Implementation Models of Compassionate Communities and Compassionate Cities at the End of Life: A Systematic Review.

In the last decade, we have seen a growth of Compassionate Communities and Cities (CCC) at the end of life. There has been an evolution of organizations that help construct Community-Based Palliative Care programs. The objective is to analyze the implementation, methodology and effectiveness of the CCC models at the end of life. We conducted a systematic review following PRISMA ScR Guideline. The protocol was registered on PROSPERO (CRD42017068501). Five databases (MEDLINE, EMBASE, Web of Science, CINAHL and Google Scholar) were searched for studies (from 2000 to 2018) using set eligibility criteria. Three reviewers screened full-texts articles and extracted study data. Outcomes were filled in a registration form which included a narrative synthesis of each article. We screened 1975 records. We retrieved 112 articles and included 31 articles for the final analysis: 17 descriptive studies, 4 interventions studies, 4 reviews and 6 qualitative studies. A total of 11 studies regard the development models of CCC at the end of life, 15 studies were about evaluation of compassionate communities' programs and 5 studies were about protocols for the development of CCC programs. There is poor evidence of the implementation and evaluation models of CCC at the end of life. There is little and low-/very low-quality evidence about CCC development and assessment models. We found no data published on care intervention in advance disease and end of life. A global model for the development and evaluation of CCC at the end of life seems to be necessary.

[Spanish experiences to promote personal autonomy in the elderly]. / Experiencias españolas en la promoción de la autonomía personal en las personas mayores.

OBJECTIVES: To identify studies analyzing the development of initiatives and the requisite characteristics of programs that promote personal autonomy, to identify the initiatives and policies developed in Spain to promote active aging and to determine whether the programs developed are consistent with the evidence in this field. METHOD: We performed a literature review and analyzed the policies developed in each Spanish region. Programs to promote personal autonomy were identified and analyzed through a questionnaire sent to the autonomous regions. RESULTS: Personal autonomy should be promoted through interventions to improve physical, cognitive, social and psycho-affective functions and by eliminating barriers that hamper independent living. Functional capacities are promoted through leisure activities (83%), reading and cognitive rehabilitation. Independent living is encouraged through podiatry services (38.9%) and food services at home (38.9%). Thirteen autonomous communities and the Biscay Regional Council have developed specific policies to promote personal autonomy. Personal autonomy activities are often conducted in senior or day centers. CONCLUSIONS: There are differences in the provision of programs to promote active aging. The development and implementation of these programs depends on the competent authority (Institute for the Elderly and Social Services, town councils, subsidized private entities, etc.). More evidence and a framework that defines common standards and criteria for the development of effective programs are required.

Experiencias españolas en la promoción de la autonomía personal en las personas mayores / Spanish experiences to promote personal autonomy in the elderly

Objetivos: Identificar en la literatura estudios que analicen el desarrollo de iniciativas y expresen las características que deben tener los programas para la promoción de la autonomía personal. Identificar las iniciativas y el desarrollo normativo de la promoción de la autonomía personal en las comunidades autónomas en España y analizar si los programas son consistentes con la evidencia disponible. Método: Revisión de la literatura y análisis de la información normativa e institucional de las comunidades autónomas. Identificación y análisis del desarrollo de programas para la promoción de la autonomía personal mediante cuestionario enviado a las comunidades. Resultados: La promoción de la autonomía personal debe fomentarse con programas que mejoren la capacidad funcional (física, cognitiva, social, psicoafectiva) y con actuaciones que eliminen barreras que dificultan la vida independiente. La capacidad funcional es promovida en las comunidades autónomas con actividades de ocio activo (83%), fomento de la lectura, mantenimiento y rehabilitación cognitiva. La eliminación de barreras personales es promovida en algunas comunidades con servicios de podología (38,9%), y las ambientales con servicios de comida a domicilio (38,9%). Trece comunidades autónomas y la Diputación Foral de Vizcaya han desarrollado normativas para la promoción de la autonomía personal. Las actividades suelen realizarse en centros para mayores o centros de día. Conclusiones: Hay diferencias en la provisión de los programas para la promoción de la autonomía personal. La ejecución y la programación dependen del organismo competente (IMSERSO, ayuntamientos, entidades privadas concertadas, etc.). Se evidencia la necesidad de desarrollar más estudios que generen consenso y establezcan un marco de iniciativas donde se definan estándares y criterios comunes para el desarrollo de programas efectivos (AU)

Objectives: To identify studies analyzing the development of initiatives and the requisite characteristics of programs that promote personal autonomy, to identify the initiatives and policies developed in Spain to promote active aging and to determine whether the programs developed are consistent with the evidence in this field. Method: We performed a literature review and analyzed the policies developed in each Spanish region. Programs to promote personal autonomy were identified and analyzed through a questionnaire sent to the autonomous regions. Results: Personal autonomy should be promoted through interventions to improve physical, cognitive, social and psycho-affective functions and by eliminating barriers that hamper independent living. Functional capacities are promoted through leisure activities (83%), reading and cognitive rehabilitation. Independent living is encouraged through podiatry services (38.9%) and food services at home (38.9%). Thirteen autonomous communities and the BiscayRegional Council have developed specific policies to promote personal autonomy. Personal autonomy activities are often conducted in senior or day centers. Conclusions: There are differences in the provision of programs to promote active aging. The development and implementation of these programs depends on the competent authority (Institute for the Elderly and Social Services, town councils, subsidized private entities, etc.). More evidence and a framework that defines common standards and criteria for the development of effective programs are required (AU)

What about telepsychiatry? A systematic review.

BACKGROUND: Mental illness has become a significant worldwide health issue in recent years. There is presently insufficient evidence to definitively determine the clinical effectiveness and cost-effectiveness of different health care models. The objective of this study was to evaluate the effectiveness of videoconferencing in mental illness. DATA SOURCES: Literature searches were performed in Medline, EMBASE, PsycINFO, Centre for Reviews and Dissemination, and The Cochrane Library Controlled Trial Registry databases (1997-May 2008). A search of the following terms was used: e-health, mental disorders (MeSH term), mental health (MeSH term), mental health services (MeSH term), telecare, teleconsultation, telehome, telemedical, telemedicine, telemental, telepsychiatric, telepsychiatry, televideo, videoconference, and videophone. STUDY SELECTION: Type of disease, interventions, and clinical outcomes or patient satisfaction were identified. Exclusion criteria included studies that did not analyze intervention outcomes and studies with a sample size of fewer than 10 cases. Peer review and quality assessment according to Cochrane recommendations were required for inclusion. DATA EXTRACTION/SYNTHESIS: Of 620 identified articles, 10 randomized controlled trials are included (1,054 patients with various mental disorders). There were no statistically significant differences between study groups for symptoms, quality of life, and patient satisfaction. CONCLUSIONS: There is insufficient scientific evidence regarding the effectiveness of telepsychiatry in the management of mental illness, and more research is needed to further evaluate its efficiency. However, there is a strong hypothesis that videoconference-based treatment obtains the same results as face-to-face therapy and that telepsychiatry is a useful alternative when face-to-face therapy is not possible.

Telemedicine for depression: a systematic review.

PURPOSE: More than 14% of the population has a mood disorder, and more than 50% do not receive treatment. Information and communication technology (ICT) could improve health care. A systematic review was considered in order to know the programs that apply ICT in the management of depression and to assess their effectiveness. CONCLUSION: There is insufficient scientific evidence regarding the effectiveness of ICT use in the management of depression. However, there is a well-founded hypothesis that videoconference produces the same results as face-to-face treatment and that self-help Internet programs could improve symptoms. PRACTICE IMPLICATIONS: More research is needed; nevertheless, when traditional care is not possible, telemedicine could be used.