program. A feasibility study was then conducted in a control group of 7 persons with schizophrenia. RESULTS: Altogether, 26 persons participated in this feasibility study. The main fields investigated by the expert group aimed to promote personal responsibility for one's health, to improve access to the healthcare system and to promote the global management of health. The feasibility study showed the ability of this program to change persons with schizophrenia representations and knowledge of this health problem. Most educational tools were considered relevant. CONCLUSION: An oral health educational program was built as part of a caregiver-persons with schizophrenia partnership and showed its feasibility. A multicentric randomized trial is currently ongoing to assess the efficacy of this program with a high level of proof.


Assuntos
Cuidadores/psicologia , Saúde Bucal/educação , Educação de Pacientes como Assunto/organização & administração , Esquizofrenia/terapia , Estudos de Viabilidade , Grupos Focais , França , Humanos
8.
Am J Health Syst Pharm ; 76(1): 34-43, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603982

RESUMO

PURPOSE: The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. SUMMARY: With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4-8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. CONCLUSION: BJC's ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Desenvolvimento de Programas , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Gestão de Antimicrobianos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Illinois , Missouri , Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/estatística & dados numéricos , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Lacunas da Prática Profissional/organização & administração , Lacunas da Prática Profissional/estatística & dados numéricos
9.
BMC Infect Dis ; 19(1): 774, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488064

RESUMO

BACKGROUND: HCV (Hepatitis C virus) is a prevalent chronic disease with potentially deadly consequences, especially for drug users. However, there are no special HCV or HIV (human immunodeficiency virus)-related intervention programs that are tailored for drug users in China; to fill this gap, the purpose of this study was to explore HCV and HIV-related knowledge among drug users in MMT (methadone maintenance treatment) sites of China and to investigate the effectiveness of HCV and HIV-related education for improving the knowledge of IDUs (injection drug users) and their awareness of infection. METHODS: The study was a randomized cluster controlled trial that compared a usual care group to a usual care plus HCV/HIV-REP (HCV/HIV-Reduction Education Program) group with a 24-week follow-up. The self-designed questionnaires, the HCV- and HIV-related knowledge questionnaire and the HIV/HCV infection awareness questionnaire, were used to collect the data. Four MMT clinics were selected for this project; two MMT clinics were randomly assigned to the research group, with subjects receiving their usual care plus HCV/HIV-REP, and the remaining two MMT clinics were the control group, with subjects receiving their usual care over 12 weeks. Sixty patients were recruited from each MMT clinic. A total of 240 patients were recruited. Follow-up studies were conducted at the end of the 12th week and the 24th week after the intervention. RESULTS: At baseline, the mean score (out of 20 possible correct answers) for HCV knowledge among the patients in the group receiving the intervention was 6.51 (SD = 3.5), and it was 20.57 (SD = 6.54) for HIV knowledge (out of 45 correct answers) and 8.35 (SD = 2.8) for HIV/HCV infection awareness (out of 20 correct answers). At the 12-week and 24-week follow-up assessments, the research group showed a greater increase in HCV-/HIV-related knowledge (group × time effect, F = 37.444/11.281, P < 0.05) but no difference in their HIV/HCV infection awareness (group × time effect, F = 2.056, P > 0.05). CONCLUSION: An MMT-based HCV/HIV intervention program could be used to improve patient knowledge of HCV and HIV prevention, but more effort should be devoted to HIV/HCV infection awareness. TRIAL REGISTRATION: Protocols for this study were approved by institution review board (IRB) of Shanghai Mental Health Center (IRB:2009036), and registered in U.S national institutes of health (http://www.clinicaltrials.gov, NCT01647191 ). Registered 23 July 2012.


Assuntos
Usuários de Drogas/educação , Infecções por HIV/prevenção & controle , Hepatite C/prevenção & controle , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Educação de Pacientes como Assunto , Adulto , Conscientização , China/epidemiologia , Análise por Conglomerados , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Eficiência Organizacional , Feminino , HIV/fisiologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hepacivirus/fisiologia , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/normas , Prevalência , Inquéritos e Questionários , Resultado do Tratamento
10.
Diabetes Metab Syndr ; 13(4): 2671-2682, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405693

RESUMO

AIMS: Diabetes educators (DEs) play a major role in diabetes education and management. The aims of this scoping review were to compile the currently identified core competencies for DEs and, to review the currently used criteria to assess DEs' core competencies. METHODS: A scoping review was conducted using the methodology of the Joanna Briggs Institute. Five databases (Ovid, CINAHL, Scopus, Web of Science and PubMed) were searched. Keywords as well as inclusion and exclusion criteria were identified as search strategies and study selection for this review. RESULTS: A total of (n = 22) publications comprising sixteen peer-reviewed studies and six professional-organisations (grey literature) were selected for review, as they listed the core competencies of DEs. The most common core competencies were related to knowledge and skills in diabetes self-management education, knowledge of pathophysiology and epidemiology, teaching skills, clinical skills and cultural competency. Evidently, an appropriate tool for assessing DEs' competencies is currently unavailable. CONCLUSIONS: Given the importance of diabetes education in the care of people living with diabetes, it is imperative that DEs possess competencies in diabetes education and management. The review also identified the need to develop a globally applicable core competency assessment tool for DEs.


Assuntos
Diabetes Mellitus/terapia , Educadores em Saúde/normas , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Competência Profissional/normas , Autogestão/educação , Gerenciamento Clínico , Humanos
11.
Soins Pediatr Pueric ; 40(309): 35-38, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31331600

RESUMO

Therapeutic education in paediatrics forms part of the child's care pathway, from the discovery of the chronic disease, through to adulthood. Around fifteen years ago, this specific healthcare activity resulted in the creation of a multiple pathology therapeutic education centre at Robert-Debré university hospital in Paris. The centre has continued to develop over the years and further improved its interventions.


Assuntos
Doença Crônica/terapia , Educação de Pacientes como Assunto/organização & administração , Pediatria , Criança , Hospitais Universitários , Humanos , Paris
12.
Am J Health Syst Pharm ; 76(14): 1038-1058, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31361881

RESUMO

PURPOSE: The results of the 2018 ASHP national survey of pharmacy practice in hospital settings are presented. METHODS: Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online using Qualtrics. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. RESULTS: The response rate was 16.6%. The percentage of hospitals that routinely have pharmacists assigned to provide drug therapy management has increased. Transitions-of-care processes have generally increased over the last 6 years. The percentage of hospitals with pharmacists in a wide variety of clinic types and clinical practice areas has increased over the last 2 years. Opioid stewardship programs are emerging in many U.S. hospitals, with pharmacists participating or taking the lead in program implementation. Outsourcing of compounded sterile product preparation is common. The proportion of hospitals not using any technology when compounding sterile preparations has declined. Pharmacy departments commonly track and monitor trends for administrative, operational, quality, and outcome metrics. CONCLUSION: Pharmacists continue to improve drug therapy monitoring for patients in U.S. hospitals. They are also responding to public health issues related to medication use. These advancements include taking an active role in opioid stewardship programs, safe compounding of sterile medications for patients, and reducing the need for hospital-based care.


Assuntos
Educação de Pacientes como Assunto/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Monitoramento de Medicamentos/estatística & dados numéricos , Humanos , Sistemas de Medicação no Hospital/organização & administração , Sistemas de Medicação no Hospital/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Educação de Pacientes como Assunto/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Sociedades Farmacêuticas , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
13.
Am J Health Syst Pharm ; 76(13): 980-990, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361883

RESUMO

PURPOSE: Complementary health approaches including the use of dietary supplements (DS) such as vitamin, mineral, nutritional, and herbal supplements are popular in the United States. Beyond a statement issued by the American Society of Health-System Pharmacists (ASHP) in 2004, knowledge about the role of pharmacists related to DS use is largely unknown. The objectives of this study were to identify pharmacists' and other key stakeholders' perceptions and opinions about assuming roles that ensure the appropriate and safe use of DS. METHODS: A grounded theory approach involving in-depth, semi-structured key informant audio-recorded phone interviews with 12 practicing pharmacists and 10 key stakeholders were conducted. Key themes were identified using open coding, grouping, and categorizing. RESULTS: Participants believed the majority of their patients self-select and purchase DS from a pharmacy, often in conjunction with conventional medicines, and reported concerns about the regulatory standards, efficacy, and safety of DS. Despite acknowledging their ethical and professional responsibilities regarding DS, as identified by the ASHP statement and other sources, the majority of pharmacists are not expecting their profession to adopt these in the near future because of multiple barriers. CONCLUSIONS: There is a substantial disconnect between awareness of DS use and pharmacists adopting professional responsibilities regarding DS. The barriers identified are multifaceted, indicating the need for a joint effort from key stakeholders in developing a coordinated approach to supporting pharmacists in their practice efforts to ensure the appropriate and safe use of DS.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Suplementos Nutricionais/efeitos adversos , Educação de Pacientes como Assunto/organização & administração , Farmacêuticos/organização & administração , Papel Profissional , Atitude do Pessoal de Saúde , Comportamento do Consumidor , Estudos Transversais , Feminino , Teoria Fundamentada , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Farmacêuticos/psicologia , Participação dos Interessados , Estados Unidos
14.
Am J Health Syst Pharm ; 76(13): 935-942, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361890

RESUMO

PURPOSE: Randomized controlled trials investigating the efficacy and safety of fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) are reviewed, and practical issues for pharmacists to consider are discussed. SUMMARY: Eight randomized controlled trials evaluating the use of FMT for recurrent CDI were analyzed. The trials varied in the type of sample (fresh, frozen, lyophilized), route of administration (nasogastric tube, colonoscopy, enema, oral), and comparator agent (different type of FMT, vancomycin). Efficacy rates ranged from 43.8% to 96.2% with FMT, and safety data were relatively similar. With these favorable data, pharmacists are likely to be involved at multiple steps in the delivery of FMT to patients with recurrent CDI, including the procurement, documentation, and administration of various products and patient education. CONCLUSION: FMT is an option for recurrent CDI that is supported by findings of randomized controlled trials, although a preferred method for the delivery remains to be defined. Pharmacists can play an important role in the successful management of patients with recurrent CDI who may benefit from FMT.


Assuntos
Infecções por Clostridium/terapia , Clostridium difficile/isolamento & purificação , Transplante de Microbiota Fecal/métodos , Farmacêuticos/organização & administração , Infecções por Clostridium/microbiologia , Transplante de Microbiota Fecal/efeitos adversos , Humanos , Educação de Pacientes como Assunto/organização & administração , Papel Profissional , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Coleta de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Resultado do Tratamento
15.
Soins ; 64(837): 18-21, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31345302

RESUMO

Therapeutic patient education (TPE) for those suffering from cardiovascular disease forms an important part of the management of risk factors. It must be continued throughout the course of the disease. The creation of a health network focused on TPE facilitates the emergence of healthier lifestyle habits and improves the care management of these patients.


Assuntos
Doenças Cardiovasculares/terapia , Educação de Pacientes como Assunto/organização & administração , Humanos , Fatores de Risco
16.
Curr Opin Anaesthesiol ; 32(5): 643-648, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356361

RESUMO

PURPOSE OF REVIEW: To summarize the safety and feasibility of outpatient total joint arthroplasty (TJA) from the perspectives of short-term complications, long-term functional outcomes, patient satisfaction and financial impact, and to provide evidence-based guidance on how to establish an outpatient TJA programme. RECENT FINDINGS: TJA has been recently transitioned from an exclusively inpatient procedure for all Medicare and Medicaid patients to an outpatient surgery in properly selected total knee arthroplasty patients. This change may decrease costs while maintaining comparable rates of readmission, adverse events, positive surgical outcomes and patient satisfaction. SUMMARY: With a standardized clinical pathway, outpatient TJA can be safe and effective in a subset of patients. Essential components of a successful outpatient TJA programme include proper patient selection, preoperative patient/family education, perioperative multidisciplinary coordination and opioid-sparing analgesia, and early and effective postdischarge planning. More studies are needed to further assess and optimize this new care paradigm.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Procedimentos Clínicos/organização & administração , Implementação de Plano de Saúde/organização & administração , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/economia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/economia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/economia , Procedimentos Clínicos/economia , Estudos de Viabilidade , Implementação de Plano de Saúde/economia , Humanos , Tempo de Internação , Medicaid/economia , Medicare/economia , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/organização & administração , Readmissão do Paciente/economia , Satisfação do Paciente , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento , Estados Unidos
17.
Nutrients ; 11(6)2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31242621

RESUMO

The clinical importance of assessment of metabolic syndrome lies in the selection of individuals with multiple risk factors based on visceral fat accumulation, and helping them to reduce visceral fat. Behavioral modification by population approach is important, which adds support to the personal approach. The complexity of visceral fat accumulation requires multicomponent and multilevel intervention. Preparation of food and physical environments could be useful strategies for city planners. Furthermore, actions on various frameworks, including organizational, community, and policy levels, have been recently reported. There are universal public health screening programs and post-screening health educational systems in Japan, and diseases management programs in Germany. Understanding one's own health status is important for motivation for lifestyle modification. The U.S. Preventive Services Task Force recommends that primary care practitioners screen all adults for obesity and offer behavioral interventions and intensive counseling. Established evidence-based guidelines for behavioral counseling are needed within the primary care setting.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Prestação Integrada de Cuidados de Saúde/organização & administração , Estilo de Vida Saudável , Síndrome Metabólica/terapia , Obesidade Abdominal/terapia , Atenção Primária à Saúde/organização & administração , Comportamento de Redução do Risco , Adiposidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Ensaios Clínicos como Assunto , Serviços de Saúde Comunitária/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gordura Intra-Abdominal/fisiopatologia , Japão/epidemiologia , Programas de Rastreamento/organização & administração , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Entrevista Motivacional/organização & administração , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/fisiopatologia , Educação de Pacientes como Assunto/organização & administração , Prognóstico , Fatores de Proteção , Fatores de Risco
18.
Artigo em Inglês | MEDLINE | ID: mdl-31247892

RESUMO

BACKGROUND: Type 2 diabetic patients are major users of medical sharps in the community. Proper sharp disposal practice among them, however, was reported to be low. The current study was aimed to determine the factors contributing to sharp waste disposal at a health care facility among Type 2 diabetic patients. METHODS: In this cross-sectional study, Type 2 diabetic patients who were on insulin therapy attending health clinics were randomly selected and interviewed using a validated questionnaire. Binary logistic regression analysis was applied. RESULTS: Out of 304 respondents, only 11.5% of them brought their used sharps to be disposed at health care facilities. Previous advice on sharp disposal from health care providers, knowledge score, and duration of diabetes were significant contributing factors for sharp waste disposal at health care facilities: (Adj. OR 6.31; 95% CI: 2.63, 15.12; p < 0.001), (Adj. OR 1.05; 95% CI: 1.03, 1.08; p < 0.001), and (Adj. OR 2.51; 95% CI: 1.06, 5.93; p = 0.036), respectively. CONCLUSION: Continuous education and a locally adapted safe sharp disposal option must be available to increase awareness and facilitate diabetic patients adopting proper sharp disposal behavior.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Eliminação de Resíduos de Serviços de Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Conscientização , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Malásia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/organização & administração , Fatores Socioeconômicos , Adulto Jovem
19.
Medicine (Baltimore) ; 98(22): e15829, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145324

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Oral anticoagulation is an effective strategy for primary and secondary prevention of stroke in patients with AF. Warfarin is an oral anticoagulant widely prescribed and, despite its benefits, the achievement of the goals of drug therapy depends on patient involvement, among other factors. Educational interventions can contribute for effectiveness and safety of oral anticoagulation therapy. We sought to describe the protocol of a clinical trial designed to evaluate the effect of a patient-centered educational strategy focused on low-income patients with AF and poor anticoagulation control. METHODS: Patients ≥18 years with AF, on warfarin for at least 6 months and time in therapeutic range (TTR) <60% will be recruited at 2 anticoagulation clinics (ACs) in Brazil. Patients from 1 AC will be allocated to the intervention group and patients from the other AC will be allocated to the control group. Intervention group will attend educational sessions based on a patient-centered care approach, and the control group will receive usual care. The intervention will be based on Paulo Freire's theory and tailored according to practices involving health empowerment and techniques applied to individuals with limited socioeconomic status. The intervention is estimated to last 5 months. We will consider TTR as the primary outcome and knowledge and self-reported non-adherence to warfarin therapy as secondary outcomes. TTR values and non-adherence will be measured before intervention (T0) and at times immediately after (T1), and 3 (T2), 6 (T3), 9 (T4), and 12 (T5) months after intervention. Knowledge will be measured at times T0, T1 e T5. The calculated sample size indicated 85 patients in each group. DISCUSSION: The proposed study aims to investigate whether an innovative educational approach to deliver care to a low-income population on warfarin improves anticoagulation control. Once our hypothesis is confirmed, our findings are expected to help improving anticoagulation control, knowledge on warfarin therapy and adherence to drug therapy. Thus, we believe our results may contribute to improve oral anticoagulation effectiveness in a low-income population. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR- 9cy6py and UTN: U1111-1217-0151 (March, 2019).


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Educação de Pacientes como Assunto/organização & administração , Pobreza , Varfarina/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Brasil , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Coeficiente Internacional Normatizado , Masculino , Projetos de Pesquisa , Varfarina/administração & dosagem , Varfarina/efeitos adversos
20.
Am J Audiol ; 28(2): 245-250, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31095405

RESUMO

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197.


Assuntos
Hiperacusia/reabilitação , Educação de Pacientes como Assunto/métodos , Audiologia , Feminino , Perda Auditiva Neurossensorial , Humanos , Masculino , Educação de Pacientes como Assunto/organização & administração , Zumbido
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