ABSTRACT
Objectives: a) to analyze the evidence available about poor adherence/non-adherence, including prevalences, associated factors, and interventions in ulcerative colitis (UC) patients; b) to provide a framework to improve poor adherence/non-adherence.Methods: a qualitative approach was used. A literature review was performed using Medline. Primary searches were performed with Mesh and free texts to identify articles that analyzed prevalence, causes, associated factors, and interventions designed to improve poor adherence/ non-adherence in UC patients. Study quality was evaluated using the Oxford scale. The results were presented and discussed in a nominal group meeting comprising a multidisciplinary committee of six gastroenterologists, one psychologist, one nurse, and one patient. Several overarching principles and recommendations were generated. A consensus procedure was implemented via a Delphi process, during which each committee member produced a score ranging from 0 = totally disagree to 10 = totally agree. Agreement was considered when at least 70 % of participants had voted ≥ 7.Results: the literature review included 75 articles. Non-adherence rates ranged from 7 % to 72 %. We found a great variability in the methods employed to assess adherence, associated factors, and interventions designed to improve adherence. Overall, eight overarching principles and six recommendations were generated, all of them achieving the pre-established agreement level, including, among others, the identification, classification, and management of non-adherence.Conclusions: Poor adherence/non-adherence are common in UC patients, this being a relevant clinical concern. Health professionals should address this issue and actively involve their patients in implementing effective, individualized interventions to improve adherence. (AU)
Subject(s)
Humans , Colitis, Ulcerative/therapy , Patients , Gastroenterologists , Consensus , PsychologyABSTRACT
OBJECTIVES: a) to analyze the evidence available about poor adherence/non-adherence, including prevalences, associated factors, and interventions in ulcerative colitis (UC) patients; b) to provide a framework to improve poor adherence/non-adherence. METHODS: a qualitative approach was used. A literature review was performed using Medline. Primary searches were performed with Mesh and free texts to identify articles that analyzed prevalence, causes, associated factors, and interventions designed to improve poor adherence/non-adherence in UC patients. Study quality was evaluated using the Oxford scale. The results were presented and discussed in a nominal group meeting comprising a multidisciplinary committee of six gastroenterologists, one psychologist, one nurse, and one patient. Several overarching principles and recommendations were generated. A consensus procedure was implemented via a Delphi process, during which each committee member produced a score ranging from 0 = totally disagree to 10 = totally agree. Agreement was considered when at least 70 % of participants had voted ≥ 7. RESULTS: the literature review included 75 articles. Non-adherence rates ranged from 7 % to 72 %. We found a great variability in the methods employed to assess adherence, associated factors, and interventions designed to improve adherence. Overall, eight overarching principles and six recommendations were generated, all of them achieving the pre-established agreement level, including, among others, the identification, classification, and management of non-adherence. CONCLUSIONS: Poor adherence/non-adherence are common in UC patients, this being a relevant clinical concern. Health professionals should address this issue and actively involve their patients in implementing effective, individualized interventions to improve adherence.
Subject(s)
Colitis, Ulcerative , Colitis, Ulcerative/therapy , Consensus , HumansABSTRACT
BACKGROUND AND AIMS: Our objective was to define, describe and organize (on the basis of consensus) the patient's preferences in the management of ulcerative colitis (UC), in order to further incorporate them in daily practice and improve patients satisfaction, adherence to the treatment and quality of care. METHODS: Qualitative study. A narrative literature review in Medline using Mesh and free-text terms was conducted to identify articles on UC patient preferences as well as clinical scenarios that may influence the preferences. The results were presented and discussed in a multidisciplinary nominal group meeting composed of six gastroenterologists, one primary care physician, one nurse practitioner and one expert patient. Key clinical scenarios and patient preferences were then defined, generating a series of points to consider and recommendations. The level of agreement with the final selection of preferences was established following a Delphi process. RESULTS: The narrative review retrieved 69 articles of qualitative design and moderate quality. The following key clinical scenarios were identified: diagnosis, follow-up, surgery, and special situations/patients profiles such as adolescents or women. Patient preferences were classified into information, treatment (pharmacological and non-pharmacological), follow-up, relations with health professionals, relations with the health system and administration. Finally, 11 recommendations on patient preferences for UC in relation to its management reached the level of agreement established. CONCLUSION: The consensual description of patient's preferences contribute to identify different areas for improvement in healthcare practice.
Subject(s)
Colitis, Ulcerative , Adolescent , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/therapy , Consensus , Female , Humans , Patient SatisfactionABSTRACT
Las alteraciones en las estructuras dentofaciales asociadas al tipo de respiración es un capítulo polémico en el campo de la ortodoncia. Aunque se han publicado muchos trabajos de investigación relacionados con el tema, parece que aún no está del todo claro para muchos investigadores. La respiración oral ha sido considerada durante mucho tiempo como un factor significante en la etiología de las maloclusiones, sin embargo, multitud de estudios científicos que examinan la relación entre el modo de respiración y la morfología dentofacial, concluyen negando que el tipo de respiración produzca cualquier alteración en el normal desarrollo craneofacial. El objetivo de esta Revisión Bibliográfica ha sido intentar aclarar si realmente la respiración oral afecta al crecimiento craneofacial y a las maloclusiones dentales, y en qué medida puede llegar a afectar a nuestros pacientes, teniendo en cuenta tanto factores locales como genéticos (AU)
The type of breathing associated with alterations in dentofacial structures is one of the most polemic topics in the field of orthodontics. A lot of work has been published about this matter, and it is still not clear to the investigators the relationship of this issues. For a long time, we have known that mouth breathing has been considered a significant factor in the etiology of maloclusions, nevertheless, multitude of studies have been done to examine the relationship between the way of breathing and dentofacial morphology without concluding data in relation to the alterations craniofacial development. The aim of this Bibliographical Review was to clarify if oral breathing affects craniofacial growth and dental maloclusions, and in which manner can they affect our patients, considering local and congenital factors (AU)
