自我管理在产后抑郁症高危产妇中的应用及疗效评价

目的针对高危产妇且在产后出现抑郁症的患者展开自我管理培训,旨在优化临床护理与管理模式,减少高危产妇在产后由于抑郁引发的危险。方法 选取花都区人民医院在2011年10月至2013年10月这2年内收治的高危产妇共126例,选取的患者均存在产后抑郁情况。将患者随机分为对照组(63例)及观察组(63例)。对照组采用常规临床管理方式,观察组采用自我管理干预方式,帮助产妇进行自我管理。对比两组患者精神状况在管理前后变化情况,了解让患者自我管理相对于常规管理模式在患者精神状态优化方面的效果。结果观察组患者产后抑郁症状减轻效果明显优于对照组患者,在SSRS量表以及SCL-90量表评定上分数更低,说明精神状况更好。两组患者管理效果存在显著差异性(P<0.05),具有统计学意义。结论帮助患者进行自我管理能够有效让患者自行控制情绪,减少产后抑郁程度,并降低抑郁情绪对产后恢复造成的不良影响。因此在临床护理与管理中使用自我管理存在推广价值。     

Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults

ObjectiveThe Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity.MethodsIn the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants’ baseline characteristics. Professionals completed questions regarding program fidelity.ResultsNo significant differences were found on effect outcomes and adherence between IMP and RCT (all p ≥ 0.135). Intervention effect sizes were equal (0.47–0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations.ConclusionThe effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity.Practice implicationsThe SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted.     

Evaluation of the “Take Five School”: An education programme for people with Type 2 Diabetes in the Western Cape,South Africa

AimTo evaluate the Take Five School (TFS) group education programme for patients with Type 2 Diabetes in South Africa.MethodsQuestionnaires, administered before and after 4 sessions of an hour each of group education, measured the effect on self-care activities in 84 patients from 6 different clinics. Individual interviews with health care workers (HCWs) and focus group interviews (FGI's) with patients explored attitudes.ResultsA significant improvement in adherence to a diabetic diet, physical activity, foot care and the perceived ability to teach others was seen. There was no significant change in smoking or adherence to medication. Qualitative data revealed that comprehensive education was appreciated, that the group process was deemed supportive, that HCWs doubt the effect of education in general and that a combination of group and individual sessions was seen as an option worth exploring. Strengths, weaknesses, opportunities and threats to the TFS are identified. Recommendations are made to improve the programme and its environment.ConclusionSignificant self-reported improvements in self-care activities after a group-education programme support the view that introducing structured group education for Type 2 Diabetics in a South African public sector primary care context holds promise. Group education for diabetics, especially in resource limited settings, should be sustained and further research should focus on clinical outcomes.     

自我管理对院外抗病毒治疗HIV感染者生活质量的影响

目的探讨自我管理对院外抗病毒治疗的艾滋病(HIV)感染者生活质量的影响。方法将在我院艾滋病咨询处定点抗病毒治疗的40例艾滋病患者随机分为对照组和试验组,每组20例。对照组采用常规健康教育,试验组开始使用抗病毒药物同时,实施自我管理教育。分别在实施自我管理教育前和实施自我管理教育12个月后对两组患者进行自我管理能力、生活质量评价。结果实施自我管理教育前,两组患者自我管理能力、生活质量指数,差异无统计学意义(P>0.05);实施自我管理教育后,试验组自我管理能力、生活质量指数均显著提高(均P<0.05)。结论自我管理教育能提高院外抗病毒治疗HIV感染者的自我管理能力,改善患者生活质量。     

[Translated article] Spanish COPD Guideline (GesEPOC) Update: Comorbidities,Self-Management and Palliative Care

The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD.     

Intention,beliefs and mood assessed using electronic diaries predicts attendance at cardiac rehabilitation: An observational study

BackgroundCardiac rehabilitationis effective in promoting physical/psychological recovery following acute coronary syndrome. Yet, rates of attendance at outpatient cardiac rehabilitation by eligible patients are low.ObjectivesThis study examined the determinants of attendance at outpatient cardiac rehabilitation in acute coronary syndrome patients following discharge until cardiac rehabilitation commencement.DesignA weekly electronic diary measured cardiac-related cognitions and mood and examined their relation to attendance at outpatient cardiac rehabilitation.SettingsThree United Kingdom National Health Service secondary care settings in two Health Board areas in Scotland.ParticipantsAcute coronary syndrome patients were recruited from March 2012 to June 2013 prior to hospital discharge. Of 488 eligible patients referred for cardiac rehabilitation, 214 consented.MethodsConsecutive patients completed a pre-hospital discharge questionnaire targeting age, diagnosis, social class and smoking history. Acute coronary syndrome patients then completed a weekly electronic diary from the first week of discharge until the start of cardiac rehabilitation. Multilevel structural equation models estimated the effects of initial, i.e. baseline and rate of change in cardiac-related cognition and mood on attendance. Intention to attend cardiac rehabilitation was reflected, log transformed, reported thereafter as “do not intend”. The role of “do not intend” was explored as a mediator of the relationship between cardiac-related cognition and mood on attendance.Results166 participants provided, on average, 5 weeks of diary entries before cardiac rehabilitation commenced. High intention (i.e. low “do not intend”) to attend CR and its rate of increase over time predicted attendance. Low negative emotional representation, high perceived necessity, high confidence in maintaining function, low negative affect, and high positive affect following discharge predicted attendance at cardiac rehabilitation. The rate of change in cardiac-related mood and these cognitions was not predictive. Baseline and rate of change in “do not intend” entirely mediated relationships between a) perceived necessity, b) negative affect and attendance at cardiac rehabilitation.ConclusionsNegative affect in the first weeks following discharge represents the key challenge to a patient maintaining their intention to attend cardiac rehabilitation. Intervention to improve attendance should focus on improving intention to attend following discharge and during recovery by improving patient understanding of cardiac rehabilitation and reducing negative affect.     

Mind over bladder: Women,aging, and bladder health

The purpose of this study was to explore the efficacy and acceptability of an innovative, electronically delivered self-management intervention for urinary incontinence (UI) that included daily mindfulness practice, completion of sequential bladder diaries, and bladder health education to improve UI in older women living independently in a retirement community. A mixed methods pilot study was conducted over ten weeks using a custom website or CD. Ten women were recruited and 8 completed the study; 5 of those (71%) experienced fewer daily UI episodes post intervention (p = 0.055). The women also reported a statistically significant decrease in the impact UI had on their everyday life (p = 0.04). Seventy-one percent (N = 5) reported subjective improvement in UI, and high acceptability scores also were achieved. The intervention was both effective in helping older women self-manage UI and acceptable to the population group. Further research is needed with a larger and diverse population of older women.