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1.
Cancer Control ; 28: 1073274821989709, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33563050

RESUMO

The 2019 novel coronavirus (COVID-19) pandemic has prompted the reorganization in the scheduling and method of care for many patients, including patients diagnosed with cancer. Cancer patients, who have an immunocompromised status, may be at a higher risk of severe symptoms from infection with COVID-19. While information is rapidly evolving regarding COVID-19, Canada, both nationally and provincially, has been conveying new information to patients online. We assessed the content and readability of COVID-19-related online Canadian patient education material (PEM) for cancer patients to determine if the content of the material was written at a grade reading level that the majority of Canadians can understand. PEMs were extracted from provincial cancer agencies and the national Canadian Cancer Society, evaluated using 10 readability scales, qualitatively analyzed to identify their themes and difficult word content. Thirty-eight PEMs from both national and provincial cancers associations were, on average, written above the recommended 7th grade level. Each of the associations' average grade levels were: BC Cancer (11.00 95% confidence interval [CI] 8.27-13.38), CancerControl Alberta (10.46 95% CI 8.29-12.62), Saskatchewan Cancer Agency (11.08 95% CI 9.37-12.80), Cancer Care Manitoba (9.55 95% CI 6.02-13.01), Cancer Care Ontario (9.35 95% CI 6.80-11.90), Cancer Care Nova Scotia (10.95 95% CI 9.86-12.04), Cancer Care Eastern Health Newfoundland and Labrador (10.14 95% CI 6.87-13.41), and the Canadian Cancer Society (10.06 95% CI 8.07-12.05). Thematic analysis identified 4 themes: public health strategy, information about COVID-19, patient instructions during COVID-19, and resources. Fifty-three percent of the complex words identified were medical jargon. This represents an opportunity to improve PEM readability, to allow for greater comprehension amongst a wider target audience.


Assuntos
/prevenção & controle , Serviços de Saúde , Oncologia/métodos , Neoplasias/terapia , Educação de Pacientes como Assunto/métodos , /isolamento & purificação , /epidemiologia , Canadá , Compreensão , Letramento em Saúde , Humanos , Neoplasias/diagnóstico , Pandemias , Educação de Pacientes como Assunto/estatística & dados numéricos , Educação de Pacientes como Assunto/tendências , Leitura , /fisiologia
2.
Br J Hosp Med (Lond) ; 81(12): 1-3, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33377831

RESUMO

This editorial explores how technology has helped clinicians during the COVID-19 pandemic, from patient care to education, the changes that have been made and the numerous exciting possibilities of where technology can amalgamate with health care.


Assuntos
/epidemiologia , Meios de Comunicação/tendências , Assistência à Saúde/tendências , Estágio Clínico/tendências , Educação Médica/tendências , Humanos , Aplicativos Móveis , Pandemias , Educação de Pacientes como Assunto/tendências , Telemedicina
3.
N Z Med J ; 133(1527): 39-50, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332327

RESUMO

AIMS: Evaluate trends in foot examinations for people with diabetes by primary healthcare nurses between 2006-2008 and 2016 in Auckland, New Zealand. METHODS: All primary care nurses in 2006-2008 and 2016 were identified and 26% and 24% were randomly sampled and surveyed, respectively. Nurse participants completed a self-administered questionnaire and telephone interview about the care provided for people with diabetes. RESULTS: Significantly more patients consulted by practice nurses received foot examinations in 2016 (58%) compared with 2006-2008 (36%), and foot-care education (66% versus 26%). Of the 43% of patients who had no foot examination in 2016, 23% had no previous examination documented. Significantly more nurses in 2016 than in 2006-2008 self-reported routinely examining patients' feet (45% versus 31%) and giving foot-care education (28% versus 13%). These practices were associated with nurses undertaking >5 hours of diabetes education within the past five years. CONCLUSIONS: Practice nurses have significantly expanded their role in managing people with diabetes over the last decade by increasing the number of foot examinations and providing recommended foot-care education. Improved management was associated with nurses attending diabetes education in the past five years. Gaps were identified in conducting the recommended number of foot examinations, categorising patients' risk of foot disease and recording previous examinations.


Assuntos
Pé Diabético/prevenção & controle , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/tendências , Exame Físico/tendências , Atenção Primária à Saúde/tendências , Estudos Transversais , Diabetes Mellitus/enfermagem , Pé Diabético/diagnóstico , Educação em Enfermagem , Feminino , , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Educação de Pacientes como Assunto/estatística & dados numéricos , Educação de Pacientes como Assunto/tendências , Exame Físico/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Autorrelato
5.
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
7.
Rev Bras Enferm ; 73(3): e20180338, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32267410

RESUMO

OBJECTIVES: to understand breastfeeding meanings and practices produced by women attending prenatal care at a Basic Health Unit in the Brazilian Northeast. METHODS: a social research characterized as participant research. A Focal Group was conducted with nine pregnant women who had other children. For the analysis, Discursive Practices and Production of Meanings in Everyday Life perspectives were worked out. RESULTS: prenatal care, mother-baby relationship, family, and pain/suffering categories were produced. FINAL CONSIDERATIONS: breastfeeding benefits for the child, wife, family and society are numerous, but it is necessary for the woman to have access to a prenatal care and a qualified puerperium so that she feels supported by a perspective of comprehensive care.


Assuntos
Aleitamento Materno/psicologia , Educação de Pacientes como Assunto/normas , Cuidado Pré-Natal/normas , Adulto , Brasil , Aleitamento Materno/métodos , Aleitamento Materno/tendências , Feminino , Humanos , Relações Mãe-Filho , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/tendências , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa
9.
Pharmacogenomics ; 21(5): 347-358, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32292118

RESUMO

Aim: Pharmacogenomics (PGx) holds potential to improve patient treatment; yet, effective patient educational materials are limited. Materials & methods: Using a 'think aloud' technique, we sought to understand comprehension and perceptions of a multimedia PGx results packet including a cover letter with QR code to an educational video, brochure and prototype report in the context of PGx case vignettes. Results: The cover letter and video components were viewed less favorably due to excess detail, complex jargon and technology challenges. Recommendations were to enhance comprehension and utility and to customize materials to each patient's medications or disease conditions. Conclusion: Educational materials were revised to improve comprehension and usability, and diminish concerns to better prepare patients to understand the importance of discussing test results with their provider.


Assuntos
Educação de Pacientes como Assunto/métodos , Farmacogenética/tendências , Testes Farmacogenômicos/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Multimídia , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/tendências , Projetos Piloto , Inquéritos e Questionários , Materiais de Ensino
10.
PLoS Med ; 17(3): e1003061, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32182239

RESUMO

BACKGROUND: Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS: A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Maori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Maori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Maori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION: Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.


Assuntos
Emigrantes e Imigrantes , Emigração e Imigração , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Recursos em Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Natimorto/etnologia , Adulto , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Recursos em Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos , Educação de Pacientes como Assunto/tendências , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Austrália Ocidental/epidemiologia , Adulto Jovem
11.
Orthop Nurs ; 39(1): 23-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977738

RESUMO

BACKGROUND: Preoperative education aids in reducing the incidence of poor outcomes after total knee replacement (TKR) and increasing patient readiness for discharge home but is not well described in the literature. PURPOSE: The purpose of the study is to describe the current design of preoperative education for TKR across the United States. METHODS: A large, national sample of orthopaedic nurses completed an online survey to describe preoperative education at their facilities. RESULTS: Most participants provided preoperative education as part of interprofessional teams in either a group format or combined group and individual education. Verbal instruction was the most common educational delivery method, followed by written instruction. Education typically lasted between 1 and 1.5 hours, was delivered in a single session, and included a variety of topics. CONCLUSION: Results of this study describe preoperative educational practices and can support future research to improve patient outcomes following TKR surgery.


Assuntos
Artroplastia do Joelho/enfermagem , Enfermeiras e Enfermeiros/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Artroplastia do Joelho/psicologia , Humanos , Enfermagem Ortopédica/métodos , Enfermagem Ortopédica/organização & administração , Enfermagem Ortopédica/tendências , Educação de Pacientes como Assunto/tendências , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/tendências , Inquéritos e Questionários , Resultado do Tratamento , Estados Unidos
13.
Rev. Rol enferm ; 43(1,supl): 472-485, ene. 2020. tab
Artigo em Português | IBECS | ID: ibc-193423

RESUMO

Introduction and Objectives: Familial Amyloidotic Polyneuropathy is an autosomal dominant disease and threatens the life of the gene carrier by extracellular deposition of transtirretin in the peripheral nervous system. This paper aims to describe how people living with Familial Amyloidotic Polyneuropathy experience the transition and uncertainty arising from the knowledge of the outcome of the pre-symptomatic genetic test. Methodology: focused ethnography study conducted in the community of Vila do Conde and Póvoa de Varzim. Data collection was performed through ethnographic interview to 31 patients. The collected data were verbatim transcribed and analyzed according to the qualitative data analysis procedures. Results and Discussion: Data have been narrowed into four categories that illustrate how people with Familial Amyloidotic Polyneuropathy, on the one hand, feel and live the uncertainty of the disease, and on the other hand explain the resources and conditions they must have to deal with this uncertainty. Thus, we have as categories, perform the presymptomatic test, personal conditions for transition, community conditions for transition and conditions of society for transition. The management of disease uncertainty is mediated by previous knowledge about a certain health condition, because it affects several generations of the same family, previous knowledge about the risk condition contributes to the acceptance of health status. Conclusions: It is important that nurses promote strategies that increase social and family support and assume as credible authorities in caring for people living with Andrade's disease, becoming facilitators of their personal growth and uncertainty management


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Incerteza , Transtornos Heredodegenerativos do Sistema Nervoso/psicologia , Neuropatias Amiloides Familiares/psicologia , Cuidados de Enfermagem/métodos , Etnopsicologia/métodos , Comparação Transcultural , Apoio Social , Estratégia Saúde da Família , Doenças Genéticas Inatas/psicologia , Educação de Pacientes como Assunto/tendências , Transplante de Fígado/estatística & dados numéricos
14.
J Oncol Pharm Pract ; 26(1): 13-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30832554

RESUMO

PURPOSE: To describe the outcomes of a pharmacist-led multi-center, collaborative patient education and proactive adverse event management program in a community-based oncology setting. METHODS: Patients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer, newly prescribed with oral afatinib, and monitored as part of the Florida Cancer Specialists patient management program, were included in a retrospective, observational analysis. During follow-up, data were collected on adverse event frequency, and changes in afatinib dosing. Data analyses were descriptive and exploratory in nature. RESULTS: The mean age of the 123 patients included in the analysis was 69 years, and 78% were female. At the time of the analysis, 3 patients had discontinued before receiving treatment, 89 patients had discontinued afatinib treatment, and 31 patients were continuing to receive afatinib treatment. The most common afatinib-related adverse events were diarrhea (85%), rash/skin reactions (58%), stomatitis/mucositis (19%), and paronychia (16%). Overall, 13% of patients discontinued due to afatinib-related adverse events. The median duration of treatment was 4 months in patients who discontinued due to adverse events, 6 months in those who discontinued for other reasons, and 18 months in those who were continuing to receive therapy. Afatinib dose-reductions were more frequent in patients continuing treatment versus those who discontinued due to adverse events (77% vs. 42%, respectively). CONCLUSIONS: Findings suggest that adverse events in patients with EGFRm + non-small cell lung cancer receiving afatinib can be successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.


Assuntos
Afatinib/efeitos adversos , Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Educação de Pacientes como Assunto/tendências , Farmacêuticos/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , Serviços Comunitários de Farmácia/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Receptores ErbB/genética , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Estudos Retrospectivos
15.
Arthritis Care Res (Hoboken) ; 72(2): 201-207, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31325229

RESUMO

OBJECTIVE: To compare the effectiveness of education (ED) plus home exercise (HE) and ED plus supervised exercise (SE) according to information provided by the Better Management of Patients With Osteoarthritis (BOA) Registry, a nationally implemented rehabilitation program for patients with hip and knee osteoarthritis (OA). In addition, we investigated whether or not the effect of the treatments differed based on the joint affected by OA (hip versus knee). METHODS: We included 38,030 participants from the BOA Registry with knee or hip OA who were treated with either ED, HE, or SE. The effect of the 3 treatment options on the pain intensity reduction (range 0-10) immediately postintervention and at 12 months was estimated using a mixed-effects model adjusted for age, sex, body mass index, affected joint (hip or knee), pain at baseline, comorbidity, and level of education. RESULTS: The participants undergoing HE or SE experienced a greater pain reduction compared to participants who received ED, both after the treatment (group mean change for ED -0.91 [95% confidence interval (95% CI) -1.15, -0.68], for HE -1.06 [95% CI -1.10, -1.01], and for SE -1.12 [95% CI -1.15, -1.08]) and at 12 months (group mean change for ED -0.58 [95% CI -0.87, -0.30], for HE -0.82 [95% CI -0.87, -0.76], and for SE -0.82 [95% CI -0.86, -0.77]). Patients with knee OA who underwent HE or SE improved more compared to patients with hip OA at both follow-ups. CONCLUSION: In primary care, HE and SE lead to similar reductions in pain intensity but are more effective than ED alone. In addition, people with knee OA benefit more from HE and SE than people with hip OA.


Assuntos
Terapia por Exercício/métodos , Serviços de Assistência Domiciliar , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Educação de Pacientes como Assunto/métodos , Sistema de Registros , Idoso , Bases de Dados Factuais/tendências , Gerenciamento Clínico , Terapia por Exercício/tendências , Feminino , Serviços de Assistência Domiciliar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor/métodos , Educação de Pacientes como Assunto/tendências
16.
Comput Inform Nurs ; 38(7): 349-357, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009402

RESUMO

The purpose of this study was to investigate nurses' need for care robots in children's hospitals and to help develop care robots that can be used by combining robot-care, game-care, and edu-care. This study employed a mixed-methods design; 198 nurses were recruited for quantitative research and 12 for qualitative research. The findings were as follows. Robot-care: Participants had an overwhelming preference for robots made of plastic or steel that could easily be washed and sterilized. Game-care: Among nursing procedures, vital sign measurements were the most common actions that could be implemented using game elements. Edu-care: The educational content that participants felt should be presented to child patients and caregivers through care robots included information about hospitalization, discharge, infection control, falls, and pressure ulcer prevention. Qualitative data divided the role of care robots into five subcategories associated with children and one subcategory associated with guardians. The findings of this study are meaningful in that it clarified the needs of nurses in the development of care robots for use in children's hospitals.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Robótica/tendências , Adulto , Cuidadores/psicologia , Feminino , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/tendências , Papel Profissional/psicologia , Pesquisa Qualitativa , Robótica/métodos , Inquéritos e Questionários
17.
Comput Inform Nurs ; 37(11): 564-572, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31599744

RESUMO

Optimal adherence to immunosuppressive medication is essential to kidney graft success. A Web-based tailored virtual nursing intervention was developed to promote medication adherence and support self-management among kidney transplant recipients. A qualitative study was undertaken in a hospital setting in Montreal (Canada) to document how users experience the intervention and to explore medication intake self-management behaviors. To participate, transplant recipients had to be at least 18 years old and had to have completed at least one computer session of the intervention. Semistructured interviews were conducted with 10 participants (two women, eight men) with a mean age of 47.8 years. They reported receiving their latest renal transplant on average 10.6 years prior. Content analysis of the interview transcripts yielded five major themes: (1) kidney transplant is a gift from life; (2) routinization of medication intake; (3) intervention is a new and positive experience; (4) using the intervention offers many benefits; and (5) individual relevance of the intervention. Patient experience shows the intervention is acceptable and can help better manage medication intake. Results also underscore the importance of offering the intervention early in the care trajectory of transplant recipients. Web-based tailored virtual nursing interventions could constitute an easily available adjunct to existing specialized services.


Assuntos
Transplante de Rim/educação , Sistemas de Medicação , Educação de Pacientes como Assunto/métodos , Autogestão/educação , Adulto , Feminino , Humanos , Internet , Entrevistas como Assunto/métodos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/tendências , Pesquisa Qualitativa , Quebeque , Autogestão/métodos , Autogestão/tendências
18.
Scand Cardiovasc J ; 53(6): 361-372, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394936

RESUMO

Objective. International guidelines recommend rehabilitation including supervised exercise therapy in patients with Intermittent Claudication (IC), but knowledge of the implementation in clinical practice is limited. This study aims to investigate current practice and opinions on rehabilitation for patients with IC among vascular surgeons and rehabilitation departments in the municipalities and hospitals. Design. Three electronic cross-sectional surveys were distributed nationally to the Danish vascular surgeons (n = 131) and to rehabilitation departments in the municipalities (n = 92) and hospitals (n = 33). Results. The response rates were 70% among the vascular surgeons, 98% among the municipalities and 94% among the hospitals. Vascular surgeons utilize oral advice to exercise by self-administered walking, pharmacological treatment, and revascularization to improve walking distance in patients with IC. Currently, only 12% of the vascular surgeons referred to rehabilitation to improve walking distance, while almost all vascular surgeons (96%) would refer their patients to IC rehabilitation, if it was available. Only 14% of municipalities and none of the hospitals, who treat patients with IC, have a rehabilitation program designed specifically for patients with IC. However, 59% of the rehabilitation departments in the municipalities and 26% in the hospitals included patients with IC in rehabilitation program designed for other patient groups - mostly cardiac patients. There was consensus among the groups of respondents that future IC specific rehabilitation should include an initial conversation, supervised exercise therapy, smoking cessation, and patient education according to guidelines. Conclusion. Vascular surgeons support referral and participation in IC rehabilitation to improve walking distance in patients with IC. Despite some hospitals and municipalities included patients with IC in rehabilitation nearly all services fail to meet current guideline as specific services tailored to patient with IC is almost non-existent in Denmark. Our findings call for action for services to comply with current recommendations of structured, systematic rehabilitation for patients with IC.


Assuntos
Terapia por Exercício/tendências , Claudicação Intermitente/reabilitação , Educação de Pacientes como Assunto/tendências , Padrões de Prática Médica/tendências , Encaminhamento e Consulta/tendências , Abandono do Hábito de Fumar , Medicina Estatal/tendências , Cirurgiões/tendências , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Dinamarca/epidemiologia , Tolerância ao Exercício , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/epidemiologia , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Cirurgiões/psicologia , Resultado do Tratamento , Caminhada
19.
PLoS Med ; 16(7): e1002846, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31283770

RESUMO

BACKGROUND: The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China. METHODS AND FINDINGS: This intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010-September 2014 and October 2014-December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period. A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: -0.09 [95% CI -0.16 to -0.02] between Stage 1 and baseline, p = 0.014; -0.11 [95% CI -0.20 to -0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = -4.368, p < 0.001) and PMR (Z = -13.142, p < 0.001) declined by stage over the intervention period. One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed. CONCLUSIONS: Apparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou's experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS.


Assuntos
Cesárea/tendências , Educação em Saúde/tendências , Assistência Perinatal/tendências , Padrões de Prática Médica/tendências , Adulto , Fortalecimento Institucional/tendências , Cesárea/efeitos adversos , Cesárea/mortalidade , China , Estudos Transversais , Feminino , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Capacitação em Serviço/tendências , Mortalidade Materna/tendências , Educação de Pacientes como Assunto/tendências , Mortalidade Perinatal/tendências , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Int J Cardiol ; 292: 277-279, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31230937

RESUMO

The connection between health literacy and health outcomes includes access and utilization of healthcare services, patient/provider interaction and self-care. Digital approaches can be designed to simplify or expand on a concept, test for understanding, and do not have a time constraint. New technologies, such as artificial intelligence and machine learning, virtual and augmented reality, and blockchain can move the role of technology beyond data collection to a more integrated system. Rather than being a passive participant, digital solutions provide the opportunity for the individual to be an active participant in their health. These solutions can be delivered in a way that builds or enhances the individual's belief that the plan will be successful and more confidence that they can stick with it. Digital solutions allow for the delivery of multi-media education, such as videos, voice, and print, at different reading levels, in multiple languages, using formal and informal teaching methods. By giving the patient a greater voice and empowering them to be active participants in their care, they can develop their decision making and shared decision making skills. The first step in our health literacy instructional model is to address the emotional state of the person. Once the emotional state has been addressed, and an engagement strategy has been deployed the final phase is the delivery of an educational solution. While a clear definition of health literacy and an instructional model are important, further research must be done to continually determine more effective ways to incorporate health technology in the process of improving health outcomes.


Assuntos
Letramento em Saúde/métodos , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Telemedicina/métodos , Letramento em Saúde/tendências , Humanos , Educação de Pacientes como Assunto/tendências , Telemedicina/tendências
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