自我管理教育对门诊肺结核患者自护能力的影响

目的探讨自我管理教育对门诊肺结核患者自护能力的影响。方法对2013年1月至2014年4月,确诊肺结核并在浙江省武义县第一人民医院结核定点防治门诊建卡的256例患者实施自我管理教育,在干预前、干预1个月和3个月后分别采用自制的疾病认知情况调查表及自我护理能力量表(the exercise of self-careagency scak,ESCA)进行调查和评价。结果实施自我管理教育1个月和3个月后,患者对疾病的认知及自我护理能力均有所提高,与干预前比较,差异均有统计学意义(P0.05或P0.01)。结论自我管理教育有利于提高门诊肺结核患者对疾病的认知及自我护理能力。     

An Automated Telephone Nutrition Support System for Spanish-Speaking Patients With Diabetes

In the United States, Spanish-speaking patients with diabetes often receive inadequate dietary counseling. Providing language and culture-concordant dietary counseling on an ongoing basis is critical to diabetes self-care. To determine if automated telephone nutrition support (ATNS) counseling could help patients improve glycemic control by duplicating a successful pilot in Mexico in a Spanish-speaking population in Oakland, California. A prospective randomized open-label trial with blinded endpoint assessment (PROBE) was performed. The participants were seventy-five adult patients with diabetes receiving care at a federally qualified health center in Oakland, California. ATNS, a computerized system that dialed patients on their phones, prompted them in Spanish to enter (via keypad) portions consumed in the prior 24 hours of various cultural-specific dietary items, and then provided dietary feedback based on proportion of high versus low glycemic index foods consumed. The control group received the same ATNS phone calls 14 weeks after enrollment. The primary outcome was hemoglobin A1c % (A1c) 12 weeks following enrollment. Participants had no significant improvement in A1c (–0.3% in the control arm, –0.1% in the intervention arm, P = .41 for any difference) or any secondary parameters. In our study, an ATNS system did not improve diabetes control in a Spanish-speaking population in Oakland.     

Ventricular Assist Devices: A Review of Psychosocial Risk Factors and Their Impact on Outcomes

BackgroundPsychosocial contraindications for ventricular assist devices (VADs) remain particularly nebulous and are driven by institution-specific practices. Our multi-institutional, multidisciplinary workgroup conducted a review with the goal of addressing the following research question: How are preoperative psychosocial domains predictive of or associated with postoperative VAD-related outcomes? Answers to this question could contribute to the development of treatment-specific (contra) indications for patients under consideration for mechanical devices.Methods and ResultsWe identified 5 studies that examined psychosocial factors and their relationship to postoperative VAD-related outcomes. Our results suggest that 3 psychosocial variables are possibly associated with VAD-related outcomes: depression, functional status, and self-care. Of the few studies that exist, the generalizability of findings is constrained by a lack of methodologic rigor, inconsistent terminology, and a lack of conceptual clarity.ConclusionsThis review should serve as a call for research. Efforts to minimize psychosocial risk before device placement can only be successful insofar as VAD programs can clearly identify who is at risk for suboptimal outcomes.     

Self-tuning for job engagement: Ugandan nurses' self-care strategies in coping with work stress

This qualitative study explored self-care among 15 Ugandan nurses with reputations for thriving despite having difficult working conditions. The analysis revealed that in the face of potential threats to the nurses' job engagement, they engaged in ‘self-tuning’, a salutogenic process involving introspection, sensibility and reflection leading to coping in one or several of these ways: sharing of experiences, trusting in God's providence, engaging in other enjoyable activities, letting go, adapting based on experiences, guarding against workplace hazards, preserving quiet time or clearly separating work from personal life. This study supports previous research that self-tuning is a learnable skill, critical in helping nurses cope with work-related adversity; this should be emphasized both during nursing training and on the job.     

Screening for determinants of self-care in patients with chronic heart failure

Heart failure self-care is vital to achieving clinical stability and improved health outcomes. Yet despite the attention it has been given, in both research and clinical practice, effective self-care remains elusive. It is recognised that there are many patient factors that impact on attaining effective self-care skills. Systematic research is warranted to resolve the knowledge gap of how patients process information and develop the necessary self-care skills. In addition, sound screening tools are needed to assess factors that hinder the development of effective heart failure self-care skills. In this manner, education and support strategies can be applied on an individualised needs basis to enhance health outcomes.     

Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Skilled Nursing Facility Discharge Among Medicare Beneficiaries

Objectives

The objectives of this study were to determine the association between patients’ functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions.

自我管理训练对社区慢性精神分裂症患者的疗效:中国上海的单盲随机对照试验(英文)

目标:评估自我管理训练对社区精神分裂症成年患者的效果。方法:总共招募了201例慢性精神分裂症患者(平均病程17.4年),并随机分为自我管理干预组(n=103)和常规治疗对照组(n=98)。自我管理训练包括每周一次小组会议,为期6个月,讨论和模拟基本的自我管理能力,然后进行24个月的每月小组助推会议,社区卫生工作人员回顾患者的自我管理清单。两名对分组单盲的精神科医生评估参与者基线和登记后6个月、30个月的症状和社会功能,采用简明精神病评定量表(BPRS),社会功能缺陷筛选量表(SDSS)和Morningside康复状态量表(MRSS)。总共有194人(干预组99人和对照组95人)完成2.5年的随访。使用末次观察结转法的意向性治疗分析进行分析。结果:相较于对照组,干预组在两个随访时间点的BPRS,SDSS和MRSS平均分较低。在入组后6个月到30个月的治疗维持阶段,干预组的评分持续改善。结论:自我管理训练是一种能改善社区慢性精神分裂症患者的症状和社会功能有效的方法。在6个月的每周自我管理技能训练后,每月的助推会议检查患者记录中与疾病相关的症状事件的日常清单,足以维持培训的有效性。将来研究应注意该方法的长期成本效益     

自我管理培训对慢性精神分裂症社区患者服药依从性的影响:在中国上海的一项单盲随机对照试验(英文)

背景:许多社区精神分裂症患者服药不规律因而很容易频繁复发。目的:评估自我管理培训对社区慢性精神分裂症患者服药依从性和复发情况的影响。方法 :共纳入上海市城市和农村的社区慢性精神分裂症患者201例,随机分为常规治疗组(n=98)或自我管理干预组(n=103)。干预组接受为期6个月的每周一次自我管理技能培训,之后参加每月一次的加强小组会议,由社区卫生工作者检查患者的自我管理清单,共24个月。由两名单盲于患者治疗情况的精神科医生使用Morisky服药依从性量表评估患者服药依从性并采用自知力评估量表(Scale to Assess Unawareness of Mental Disorders,SAUMD)了解基线时和30个月后患者的自知力。总共194人(95.6%)完成研究。结果 :基线时两组间无显著差异,但在30个月后,干预组服药依从性比常规治疗组好,对疾病的自知力提高,自我报告使用抗精神病药物的剂量相对高。在随访30个月里,干预组103例患者中只有2例(1.9%)复发(即一次或多次住院),然而对照组98例患者中有14例(14.3%)复发(X2=8.83,p=0.003)。结论 :本研究样本量大、随访时间相对长、随机设计并采用单盲法评估,研究结果的说服力相对强。本研究发现自我管理干预后患者复发显著减少、服药依从性改善以及自知力提高。这些结果拓展了我们先前的研究发现,显示自我管理训练可以有效改善社区慢性精神分裂症患者的症状和社会功能。今后需要纳入成本效益分析研究,评估将自我管理干预扩大到其他更多社区的可行性。