Mindfulness Practice for Glycemic Control: Could it be a New Strategy for an Old Problem? A Systematic Review and Meta-Analysis.

BACKGROUND: The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient's lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual's adherence. Therefore, equipping the patients with the necessary coping and self-care techniques may be an important step in managing diabetes. OBJECTIVE: To evaluate the effect of interventions using established mindfulness-based protocols on glycemic control of individuals with T2DM. METHODS: Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in English, Spanish and Portuguese languages. STUDY SELECTION: Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected. DATA EXTRACTION: Two authors independently assessed the risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence). CONCLUSION: Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness have no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, large-scale trials are needed to evaluate the contribution of mindfulness to glycemic control in clinical practice. PROSPERO Registration ID: RD42020161940.

Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack: A Cluster Randomized Clinical Trial.

IMPORTANCE: Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries. OBJECTIVE: To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. DESIGN, SETTING AND PARTICIPANTS: This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. INTERVENTIONS: The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). RESULTS: A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01). CONCLUSIONS AND RELEVANCE: A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02223273.

An international cluster-randomized quality improvement trial to increase the adherence to evidence-based therapies for acute ischemic stroke and transient ischemic attack patients: Rationale and design of the BRIDGE STROKE Trial.

BACKGROUND: Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging especially in low- and middle-income countries. OBJECTIVES: The aim of this study is to assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for AIS and TIA patients care. DESIGN: We designed a pragmatic, 2-arm cluster-randomized trial involving 36 clusters and 1624 patients from Brazil, Argentina, and Peru. Hospitals are randomized to receive a multifaceted quality improvement intervention (intervention group) or to routine care (control group). The BRIDGE Stroke multifaceted quality improvement intervention includes case management, reminders, health care providers' educational materials (including treatment algorithms), interactive workshops, and audit and feedback reports. Primary outcome is a composite adherence score to AIS and TIA performance measures. Secondary outcomes include an "all or none" composite end point to performance measures, the individual components of the composite end points, and clinical outcomes at 90 days following admission (stroke recurrence, death, and disability measured by the modified Rankin scale). SUMMARY: The BRIDGE Stroke Trial is an international pragmatic evaluation of a multifaceted quality improvement intervention. If effective, this intervention could be potentially extended widely to improve the quality of care and outcomes of patients with AIS or TIA.

Psico-Oncologia: atuação do psicólogo no Hospital de Câncer de Barretos / Psycho-oncology: the psychologist in the Barretos Cancer Hospital / Psico-oncología: el psicólogo en el Hospital del Cáncer de Barretos / La psycho-oncologie: le psychologue à L' Hôspital des Cancers de Barretos

A Psico-Oncologia surgiu a partir da necessidade do acompanhamento psicológico ao paciente com câncer, a sua família e à equipe que o acompanha. O papel do psicólogo em oncologia propõe o apoio psicossocial e psicoterapêutico diante do impacto do diagnóstico e de suas consequências e mostra a possibilidade de auxílio para melhor enfrentamento e qualidade de vida do doente e de seus familiares. O objetivo deste relato consiste em descrever a atuação desenvolvida por psicólogos do Serviço de Psicologia do Hospital de Câncer de Barretos/Fundação Pio XII - SP, uma instituição médica especializada em oncologia.(AU)

Psycho-oncology arose from the need of psychological intervention for patients with cancer, their families and medical staff. The role of the psychologist in this field is to provide psychosocial support and psychotherapy in face of the impact of the diagnosis and its aftermath. It aims at facilitating better coping and quality of life for patients and their families. The objective of this report is to describe the actions developed by the psychologists of the Department of Psychology at the Barretos Cancer Hospital/ Pio XII Foundation - SP, a medical institution specialized in oncology.(AU)

La Psico-oncología surgió de la necesidad del acompañamiento psicológico al paciente con cáncer, su familia y el personal que lo acompaña. El papel del psicólogo en oncología ofrece apoyo psicosocial y psicoterapéutico contra el impacto del diagnostico y sus consecuencias, y muestra la posibilidad de una ayuda a un mejor afrontamiento y calidad de vida de los pacientes y sus familias. El propósito de este informe es describir el papel desarrollado por psicólogos del Servicio de Psicología del Hospital de Cáncer de Barretos/Fundación Pio XII - SP - Brasil, una institución médica especializada en oncología.(AU)

La psycho-oncologie aborde la nécessité de l`accompagnemente psychique des patients avec le cancer, sa famille et l'équipe qui lui accompagnent. Le rôle du psychologue qui travaille dans le service d'oncologie propose un appui psychosocial et psychothérapeutique devant l'impacte de la diagnostique et ses consequences, et montre la possibilité d'une aide pour le meilheur affaire face à la qualité de la vie du pacient et de ses familliers. L'object de ce rapport c'est la description de la performance du psycologue de l'Hôpital des Cancers de Barretos - Fondaction Pio XII - São Paulo - Brésil, une institution médicale specialisée en oncologie.(AU)

Psico-Oncologia: atuação do psicólogo no Hospital de Câncer de Barretos / Psycho-oncology: the psychologist in the Barretos Cancer Hospital / Psico-oncología: el psicólogo en el Hospital del Cáncer de Barretos / La psycho-oncologie: le psychologue à L' Hôspital des Cancers de Barretos

A Psico-Oncologia surgiu a partir da necessidade do acompanhamento psicológico ao paciente com câncer, a sua família e à equipe que o acompanha. O papel do psicólogo em oncologia propõe o apoio psicossocial e psicoterapêutico diante do impacto do diagnóstico e de suas consequências e mostra a possibilidade de auxílio para melhor enfrentamento e qualidade de vida do doente e de seus familiares. O objetivo deste relato consiste em descrever a atuação desenvolvida por psicólogos do Serviço de Psicologia do Hospital de Câncer de Barretos/Fundação Pio XII - SP, uma instituição médica especializada em oncologia.

Psycho-oncology arose from the need of psychological intervention for patients with cancer, their families and medical staff. The role of the psychologist in this field is to provide psychosocial support and psychotherapy in face of the impact of the diagnosis and its aftermath. It aims at facilitating better coping and quality of life for patients and their families. The objective of this report is to describe the actions developed by the psychologists of the Department of Psychology at the Barretos Cancer Hospital/ Pio XII Foundation - SP, a medical institution specialized in oncology.

La Psico-oncología surgió de la necesidad del acompañamiento psicológico al paciente con cáncer, su familia y el personal que lo acompaña. El papel del psicólogo en oncología ofrece apoyo psicosocial y psicoterapéutico contra el impacto del diagnostico y sus consecuencias, y muestra la posibilidad de una ayuda a un mejor afrontamiento y calidad de vida de los pacientes y sus familias. El propósito de este informe es describir el papel desarrollado por psicólogos del Servicio de Psicología del Hospital de Cáncer de Barretos/Fundación Pio XII - SP - Brasil, una institución médica especializada en oncología.

La psycho-oncologie aborde la nécessité de l`accompagnemente psychique des patients avec le cancer, sa famille et l'équipe qui lui accompagnent. Le rôle du psychologue qui travaille dans le service d'oncologie propose un appui psychosocial et psychothérapeutique devant l'impacte de la diagnostique et ses consequences, et montre la possibilité d'une aide pour le meilheur affaire face à la qualité de la vie du pacient et de ses familliers. L'object de ce rapport c'est la description de la performance du psycologue de l'Hôpital des Cancers de Barretos - Fondaction Pio XII - São Paulo - Brésil, une institution médicale specialisée en oncologie.