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Martínez-González CL, Camargo Fajardo MCC, Martínez-Ortiz EJ, Segura-Medina P. A soft systems approach of asthma management in children based on therapeutic education and e-learning. Respir Med 2024; 230:107691. [PMID: 38844003 DOI: 10.1016/j.rmed.2024.107691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
One of the most common respiratory chronic diseases is asthma, with 5-16 % of world prevalence. In chronic disease, prevention, diagnosis, management, and palliation are the strategies for a care model; the patient-self management is fundamental with the so-called therapeutic education (TE) to train the patient in the necessary skills. The challenge of TE grows when the patient is a child or a person with special needs, even more in public health care in low- and middle-income countries. This is a problematic human situation, that needs soft system thinking. In this research, the analytic hierarchy process was used to determine the perceived importance of the factors that affect children's asthma health care in a public health institution in Mexico. The soft systems methodology (SSM) was applied to learn about the disease self-management, in order to obtain activities models and an action plan. According to AHP, human resources and education were percived as the most important among the factors that affect children health care within the institution. The perceived importance of two main subfactors (human resources training and TE) was around 34 %, which emphasizes the need to generate strategies for the improvement of the education of patients and health care providers. In MSS, the rich vision, the CATWOE, the root definition, and an activities model were proposed, including the application of an instructional design methodology (ADDIE) for the development of learning objects of asthma for children. Desirable and feasible actions and recommendations include the update of the national clinical practice guides, the use of control measures such as the Asthma Control Test, and a daily asthma diary to register the daily status of the breathing capacity, the drug administration, and the potential trigger events. The proposed model can be used as part of a systemic patient-and-family centered approach for chronic care model (CCM), particularly in diseases unsuitable for prevention interventions.
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Affiliation(s)
- C L Martínez-González
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, CP. 07738, Mexico.
| | - M C C Camargo Fajardo
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, CP. 07738, Mexico
| | - E J Martínez-Ortiz
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, CP. 07738, Mexico
| | - P Segura-Medina
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias, CP. 14080, Mexico; Escuela de Medicina y Ciencias de la Salud, ITESM-CCM, CP. 14380, Mexico
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Cámara A, Compta Y, Baixauli M, Maragall L, Pérez-Soriano A, Montagut N, Ahuir M, Ludeña E, Peri L, Fernández N, Villote S, Lopez de Los Reyes JC, Navarro-Otano J, Zaro I, Muñoz E, Buongiorno M, Caballol N, Pont-Sunyer C, Puente V, Giraldo D, Valldeoriola F, Lombraña M, Martí MJ. Pilot therapeutic education program in multiple system atrophy: Safety, quality of life and satisfaction from a national registry based longitudinal study. Parkinsonism Relat Disord 2024; 124:106993. [PMID: 38735163 DOI: 10.1016/j.parkreldis.2024.106993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers. METHODS In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants. RESULTS At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations. CONCLUSIONS The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.
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Affiliation(s)
- A Cámara
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain.
| | - Y Compta
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain.
| | - M Baixauli
- Urology Service. Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Maragall
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - A Pérez-Soriano
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - N Montagut
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M Ahuir
- Psychology Unit Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Ludeña
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - L Peri
- Psychology Unit Hospital Clinic de Barcelona, Barcelona, Spain
| | - N Fernández
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - S Villote
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - J C Lopez de Los Reyes
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - J Navarro-Otano
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - I Zaro
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - E Muñoz
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | | | - N Caballol
- Hospital Moisès Broggi, Sant Joan Despí, Spain
| | | | - V Puente
- Hospital del Mar, Barcelona, Spain
| | - D Giraldo
- Hospital Comarcal Sant Jaume de Calella, Spain
| | - F Valldeoriola
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M Lombraña
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M J Martí
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
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Bahendeka S, Kaushik R, Swai AB, Otieno F, Bajaj S, Kalra S, Bavuma CM, Karigire C. EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management. Diabetes Ther 2019; 10:341-366. [PMID: 30815830 PMCID: PMC6437255 DOI: 10.1007/s13300-019-0574-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Indexed: 02/07/2023] Open
Abstract
To date, insulin therapy remains the cornerstone of diabetes management; but the art of injecting insulin is still poorly understood in many health facilities. To address this gap, the Forum for Injection Technique and Therapy Expert Recommendations (FITTER) published recommendations on injection technique after a workshop held in Rome, Italy in 2015. These recommendations are generally applicable to the majority of patients on insulin therapy, athough they do not explore alternative details that may be suitable for low- and middle-income countries. The East Africa Diabetes Study Group sought to address this gap, and furthermore to seek consensus on some of the contextual issues pertaining to insulin therapy within the East African region, specifically focusing on scarcity of resources and its adverse effect on the quality of care. A meeting of health care professionals, experts in diabetes management and patients using insulin, was convened in Kigali, Rwanda on 11 March 2018, and the following recommendations were made: (1) insulin should be transported safely, without undue shaking and exposure to high (> 32 °C) temperature environments. (2) Insulin should not be transported below 0 °C. (3) If insulin is to be stored at home for over 2 months, it should be stored at the recommended temperature of 2-8 °C. (4) Appropriate instructions should be given to patients while dispensing insulin. (5) Insulin in use should be kept at room temperature and should never be kept immersed under water. Immersing insulin under water after the vial has been pierced carries a high risk of contamination, leading to loss of potency and likelihood of causing injection abscesses. (6) The shortest available needles (4 mm for pen and 6 mm for insulin syringe) should be preferred for all patients. (7) In routine care, intramuscular injections should be avoided, especially with long-acting insulins, as it may result in severe hypoglycaemia. (8) The practice of slanting the needle excessively should be avoided as it results in sub-epidermal injection of insulin which leads to poor absorption and may cause "tattooing" of the skin and scarring. (9) In patients presenting in a wasted state, with "paper-like skin", injections should, if possible, be initiated with pen injection devices, so as to utilise the 4-mm needle without lifting a skin fold (pinching the skin); otherwise lifting of a skin fold is required, if longer needles are utilised. (10) Reuse of needles and syringes is not recommended. However, as the reuse of syringes and needles is practiced for various reasons, and by many patients, individuals should not be given alarming messages; and usage should be limited to discarding when injections become more painful; but at any rate not to exceed reusing a needle more than 5 times.
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Affiliation(s)
- Silver Bahendeka
- Department of Internal Medicine, Mother Kevin Post Graduate Medical School, Uganda Martyrs University, Kampala, Uganda.
- St. Francis Hospital, Kampala, Uganda.
| | | | - Andrew Babu Swai
- Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | - Fredrick Otieno
- Department of Clinical Medicine and Therapeutics School of Medicine, College of Health Science, University of Nairobi, Nairobi, Kenya
| | - Sarita Bajaj
- Department of Clinical Medicine and Therapeutics School of Medicine, College of Health Science, University of Nairobi, Nairobi, Kenya
| | - Sanjay Kalra
- Moti Lal Nehru Medical College, Allahabad, India
- Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - Charlotte M Bavuma
- Department of Internal Medicine, College of Medicine and Health Sciences, Kigali University Teaching HospitalUniversity of Rwanda, Kigali, Rwanda
| | - Claudine Karigire
- Department of Internal Medicine, Rwanda Military Hospital, Kigali, Rwanda
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Jansà M, Bertran MJ, Vilardell J, Garcia F, Escarrabill J. Analysis of the quality of patient therapeutic education and information in a high complexity reference hospital. J Healthc Qual Res 2018; 33:343-351. [PMID: 30482647 DOI: 10.1016/j.jhqr.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The application and monitoring of quality criteria in information and therapeutic patient education can identify areas to improve care. The objectives of this study were: (1) To analyze the characteristics of patient information materials, educational activities, and self-management programs, and (2) to determine health care provider (HCP) proposals on therapeutic patient education. MATERIALS AND METHODS Using a cross-sectional study, an online questionnaire was sent to hospital departments in a high complexity reference hospital from September to December 2013 to record: (a) information materials, (b) patient educational activities, and self-management program characteristics, (c) HCP proposals. The materials were analyzed using Health Promoting Hospitals (HPH) recommendations. RESULTS (1) An analysis was performed on 258 materials (leaflets [54%]) for chronic patients (86%), acute patients (7%), and the general population (7%). More than half (55%) lacked the authors, and 43% the year issued, and 69% followed HPH recommendations. (2) An evaluation was made of 70 educational activities and 37 self-management programs addressed to patients/relatives with diabetes/obesity, musculoskeletal disorders, COPD/asthma, pelvic-floor disorders, transplantation, bowel-inflammation/liver disease, hypertension, cancer, heart failure, acquired immune deficiency syndrome, chronic renal insufficiency, splenectomy, anticoagulation and older-patient dependence. The structure, process and outcome evaluation varied. (3) HCP proposals included: standardization of materials criteria, web accessibility, list of accredited websites, cross-sectional use, and HCP training in self-management education. CONCLUSIONS The online questionnaire showed the weaknesses and strengths of patient information and education, and can be used to monitor their quantity and quality. These results help in the definition of a useful model to improve patient information and education policies.
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Affiliation(s)
- M Jansà
- Diabetes Unit, Chronic Care Program, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain; Chronic Care Program, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain.
| | - M J Bertran
- Preventive Medicine and Epidemiology Department, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
| | - J Vilardell
- Communication Area, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
| | - F Garcia
- Information Technologies Systems, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
| | - J Escarrabill
- Chronic Care Program, Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain; REDISSEC, Health Services Research on Chronic Patients Network, Mater Plan for Respiratory Diseases & Home Respiratory Therapies Observatory ((Ministry of Health, Catalonia), Hospital Clínic, 170 Villarroel Street, 08036 Barcelona, Spain
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