Self-management and spina bifida: A systematic review of the literature

BackgroundSelf-management is critical to optimizing the health of individuals with a chronic condition or disability and is, therefore, a central concept in individual and family-centered healthcare delivery. The purpose of this review is to report the state of the science of self-management for individuals with spina bifida (SB) from a lifespan perspective.ObjectiveThis review will summarize the (a) development and use of self-management skills and behaviors across the life span, (b) factors related to self-management behaviors, (c) development of generic or condition-specific measures of self-management used with a spina bifida population, and (d) development and/or outcomes of interventions to improve self-management in SB.MethodsThe search strategy was limited to primary research articles published between 2003 and 2019 and followed PRISMA guidelines. The databases searched included: PubMed, CINAHL, PsycINFO, Web of Science, Cochrane, and Google Scholar. Studies that addressed self-management concepts in individuals throughout the life span and published in English were included.ResultsThe search yielded 108 citations and 56 articles met inclusion/exclusion criteria. A systematic narrative synthesis was reported. The level of evidence identified was primarily Level III articles of good quality. Multiple demographic, environmental, condition and process factors were related to self-management behaviors. SB self-management instruments and intervention development and testing studies were identified.ConclusionsThis review provides a synthesis of the state of the science of self-management including factors related to self-management behaviors, preliminary evidence of instruments for use in SB, factors important to consider in the development and testing of future interventions, and gaps in the literature.     

早期认知-行为干预对冠心病介入治疗患者心功能及自我管理能力的影响

目的 观察早期认知-行为干预对冠心病介入治疗患者心功能及自我管理能力的影响。方法 将2019年2月至2021年2月于我院接受介入治疗的100例冠心病患者随机分为观察组与对照组各50例。对照组予以常规护理,观察组在对照组基础上实施早期认知-行为干预。对比两组的心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左室后壁厚度(LVPWd)]、自我管理能力。结果 护理后,观察组的LVEF高于对照组, LVEDD、 LVPWd低于对照组(P<0.05)。护理后,观察组症状管理、角色功能、情绪控制、沟通能力评分均高于对照组(P<0.05)。结论 早期认知-行为干预可显著改善冠心病介入治疗患者心功能状态与自我管理能力,促进其病情恢复,值得临床推广应用。     

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía

ObjectiveTo understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations.MethodA qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia.ResultsPeople with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases.ConclusionsBesides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions.     

维持性血液透析患者自我管理与运动自我效能及运动水平的相关性

目的 探讨维持性血液透析（MHD）患者自我管理水平与运动自我效能及运动水平的相关性。方法 采用横断面调查方式,对我院2018年1月～2018年5月的199例MHD患者,采用自行设计的一般资料调查表、自我管理量表、运动自我效能量表（ESE）及运动水平量表进行调查,并使用SPSS 17.0软件进行统计分析。结果 MHD患者自我管理与运动自我效能之间呈正相关（r=0.419,P＜0.05）;自我管理与运动水平亦呈正相关（r=0.348,P＜0.05）。结论 MHD患者自我管理与运动自我效能及运动水平息息相关,应有效干预MHD患者自我管理与运动自我效能及运动水平,进而提高MHD患者的临床疗效。     

基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响

目的 探讨基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响.方法 选取2018年9月至2020年7月我院收治的中青年居家腹膜透析患者74例,随机分为实验组和对照组各37例.对照组采用常规健康教育,实验组采用基于微信平台的健康教育.比较两组患者干预前后的负性情绪和自我管理能力.结果 干预前,两组...     

老年人慢性疼痛自我管理策略及有效性的调查研究

目的探讨老年人慢性疼痛的临床特征和自我管理策略及有效性的现状，并分析之间的关系。方法对243名年龄≥65岁慢性疼痛老年人进行系列问卷调查，了解老年人慢性疼痛的临床特征及自我管理策略，并对结果进行分析。结果非麻醉性镇痛药、体育运动、冷热疗法和精神转移活动为4种最常使用的疼痛管理策略，不同年龄组的老年慢性疼痛患者间其所应用的疼痛管理策略比较差异无统计学意义。管理策略的有效性与疼痛强度，疼痛干扰日常生活程度及忧郁程度呈负相关，但与自我效能分数呈正相关。结论老年人愿意尝试各种不同的策略应对慢性疼痛，在今后的老年人慢性疼痛管理培训中应注重体育运动程序的规范化、对抗抑郁并增加自我效能以提高疼痛管理的效果。     

糖尿病患者自我管理健康教育研究临床效果评价

目的评价糖尿病患者自我管理健康教育研究临床效果。方法按照随机对照试验研究设计,将220例自愿参加该项目的糖尿病患者,随机分为干预组118例和对照组102例。干预组接受自我管理健康教育课程,对照组接受常规健康教育课程。比较干预组和对照组患者在项目实施6个月后自我管理行为、自我效能和代谢指标改变情况。结果在实验组与对照组各变量差值比较中,2项运动管理指标具有统计学意义(P<0.05);3项症状管理指标具有统计学意义(P<0.05);所有医从行为具有统计学意义(P<0.05);3项自我效能指标具有统计学意义(P<0.05);在血压和代谢指标中,收缩压、甘油三酯、空腹血糖和糖化血红蛋白的下降幅度明显优于对照组,具有统计学意义(P<0.05)。结论自我管理健康教育6个月后可改善参加者的自我管理行为、自我效能及代谢指标,该教育模式能有效提高糖尿病患者的自我管理能力,糖尿病自我管理健康教育具有较强的实用性,它的实施与推广具有一定的社会意义。     

三主体双轨道互动护理干预模式在永久心脏起搏器植入术患者中的应用

目的:探讨三主体双轨道互动护理干预模式在永久心脏起搏器植入术患者中的应用效果.方法:选取2017年1月1日～2019年12月31日收治的110例行永久心脏起搏器植入术患者为研究对象,根据随机数字表法分为观察组和对照组各55例.对照组采取常规护理干预,观察组在常规护理干预基础上实施三主体双轨道互动护理干预模式.比较两组入...     

Factors associated with patient activation in a socially deprived population: Evidence from Germany

ObjectivePatient activation has been identified as a crucial determinant of health, but little is known about its own determinants, particularly in low socioeconomic status populations. To address this research gap, we analyzed factors that might explain variation in patient activation in such a population.MethodsWe conducted a cross-sectional patient survey (n = 582) in a low socioeconomic status urban district in Germany in 2017. Using multivariate linear regressions, we examined the association between patient activation and a range of psychological, sociodemographic, and health-related factors. To assess the relative importance of these factors, we used dominance analysis.ResultsOur results suggest that age, employment status, linguistic acculturation, health status, and self-efficacy were significantly associated with patient activation. Dominance analysis indicated that self-efficacy was the most important factor explaining variation in patient activation.ConclusionsAge, employment status, linguistic acculturation, health status, and self-efficacy are important determinants of patient activation.Practice implicationsOur results can inform decision makers about approaches for more targeted and effective interventions to improve patient activation in low socioeconomic status populations. Much might be gained by investing in interventions that focus on age, employment status, linguistic acculturation, and health status. Interventions that improve self-efficacy may represent a particularly promising approach.     

Impact of blinded retrospective continuous glucose monitoring on clinical decision making and glycemic control in persons with type 2 diabetes on insulin therapy

Background and aimsBlinded retrospective continuous glucose monitoring (rCGM) provides detailed information about real-life glycaemic profile. In persons with type 2 diabetes without adequate glycaemic control, the structured introduction of rCGM may be beneficial to sustain improvements in diabetes management.Methods and results102 individuals with insulin-treated type 2 diabetes, age less than 66 years old and HbA1c >7.5%, were recruited. Participants performed a 7-day blinded rCGM (iPro2) every four months for one year. Biochemical, anthropometric, and rCGM data was collected. Participants' and healthcare professionals’ perceptions were assessed.90 participants completed the protocol. HbA1c was 9.1 ± 0.1% one year prior to enrolment and 9.4 ± 0.1% at enrolment (p < 0.01). With the rCGM-based intervention, a decrease in HbA1c was achieved at 4 months (8.4 ± 0.1%, p < 0.0001), and 12 months (8.1 ± 0.1%, p < 0.0001). A significant increase in time-in-range was observed (50.8 ± 2.4 at baseline vs 61.5 ± 2.2% at 12 months, for 70–180 mg/dL, p < 0.001), with no difference in exposure time to hypoglycaemia. After 12 months, there was an increase in self-reported diabetes treatment satisfaction (p < 0.05).ConclusionIn persons with type 2 diabetes and poor metabolic control, specific data from blinded rCGM informed therapeutic changes and referral to targeted education consultations on nutrition and insulin administration technique. Therapeutic changes were made more frequently and targeted to changes in medication dose, timing, and/or type, as well as to lifestyle. Together, these brought significant improvements in clinical outcomes, effective shared decision-making, and satisfaction with treatment.Registration numberNCT04141111.