Care transition strategies in Latin American countries: an integrative review / Estrategias de transición de cuidados en los países latinoamericanos: una revisión integrativa / Estratégias de transição de cuidados nos países latino-americanos: uma revisão integrativa

Abstract OBJECTIVE To identify and analyze available literature on care transition strategies in Latin American countries. METHODS Integrative literature review that included studies indexed in PubMed, LILACS, Web of Science Core Collection, CINAHL, SCOPUS databases, and the Scientific Electronic Library Online (SciELO), published in Portuguese, Spanish or English, between 2010 and 2017. RESULTS Eleven articles were selected and the strategies were grouped into components of care transition: discharge planning, advanced care planning, patient education and promotion of self-management, medication safety, complete communication of information, and outpatient follow-up. These strategies were carried out by multidisciplinary team members, in which nurses play a leading role in promoting safe care transitions. CONCLUSIONS Care transition activities are generally initiated very close to patient discharge, this differs from recommendations of care transition programs and models, which suggest implementing care transition strategies from the time of admission until discharge.

Resumen OBJETIVO Identificar la literatura disponible sobre estrategias de transición del cuidado entre niveles de atención a la salud en países de América Latina. MÉTODOS Revisión integradora que incluyó estudios indexados en las bases de datos PubMed, LILACS, Web of Science Core Collection, CINAHL, Scopus y Scientific Electronic Library Online (SciELO), publicados en portugués, español o inglés, entre 2010 y 2017. RESULTADOS Se seleccionaron once artículos y las estrategias fueron agrupadas en componentes de la transición del cuidado: planificación de alta, planificación anticipada de cuidados, educación del paciente y promoción de la autogestión, seguridad de la medicación, comunicación completa de las informaciones y acompañamiento ambulatorial. Estas estrategias fueron realizadas por miembros del equipo multidisciplinario, en los que las enfermeras desempeñan un papel de liderazgo en la promoción de transiciones de cuidados seguras. CONCLUSIÓN Las actividades de transición del cuidado generalmente se inician muy cerca del alta del paciente, esto difiere de las recomendaciones de programas y modelos de transición de cuidados, que sugieren la implementación de estrategias de transición del cuidado desde el momento de la admisión hasta la alta.

Resumo OBJETIVO Identificar a literatura disponível sobre estratégias de transição do cuidado entre níveis de atenção à saúde em países da América Latina. MÉTODOS Revisão integrativa da literatura que incluiu estudos indexados nas bases de dados PubMed, LILACS, Web of Science Core Collection, CINAHL, SCOPUS e Scientific Electronic Library Online (SciELO), publicados em português, espanhol ou inglês, entre 2010 e 2017. RESULTADOS Onze artigos foram selecionados e as estratégias foram agrupadas em componentes da transição do cuidado: planejamento de alta, planejamento antecipado de cuidados, educação do paciente e promoção do autogerenciamento, segurança da medicação, comunicação completa das informações e acompanhamento ambulatorial. Essas estratégias foram realizadas por membros da equipe multidisciplinar, nas quais enfermeiros desempenham um papel de liderança na promoção de transições de cuidados seguras. CONCLUSÕES As atividades de transição do cuidado geralmente são iniciadas muito próximas da alta do paciente, isso difere das recomendações de programas e modelos de transição de cuidados, que sugerem a implementação de estratégias transição de cuidado desde o momento da admissão até a alta.

Conhecimento da doença em pacientes com insuficiência cardíaca / Disease knowledge of patients with heart failure

Uma das maiores dificuldades na adesão ao tratamento de portadoresde insuficiência cardíaca (IC) é a falta de conhecimentosobre a doença e seu tratamento. Este estudo teve como objetivoavaliar o conhecimento do paciente com IC em relação à suadoença. Estudo de natureza descritiva e exploratória realizado noambulatório de Cardiologia de um hospital terciário no interiordo Estado de São Paulo. O conhecimento foi avaliado por meiodo questionário de avaliação do conhecimento e autocuidado daIC. Fizeram parte desta amostra 32 pacientes com idade médiade 61 (± 12) anos. Os pacientes apresentaram média de acertosde 11,4% (± 7), sendo que 44% conheciam sobre a afecção, 25%souberam relatar os sintomas de IC, 31% responderam corretamentea ação do IECA e 28% da digoxina; entretanto, pequenaparcela soube informar os efeitos adversos desses medicamentos.Referente ao tratamento não farmacológico, 16% dos pacientesresponderam corretamente sobre o consumo de bebidas alcoólicas,34% sobre os alimentos que contribuem na soma de líquidosingeridos por dia e 31% entendem a importância do controlede peso. Este estudo revelou que os pacientes portadores de ICapresentaram baixa média de acertos sobre o conhecimento,tratamento e autocuidado. A ampliação do conhecimento dospacientes, com implementação de novas estratégias, constituiaspecto relevante para a mudança do seu comportamento e,consequentemente, melhora do autocuidado.

A major difficulty with treatment adherence in patients withheart failure (HF) is the lack of knowledge about the diseaseand its treatment. This study aimed to assess the knowledgeof patients with HF in relation to their disease. Study of descriptiveand exploratory nature performed in cardiology clinicof a tertiary hospital in the countryside of the state of SãoPaulo. The knowledge was assessed through a questionnaireevaluating knowledge and self-care of HF. This questionnairewas applied in a sample of 32 patients with a mean age of 61years old (± 12). Patients had mean score correct of 11.4%(± 7), 44% knew about the disease, 25% were able to reportthe symptoms of HF, 31% answered correctly the action ofACE inhibitors and 28% knew about the action of digoxin.A small part, however, could inform the adverse effects ofthese drugs. Referring to non-pharmacological treatment,16% of patients answered about the consumption of alcoholicbeverages, 34% about foods that contribute to add to theliquid ingested per day and 31% understood the importanceof weight control. This study showed that patients with HFhad low score correct on knowledge, treatment and self-care.Broadening knowledge of patients with implementation ofnew strategies is a relevant aspect to change their behaviorand therefore improve self-care.

Uso de hipoglicemiantes e adesã à terapia por pacientes diabéticos atendidos no Sistema Único de Saúde / Use of oral hypoglycemic agents and adherence to therapy by diabetics in the Brazilian Unified Health System

Introdução: A incidência de Diabetes Melito atinge proporções epidêmicas fazendo com que sua prevenção seja uma prioridade de saúde pública. Programas de Atenção Farmacêutica vêm se destacando como instrumentos no cuidado dos pacientes diabéticos. Objetivo: Avaliar o uso de hipoglicemiantes e a adesão à terapia por pacientes diabéticos atendidos pelo Sistema Único de Saúde. Métodos: Foi realizado um estudo transversal. Utilizou-se um questionário farmacoterapêutico e avaliaram-se os valores de glicemia capilar, colesterol, triglicerídeos, hemoglobina glicada, pressão arterial e índice de massa corporal. Foi avaliada a existência dos Problemas Relacionados com Medicamentos. Resultados: Foram entrevistados 52 pacientes diabéticos, com idade média de 69,2±10,8 anos para as mulheres e 67,8 ±10,9 anos para os homens. Os valores de hemoglobina glicada mostraram diferença significativa (P<0,001) entre os sexos e o índice de massa corporal mostrou-se acima dos valores normais. Verificou-se que 51,9% dos pacientes utilizava mais de 5 medicamentos e 48,1% eram pouco aderentes à terapia. Encontrou-se 21 potenciais interações medicamentosas. Conclusão: Este estudo mostra a relevância do acompanhamento farmacoterapêutico à pacientes diabéticos e a importância do comprometimento de toda a equipe de saúde para desenvolver e acompanhar o plano terapêutico desses pacientes.

Background: The incidence of diabetes mellitus has reached epidemic proportions; therefore, its prevention is a public health priority in our days. Pharmaceutical care programs have gained prominence as a tool in the care of diabetic patients. Aim: To evaluate the use of hypoglycemic agents as well as the adherence to therapy by diabetic patients receiving treatment from the Brazilian Unified Health System. Methods: We conducted a cross-sectional study. A pharmacotherapeutic questionnaire was administered and values of capillary blood glucose, cholesterol, triglycerides, glycated hemoglobin, blood pressure, and body mass index were assessed. We evaluated the existence of drug related problems and drug interactions. Results: Fifty-two diabetic patients were interviewed with a mean age of 69.2±10.8 for women and 67.8±10.9 for men. Glycated hemoglobin levels showed significant difference (P<0.001) between men and women, body mass index was found to be above normal. The analysis of the drugs showed that 51.9% of the patients used more than five drugs and 48.1% of the patients were poorly adherent to therapy. We found 21 potential drug interactions. Conclusion: The present study demonstrates the relevance of the pharmaceutical follow-up of patients with diabetes; thus, the commitment of the entire health care team to develop and monitor the treatment of these patients is very important.

An ICMR task force study of Prevention of Parent to Child Transmission (PPTCT) service delivery in India.

A retrospective survey was conducted during August to December 2007 in 19 medical colleges of India to examine the functioning of the PPTCT service delivery. Data was extracted from records of the PPTCT centers for the year 2005-2006. HIV prevalence was higher than 2005 NACO figures in 11 out of 19 (57.8%) centers. There was wide variation in the proportion of women counseled & tested for HIV in different centers. Antenatal prophylaxis was practiced in 7 out of 19 (36.8%) centers. Overall intra-natal ART was provided to 52.8% of HIV positive women. Early newborn testing was available at 3 out of 19 (15.7%) centers. Improved counseling services are required for better case detection.

The informed consent status for surgery patients in eastern Turkey: a cross-sectional study.

This study assesses the quality of the informed consent process and satisfaction with the informed consent process, for surgery patients in Turkey. Four hundred and eighty three patients were interviewed after their surgeries. More than half of the patients were satisfied with the information on eight issues that pertained to the informed consent process. A majority of patients (91 per cent) were satisfied with the information regarding why an operation necessary. However, only 205 of 483 patients(42 per cent) indicated that they had received sufficient information on the potential side effects and complications of surgery. Patients' educational level and the type of surgery--urgent or elective--were associated with the satisfaction status.

Patients' perspectives on medical information: results of an informal survey.

The autonomy of patients in making medical decisions is increasingly recognised globally, but is not fully adhered to in India. Information is the first step for a patient to be able to make a decision on his or her health care. The objective of this survey was to ascertain patients' perspectives on the amount of information given to them by health professionals. The results of interviews with 222 patients show that perspectives vary, often according to the diagnosis. The amount of information given and the manner in which it is given are often not acceptable to the patient.

Informed consent in an antiretroviral trial in Nigeria.

We examined the process of informed consent in an antiretroviral trial in Nigeria. A semi-structured questionnaire was administered to 88 out of 180 people enrolled in the trial. This covered all aspects of the information disclosed in the leaflet of the antiretroviral trial. We found that 75 (85 per cent) of the respondents knew that the purpose of the research was to test a new drug and 13 (14 per cent) believed that they were receiving free treatment for HIV. Participants understood certain aspects of the research, especially the benefits and duration. Their understanding of the trial's risks and their right to refuse to participate and to withdraw was low. Their level of understanding was significantly related to age but not to gender, marriage, education, religion, employment and occupation. Signed informed consent is not a guarantee that participants have understood the information given to them and therefore made a voluntary decision to participate. Researchers should make sure that the process of obtaining informed consent achieves the desired outcome. This is especially important in the developing world where access to health care is limited, potential participants are poor and literacy levels are low.

Morbidity pattern of children with asthma: a prospective study.

OBJECTIVES: To determine the morbidity pattern of asthma in children attending the paediatric asthma follow-up clinic. MATERIALS AND METHODS: Longitudinal prospective follow up of hundred and four patients, diagnosed as asthma, over a period of 2 years was done. Regular follow up by the same person during each visit and proper supervision of standard treatment along with parental education regarding the asthma, was done. RESULTS: The mean age of children presenting with asthma was 6.7 years. Majority of children 49 (47.5%) were graded as mild persistent asthma. Fifty nine (56.7%) children were missing school more than 7 days per month. Family history was present in forty one percent of the children. Fifty seven (54.8%) children were taking significant amount of junk food and were undernourished. Significant reduction in school-missing days and Emergency Room visits was noted in these children during the follow up period. CONCLUSION: Awareness of disease is an important aspect of asthma management. Proper treatment and follow up with emotional support and education of the care taker, about the asthma, can reduce the morbidity pattern of asthma in children.

HIV/AIDS care and treatment in three provinces in northern Thailand before the national scale-up of highly-active antiretroviral therapy.

In 2003, Thailand launched a program to place 50,000 persons on highly active antiretroviral therapy (HAART) by the end of 2004, following a series of efforts since the early 1990s to develop comprehensive HIV/AIDS care services. To evaluate existing services and needs in advance of the national HAART scale-up, in 2002 we surveyed 31 hospitals and 389 community health centers in three northern Thai provinces, and interviewed 1,015 HIV-infected patients attending outpatient clinics. All hospitals offered voluntary HIV counseling and testing, 84% provided primary prophylaxis for Pneumocystis carinii pneumonia, 58% for tuberculosis, 39% for cryptococcal meningitis, and 87% had some experience providing antiretroviral therapy. Community health centers provided more limited service coverage. Of patients interviewed, 63% had been diagnosed with symptomatic HIV disease, and of these, 32% reported ever receiving antiretroviral therapy; 51 % of all patients had received a CD4 T-lymphocyte count. Thailand's current national HAART scale-up is being performed in a setting of well-developed hospital-based services introduced over the course of the epidemic.

The Effects of Brisk Walking versus Brisk Walking Plus Diet on Triglycerides and Apolipoprotein B Levels in Middle-aged Overweight/obese Women with High Triglyceride Levels / 간호학회지

PURPOSE: The purpose of this study were to investigate the effects of a 12-week brisk walking program on triglycerides (TG) and apolipoprotein B (Apo B) and to compare these effects to those of a brisk walking plus diet program in middle-aged overweight/obese (BMI> or =23) Korean women with hypertriglyceridemia. METHOD: This analysis was done with nineteen middle-aged overweight/obese Korean women who completed either the brisk walking program (9 women) or the brisk walking plus diet program (10 women) for 12 weeks. The brisk walking consisted of walking for 20 to 50 minutes/day at an intensity of 40 to 70% of heart rate reserve (HRR) for 3 to 6 days/week. The diet consisted of 60 minutes of group education and 20 to 30 minutes of individual counseling every week. TG and Apo B were assessed pre- and post-intervention. RESULTS: TG and Apo B decreased significantly after the brisk walking program (Z = -2.31, p = 0.021; Z = -2.59, p = 0.009). TG and Apo B lowering effects of the brisk walking program were not significantly different from those of the brisk walking plus diet program (U = 37.0, p = 0.549; U = 42.0, p = 0.842). CONCLUSION: Brisk walking can be an effective intervention for overweight/obese middle-aged women with hypertriglyceridemia in reducing cardiovascular risk by lowering TG and Apo B levels. Adding diet to brisk walking may have no additional significant effects on changes in TG and Apo B.

Effects of the Weight Management Program Based Self-Efficacy for Body Composition, Blood Lipid Profile, Weight Self-Efficacy Lifestyles, Depression in Middle-Aged Obese Women / 간호학회지

PURPOSE: This study was done to determine the effects of weight management program using self-efficacy in middle-aged obese women. The study also attempted to measure the effects of the program on the weight efficacy lifestyle, body composition, and depression. METHOD: The research design of this study was a nonequivalent control group pretest-posttest design. The experimental group consisted of 21 middle-aged obese women and another 21 middle-aged obese women in the control group. The women in the experimental group participated in the weight management program for 12 weeks using self-efficacy. The weight management program using self-efficacy included education on effects of exercise for weight control, aerobic exercise program, muscle training and counseling through the telephone. RESULTS: After 12 weeks of participation in the program, BMI (p<.0001), body fat % (p<.0001), abdominal fat (p<.0001), in the experimental group were significantly decreased compared to the control group. Weight self-efficacy lifestyle (p<.0001) and depression (p=.006) in the experimental group were significantly improved after the program compared to the control group. According to these findings, weight management program self-efficacy for middle-aged obese women could increase weight efficacy lifestyle, and decrease depression, BMI, body fat, and abdominal fat. CONCLUSION: The result also suggested that the increasing weight efficacy and lifestyle help the obese women to perform and continue exercise. This program could be used in the community such as public health center for weight care and mental health promotion of middle-aged obese women.

What do parents of asthmatic children know about asthma?: An Indian perspective.

BACKGROUND: Despite the magnitude of the asthma problem, very little is known about the public perception about asthma. METHODS: This descriptive study was conducted to evaluate the knowledge, attitude and practice about the causation, treatment and prognosis of asthma amongst the parents of children with asthma. Subjects were parents of asthmatic children attending two exclusive paediatric hospitals at Chennai, India. A semi-structured pre-validated questionnaire, which included their general understanding on asthma, its triggers and management, was administered. RESULTS: One hundred parents of asthmatic children participated in this study. A diagnosis of asthma was accepted only by 39%, of which only three knew exactly what asthma means. Perception that asthma is contagious was observed by 26%, and 35% believed asthma to be a hereditary disease. Various dietary items were perceived as triggers. Most of the parents (62%) administered oral beta-agonist medication at home before proceeding to hospital, but majority were using them as cough medication. Only 13 were administering aerosol therapy at home. Nearly one-third of the parents opined that the disease might remit with advancing age. CONCLUSIONS: General awareness of asthma in the community is poor. Patient education programme should augment awareness, eliminate social stigma and misconcepts in the community regarding asthma. Knowledge about the prevailing perception in the community would be the first step in achieving this.

Knowledge and concerns about cancer in patients with primary gynecologic cancers.

OBJECTIVE: The aim of this study was to measure the level of knowledge about cancer among patients with primary gynecologic cancers and the rate of awareness for diagnosis. METHODS: Two hundred patients with primary gynecologic cancers in Vaie Asr & Mirza Kochak Khan hospitals, Tehran/Iran, participated and entered the study and were interviewed by trained nurses. The interview included questions about knowledge of their cancer and risk factors. RESULTS: One hundred fifteen of 200 subjects (58%) knew that their disease was malignant, of which 56 were aware of the exact diagnosis. Fifty six percent of the subjects believed that doctors must say the true diagnosis. The level of general knowledge about cancer was poor in 34%of cases. Regarding cancer risk factors, 47% had a poor level of knowledge. Misconception about injury and depression as predisposing factors were common. Level of general knowledge was significantly higher in younger than in older patients (p<0.05). Also patients with a greater length of formal education had a higher level of knowledge (p<0.0001). Patients who received information from medical personnel and who were aware of diagnosis had a higher level of knowledge (p<0.0001). CONCLUSION: The level of knowledge about cancer should be promoted in both the general public and in patients. Medical personnel may play a great role in this field.

Effectiveness of a Smoking Cessation Program for Adolescents / 간호학회지

PURPOSE: The purpose of this study was to test the effectiveness of a comprehensive smoking cessation program for Korean adolescents. METHOD: The study design was quasi-experimental with one pre and three post-tests. The three posttests were done immediately after, three months later, and six months after the completion of the program. A total of 43 high school students who smoked participated in the study with 22 in the experimental group and 21 in the control group. The smoking cessation program consisted of 9 sessions with content on enhancement of self-efficacy, stress management, correction of distorted thoughts, consciousness raising, and assertiveness training. The study variables were urine cotinine levels, self-efficacy, stress, and stages of changed behavior. RESULTS: Urine cotinine levels significantly decreased in the experimental group after the program (F=3.02, p=.06) but significantly increased in the control group (F=6.32, p=.004). Self-efficacy and the degree of stress did not change in either group. The stages of smoking cessation behavior tended to change when compared with raw data for the experimental group. For most participants, the stages of change had been precontemplation and contemplation, but changed to action and maintenance stage among the experimental group. CONCLUSION: The program was effective in smoking cessation and influencing stages of change but did not change psychosocial factors such as self-efficacy and stress. It is suggested a program should be developed to change psychosocial variables on a long-term basis. It is also desirable to involve peers and families of adolescents who smoke when planning programs to enhance social support.

The Development and Evaluation of an Incontinence Intervention Program for the Elderly Women at Elderly Welfare Center / 간호학회지

PURPOSE: The elderly with UI experienced urine leakage for a long time. The prevalence of UI has increased and it makes costly. Particularly, the elderly were reluctant to visit a hospital or a clinic for the reasons of modesty and poverty. To solve this problem, incontinence intervention programs should be provided at the elderly welfare center. The purpose of this research was to develop Incontinence Intervention Program for the Elderly Women (IIPE) and evaluate in its effect. METHODS: The study design was quasi-experimental with pre and post-test. The study was performed for ten weeks at one elderly welfare center, Seoul, Korea. The subjects were gathered through an official announcement and informed consent was obtained. IIPE, in this study, was consisted of diagnosis, education, exercise and evaluation. The study variables were PFM exercise adherence, pelvic muscle strength, Continence selfefficacy, geriatric depression and incontinence stress. The effects of the IIPE on PFM exercise adherence, pelvic muscle strength, Continence self-efficacy, geriatric depression and incontinence stress were also evaluated. RESULTS: The mean age of the subjects was 75.2 years. The average attendance was 6.2 times. The IIPE improved PFM exercise adherence, intra-vaginal contraction power and CSE significantly. But it was not significant in incontinence stress and geriatric depression. Other important results were that the two-finger test and urine stream interruption were more useful for elderly women with rigid vaginas in teaching and evaluating. CONCLUSION: The Findings suggest that IIPE is effective to the community-residing elderly. Further investigation is needed on a long-term basis with control group.

Intensive diabetes education program and multidisciplinary team approach in management of newly diagnosed type 1 diabetes mellitus: a greater patient benefit, experience at Siriraj Hospital.

It is accepted worldwide that an effective multidisciplinary management team is essential for providing comprehensive self-management training to type I diabetics and their families. Therefore, the authors developed an intensive multidisciplinary education team that included pediatric endocrinologists, a dietitian, a psychologist, nurses, scientists and volunteers in the Department of Pediatrics, Siriraj Hospital in August 1996. This study aimed to analyze twenty-four newly diagnosed diabetics who underwent this specified program and multidisciplinary team approach in comparison to twenty-eight diabetic patients who were diagnosed before the program and team were established in order to see whether the length of hospitalization had been reduced and to compare the readmission rates of recurrent DKA with previous patients. The results demonstrated that by using the intensive program and multidisciplinary team the average length of admission was reduced from 36.04 days to 17.63 days (p value = 0.03). The readmission rate in the first year after diagnosis was also reduced from 17.8 per cent to 4 per cent. Concerning diabetes control, the average HbA1c level showed significantly better control. Therefore, this study demonstrated a successful team and program for newly diagnosed Thai childhood and adolescent diabetics and also emphasized that a multidisciplinary team approach with an effectively intensive education program is important in helping diabetics and families cope with their emerging problems and receive the long-term benefits of effective self-care.