Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: A randomized controlled trial

ObjectiveTo examine the effectiveness of a nurse-led multidisciplinary self-management program (NMSP) on self-management behaviors, self-efficacy, health-related quality of life (HRQoL) and unplanned health service utilization (HSU) among Chinese patients with coronary heart disease (CHD) in communities.MethodsA randomized controlled trial with repeated measurements was used. A convenience sample of 144 participants was recruited from a community health center in China. All participants were randomly assigned to an intervention group (n = 72) in the newly developed NMSP or a control group (n = 72) in routine care. Outcome measurement was performed at baseline, 3 months and 6 months using Coronary Artery Disease Self-Management Scale (CADSs), Self-efficacy for Chronic Disease 6-item Scale (SECD6), and Short Form-12 health survey questionnaire (SF-12).ResultsOver the six months, the two groups reported significant differences in disease medical and emotional management of CADSs, confidence in symptom and disease management of SECD6, physical and mental component summary of SF-12, as well as emergency and outpatient visits of unplanned HSU.ConclusionsThe NMSP improves self-management behaviors, self-efficacy, HRQoL and reduces unplanned HSU among CHD patients in communities.Practice implicationsThis study provides an effective approach to empower CHD patients with emphasizing on collaboration support of health professionals in communities.     

妊娠期糖尿病女性产后自我管理现状及影响因素分析

目的 了解妊娠期糖尿病女性产后一年内自我管理水平及影响因素,为提高妊娠期糖尿病女性产后自我管理水平、制定预防2型糖尿病的针对性策略提供参考依据。方法 2021年1月至9月按多阶段抽样方法抽取海口市5家医院205例既往有妊娠期糖尿病病史的女性进行调查。结果 产后一年内的妊娠期糖尿病女性自我管理处于低水平,得分率为59.6%;多元逐步线性回归分析结果显示,妊娠期糖尿病女性产后自我管理水平的影响因素有职业为医务人员（t=2.206,P=0.029）、文化程度（t=4.028,P＜0.001）、T2DM自我感知风险（t=4.510,P＜0.001）、孕期使用胰岛素情况（t=3.382,P=0.001）、产后新生儿进入NICU（t=-3.675,P＜0.001）、产后行OGTT筛查（t=2.467,P=0.014）、停止母乳喂养（t=3.296,P=0.001）、产后抑郁（t=-3.684,P＜0.001）及自我效能（t=5.257,P＜0.001）。结论 妊娠期糖尿病女性产后一年内的自我管理水平亟待提升,其影响因素较多,医务人员应根据人群不同特征进行针对性指导,从而实现科学有效的自我管理。     

基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响

目的探讨基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响。方法选取2018年9月至2020年7月我院收治的中青年居家腹膜透析患者74例,随机分为实验组和对照组各37例。对照组采用常规健康教育,实验组采用基于微信平台的健康教育。比较两组患者干预前后的负性情绪和自我管理能力。结果干预前,两组的SDS、SAS、ESCA评分比较差异无统计学意义(P>0.05);干预后,实验组的SDS、SAS评分低于对照组,ESCA评分高于对照组(P<0.05)。结论基于微信平台的健康教育可有效改善中青年居家腹膜透析患者的焦虑、抑郁等负性情绪,显著提升其自我管理能力。     

Self-management and spina bifida: A systematic review of the literature

BackgroundSelf-management is critical to optimizing the health of individuals with a chronic condition or disability and is, therefore, a central concept in individual and family-centered healthcare delivery. The purpose of this review is to report the state of the science of self-management for individuals with spina bifida (SB) from a lifespan perspective.ObjectiveThis review will summarize the (a) development and use of self-management skills and behaviors across the life span, (b) factors related to self-management behaviors, (c) development of generic or condition-specific measures of self-management used with a spina bifida population, and (d) development and/or outcomes of interventions to improve self-management in SB.MethodsThe search strategy was limited to primary research articles published between 2003 and 2019 and followed PRISMA guidelines. The databases searched included: PubMed, CINAHL, PsycINFO, Web of Science, Cochrane, and Google Scholar. Studies that addressed self-management concepts in individuals throughout the life span and published in English were included.ResultsThe search yielded 108 citations and 56 articles met inclusion/exclusion criteria. A systematic narrative synthesis was reported. The level of evidence identified was primarily Level III articles of good quality. Multiple demographic, environmental, condition and process factors were related to self-management behaviors. SB self-management instruments and intervention development and testing studies were identified.ConclusionsThis review provides a synthesis of the state of the science of self-management including factors related to self-management behaviors, preliminary evidence of instruments for use in SB, factors important to consider in the development and testing of future interventions, and gaps in the literature.     

早期认知-行为干预对冠心病介入治疗患者心功能及自我管理能力的影响

目的 观察早期认知-行为干预对冠心病介入治疗患者心功能及自我管理能力的影响。方法 将2019年2月至2021年2月于我院接受介入治疗的100例冠心病患者随机分为观察组与对照组各50例。对照组予以常规护理,观察组在对照组基础上实施早期认知-行为干预。对比两组的心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左室后壁厚度(LVPWd)]、自我管理能力。结果 护理后,观察组的LVEF高于对照组, LVEDD、 LVPWd低于对照组(P<0.05)。护理后,观察组症状管理、角色功能、情绪控制、沟通能力评分均高于对照组(P<0.05)。结论 早期认知-行为干预可显著改善冠心病介入治疗患者心功能状态与自我管理能力,促进其病情恢复,值得临床推广应用。     

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía

ObjectiveTo understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations.MethodA qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia.ResultsPeople with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases.ConclusionsBesides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions.     

健康素养在脑卒中患者积极度与自我管理行为间的中介效应

目的 探讨脑卒中患者健康素养、患者积极度和自我管理行为的现状,明确三个变量间关系,并探讨健康素养在患者积极度与自我管理行为间的中介效应。方法 采用一般资料问卷、慢性病健康素养调查量表、患者积极度量表、脑卒中自我管理行为调查问卷对河南省4所三级甲等医院就诊的223名脑卒中患者进行调查。结果 脑卒中患者健康素养得分为（82.30±15.28）分,自我管理行为得分为（40.89±9.74）分,患者积极度得分为（45.21±11.30）分。脑卒中患者健康素养、自我管理行为与患者积极度三个变量间呈正相关（r值分别为0.622、0.479、0.457,且均P<0.01）;且健康素养在患者积极度与自我管理行为间起显著部分中介效应,中介效应占总效应的53.79%。结论 脑卒中患者健康素养、患者积极度可预测其自我管理行为,且患者积极度既可直接影响自我管理行为,也可通过健康素养间接影响自我管理行为。     

上海市386例心血管病患者积极度现状及其影响因素研究

目的 分析上海浦东新区心血管病患者积极度现状及其影响因素。方法 以上海市某医院2021年2—10月诊治的心血管疾病患者(本研究范围为高血压、高血脂、冠心病、心律失常及外周血管病)为研究对象进行积极度相关问卷调查。利用描述流行病学方法分析心血管病患者积极度现状。使用单因素、多因素分析方法对心血管病患者积极度的影响因素进行分析。结果 386例患者完成调查,男性235例,女性151例,平均年龄(67.12±8.14)岁。心血管疾病患者积极度评分平均为(66.04±10.47)分。在量表的条目中,以我可以为管理自身的健康负责的得分最高,达到(3.27±0.55)分。积极度水平为第4级的构成比最高,201例,占52.07%。多重线性回归分析结果显示男性(β’=0.137)、主动获取相关知识(β’=0.201)、自我效能水平高(β’=0.328)、心血管疾病等级低(β’=0.241)的心血管疾病患者具有更高的积极度。结论 上海市浦东新区心血管疾病患者的积极度相对较高,自我效能水平、性别、是否主动获取疾病的相关知识、合并症情况均对该地区心血管疾病患者积极度产生影响。今后需要继续加强工作,提升该人群的积极度水平。     

维持性血液透析患者自我管理与运动自我效能及运动水平的相关性

目的 探讨维持性血液透析（MHD）患者自我管理水平与运动自我效能及运动水平的相关性。方法 采用横断面调查方式,对我院2018年1月～2018年5月的199例MHD患者,采用自行设计的一般资料调查表、自我管理量表、运动自我效能量表（ESE）及运动水平量表进行调查,并使用SPSS 17.0软件进行统计分析。结果 MHD患者自我管理与运动自我效能之间呈正相关（r=0.419,P＜0.05）;自我管理与运动水平亦呈正相关（r=0.348,P＜0.05）。结论 MHD患者自我管理与运动自我效能及运动水平息息相关,应有效干预MHD患者自我管理与运动自我效能及运动水平,进而提高MHD患者的临床疗效。     

Preferences and needs of patients with a rheumatic disease regarding the structure and content of online self-management support

ObjectiveAim of this study was to investigate preferences and needs regarding the structure and content of a person-centered online self-management support intervention for patients with a rheumatic disease.MethodsA four step procedure, consisting of online focus group interviews, consensus meetings with patient representatives, card sorting task and hierarchical cluster analysis was used to identify the preferences and needs.ResultsPreferences concerning the structure involved 1) suitability to individual needs and questions, 2) fit to the life stage 3) creating the opportunity to share experiences, be in contact with others, 4) have an expert patient as trainer, 5) allow for doing the training at one’s own pace and 6) offer a brief intervention. Hierarchical cluster analysis of 55 content needs comprised eleven clusters: 1) treatment knowledge, 2) societal procedures, 3) physical activity, 4) psychological distress, 5) self-efficacy, 6) provider, 7) fluctuations, 8) dealing with rheumatic disease, 9) communication, 10) intimate relationship, and 11) having children.ConclusionA comprehensive assessment of preferences and needs in patients with a rheumatic disease is expected to contribute to motivation, adherence to and outcome of self-management-support programs.Practice implicationsThe overview of preferences and needs can be used to build an online-line self-management intervention.