A literature review on self-care of chronic illness: definition, assessment and related outcomes.

INTRODUCTION: Chronic illnesses care represents a challenging issue for people well-being and future health systems' sustainability. Promotion of self-care is considered a key point for chronically ill patients' care. The aim of this literature was to explore: how self-care of chronic illness has been theoretically defined; how self-care can be assessed in clinical and research settings; what associations exist between self-care and health outcomes of chronically ill patients. RESULTS: A wide range of definitions and terminologies related to self-care of chronic illness has been found in the literature. Although some common elements useful to explain the concept of self-care have been identified, the physical, cognitive, emotional and social processes underlying self-care remain controversial and poorly defined. Valid and reliable disease-specific assessment tools have been developed and used in a growing number of studies; however, the lack of utilization of standardized instruments in clinical practice has been referred by many authors. Significant correlations between self-care of chronic illness and outcome measures e.g. general health status, quality of life and healthcare costs, are reported by a limited number of studies. CONCLUSION: Supporting patient self-care is recognized as a crucial factor in chronic illness care. A deeper analysis of variables and processes influencing self-care could help for a full description of the phenomenon. A systematic evaluation of self-care in health professionals' everyday clinical practice is strongly recommended. The development of general non-disease-specific assessment tools could facilitate the evaluation of complex patients, especially those with multiple co-morbidities. Although self-care has been recognized as a vital intermediate outcome, further large-scale studies clarifying the association between self-care and patients' and health systems' outcomes are needed.

[Does free assumption of water from one hour after extubation reduce thirst without increasing complications in heart surgery patients?]. / L'assunzione libera di acqua, nei pazienti cardiochirurgici, a partire da un'ora dall'estubazione, può ridurre la sensazione di sete senza aumentare le complicanze?

OBJECT: The aim of this study was to assess whether free assumption of water in heart surgery patients, as early as one hour after extubation, produces measurable differences in thirst, nausea and vomiting. METHODS: Randomized controlled trial (pilot phase), by sex and age. Eventual cases of dysphagia are identified by both a functional examination and a water test. The sense of thirst and sickness are registered 1 hour post-extubation and subsequently at the 3rd, 6th and 12th hour using an NRS-scale 0-10. Data analysis was performed using a logistic regression model. RESULTS: 54 patients have been enrolled in the study. The sense of thirst is diminished in 17.39% of female, in 24.29% of male, leading to a total reduction in 22.58% of patients. The sense of sickness is arisen in 13.04% of female, in 2.86% of male, leading to a total rise of 5.38% of patients. Moreover, the sensation of thirst is diminished in 33.33% of patients with free water intake (treatment group), but only in 16.07% of patients who cannot drink water (control group). Finally, as far as the sensation of sickness is concerned, our results show a rise of 11.11% in patients with free water intake, higher if compared to 1.79% of the control group, but smaller than the value indicated in the literature. DISCUSSION: The collected data showed that drinking water from one hour after extubation had a positive effect without a significant increase in the patient's perception of nausea.