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BACKGROUND: Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. OBJECTIVE: This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. METHODS: A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. RESULTS: The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. CONCLUSIONS: This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.
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Abstract Introduction: Immobility is associated with adverse outcomes such as loss of functional capacity and longer hospitalization. Objective: To assess intra-hospital mobility at admission as a predictor of loss of functional capacity during older adults´ hospitalization. Methods: A prospective cohort study was conducted, and personal and hospital related risk factors were assessed at admission and discharge. To determine whether Short Physical Performance Battery (SPPB) on admission could predict loss of functional capacity during hospitalization, a ROC curve was performed and area under the curve (AUC) was calculated. Binary logistic regression models were used to identify predictors of loss of functional capacity. Model 1 contained only SPPB. Model 2 SPPB was matched with age, sex, instrumental activity of daily living (IADL), cognition, depression and surgery. Data were entered into SPSS version 18.0. Results: 1,191 patients were included with a mean age of 70.02 (± 7.34). SPPB cutoff point of 6.5 (sensitivity 62%, specificity 54%) identified 593 (49.8%) patients at risk for functional loss. In logistic regression, SPPB alone showed prediction of functional loss (p < 0.001, OR 1.8, 95% CI = 1.5-2.5) between admission and discharge. Model 1 explained between 22 to 32% of the variation in functional capacity. In Model 2, three variables contributed to the loss. SPPB 6.5 increased 1.8 times (95% CI = 1.3-2.4), being a woman increased 1.4 times (95% CI = 1.0-1.8) and not having surgery increased 2 times (95% CI = 1.4-2.8) the chance of having functional loss during hospitalization. Conclusion: SPPB is a good instrument to predict loss of functional capacity in hospitalized older adults.
Resumo Introdução: A imobilidade está associada a resultados adversos, como perda da capacidade funcional e maior tempo de hospitalização. Objetivo: Avaliar a mobilidade intra-hospitalar na admissão como preditor de perda da capacidade funcional durante a hospitalização de idosos. Métodos: Um estudo de coorte prospectivo foi conduzido e os fatores de risco pessoais e relacionados ao hospital foram avaliados na admissão e alta. Para determinar se o Short Physical Performance Balance (SPPB) na admissão poderia prever a perda de capacidade funcional durante a internação, uma curva ROC foi realizada e a área sob a curva (AUC) foi calculada. Modelos de regressão logística binária foram usados para identificar preditores de perda de capacidade funcional. O modelo 1 continha apenas SPPB. O modelo 2 SPPB foi pareado com idade, sexo, atividades instrumentais da vida diária (AIVD), cognição, depressão e cirurgia. Os dados foram inseridos no SPSS versão 18.0. Resultados: Foram incluídos 1.191 pacientes com idade média de 70,02 (± 7,34). O ponto de corte do SPPB de 6,5 (sensibilidade 62%, especificidade 54%) identificou 593 (49,8%) pacientes com risco de perda funcional. Na regressão logística, o SPPB sozinho mostrou predição de perda funcional (p < 0,001, OR 1,8, IC 95% = 1,5-2,5) entre a admissão e a alta. O modelo 1 explicou entre 22 a 32% da variação da capacidade funcional. No Modelo 2, três variáveis contribuíram para a perda. SPPB 6,5 aumentou 1,8 vezes (IC 95% = 1,3-2,4), ser mulher aumentou 1,4 vezes (IC 95% = 1,0-1,8) e não ter operado aumentou 2 vezes (IC 95% = 1,4-2,8) a chance de ter perda funcional durante a hospitalização. Conclusão: O SPPB é um bom instrumento para predizer a perda da capacidade funcional em idosos hospitalizados.
Subject(s)
Humans , Aged , Risk Factors , Physical Therapy Modalities , Hospitalization , Cohort Studies , Physical Functional PerformanceABSTRACT
O estudo teve como objetivo desvelar a percepção dos residentes sobre prevenção de quedas no Programa de Residência Multiprofissional em Saúde para estabelecer melhoria de processos assistenciais em um Hospital Universitário. Realizou-se uma pesquisa qualitativa, descritiva- exploratória, com os residentes do primeiro ano dos programas de cardiologia e terapia intensiva do adulto. Para a coleta de informações, optou-se pela técnica de grupo focal, onde as conversas foram gravadas e transcritas na íntegra, e a análise de conteúdo por BARDIN. Evidenciou-se com os relatos dos participantes, o conhecimento sobre as estratégias de prevenção de quedas, a integração dos profissionais de saúde e a construção de propostas de ações de mudanças na incorporação de atividades multiprofissionais. Concluiu-se com a percepção dos residentes, a necessidade de educação permanente em saúde, o trabalho em equipe no cuidado integral ao usuário e a revisão periódica de protocolos para promover a redução de quedas
Subject(s)
Humans , Female , Patient Care Team , Accidental Falls/prevention & control , Health Knowledge, Attitudes, Practice , Internship and ResidencyABSTRACT
Independent mobility is a key factor in predicting morbidity and determining hospital discharge readiness for older patients. The main objective was identify and appraise relevant instruments for the measurement of mobility of hospitalized geriatric patients. A systematic review was performed in two consecutive steps. Based on the definition of mobility of the International Classification of Functioning (ICF). Step 1 identified mobility measurement instruments used to assess patients 60 years of age and over hospitalized in acute care or intensive geriatric rehabilitation unit. Aim of the instrument, coverage of mobility construct, applicability (format, training required, administration time and use of assistive devices) were extracted. For each included instrument, Step 2 identified and appraised articles reporting about their measurement properties. Consensus-based Standards for the selection of health status Measurement INstruments (COSMIN) was used by two independent reviewers to critically appraise and compare the measurement properties. Step 1 resulted in 6350 articles, of which 28 articles reported about 17 different instruments. Step 2 retained 11 instruments with 70 articles reporting about their measurement properties in various settings. Judgement-based instruments (n=5) covered the ICF mobility construct more broadly than performance-based measures (n=6). Our results showed that 3 instruments (DEMMI, SPPB and Tinetti scale) had the most extensive and robust measurement properties, and from those, SPPB and DEMMI covered the mobility construct more broadly but SPPB had the longest administration (10-15min). Conclusion SPPB presents the best balance between mobility coverage, measurement properties and applicability to acute care or intensive geriatric rehabilitation unit.
