-
1.
Engaging people with chronic kidney disease in their own care an integrative review.
Almeida, OAE, Santos, WS, Rehem, TCMSB, Medeiros, M
Ciencia & saude coletiva. 2019;(5):1689-1698
Abstract
The treatment of chronic kidney disease (CKD) places a major burden on patients and their families. Interventions such as nutritional management, medication regimen, and renal replacement therapies require active patient participation. An integrative literature review was carried out to identify articles on the engagement and participation of people with CKD in their care. The Medical Subject Headings (MeSH) "Kidney Failure, Chronic", "Self Care", and "Patient Participation" were used to conduct a search on the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the U.S. National Library of Medicine® (Medline/PubMed), Biblioteca Virtual em Saúde (Bireme). A total of 21 articles published between 2012 and 2016 were selected. The most commonly used data collection and analysis techniques were semi-structured interviews and phenomenological thematic analysis, respectively. The articles were categorized into the following thematic groups: illness management and treatment; involvement in the decision-making process; advanced care plan; and home peritoneal dialysis. We found that there is a lack of qualitative research in certain areas, namely kidney transplant recipients and people with initial stages of CKD. People with CKD should be encouraged to actively engage in their own care, which in turn requires the knowledge, motivation and support of health professionals.
-
2.
Role of Diabetes Education Program in Controlling Posttransplant Diabetes in a Recent Renal Transplant Bodybuilder: Case Report and Review of the Literature.
Othman, N, Gheith, O, Al-Otaibi, T, Abdou, H, Halim, MA, Mahmoud, T, Nair, P, Yagan, J, Maher, A, Dahab, M, et al
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2019;(Suppl 1):169-171
Abstract
Posttransplant diabetes is a common complication of solid-organ transplantation. We present the possible role of diabetes education in improvement of posttransplant diabetes in a 36-year-old bodybuilder who was a kidney transplant recipient. The patient had been abusing some medications to help in bodybuilding. He underwent living unrelated-donor renal transplant with thymoglobulin induction and was maintained on steroids, tacrolimus, and mycophenolate mofetil. Posttransplant diabetes was confirmed by blood tests. His blood sugar was partially controlled by 3 oral agents. The patient participated in our structured diabetes education program. This program was created to cover different items related to diabetes control, including diet, proper exercise, blood sugar monitoring, sick day management, and pathophysiologic roles of diabetes medications. Within 4 months of participation in this program, the patient's blood sugar became well controlled and his diabetes medications started to be minimized. He presently has stable graft function with hemoglobin A1c level around 5.6% on only diet management. Bodybuilders are at risk of deterioration of their kidney function. A proper diabetes education program is recommended to help renal transplant recipients with early posttransplant diabetes mellitus to control their disease. Success requires close evaluation and a multidisciplinary approach.
-
3.
Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance.
Duff, W, Haskey, N, Potter, G, Alcorn, J, Hunter, P, Fowler, S
World journal of gastroenterology. 2018;(28):3055-3070
Abstract
We performed a scoping review on sought-after complementary therapies for patients with inflammatory bowel disease (IBD), specifically diet, physical activity and exercise (PA/E), and psychotherapy. We aim to update patients with IBD on therapies for self-care and provide physicians with guidance on how to direct their patients for the management of IBD. A search of MEDLINE, EMBASE, and PUBMED was completed in Sept 2016. Studies on diet, PA/E, or psychotherapy in patients with IBD were included. Medical Subject Heading terms and Boolean operators were used. The search was limited to full-text English articles describing an adult population. This review included 67 studies: Diet (n = 19); PA/E (n = 19); and psychotherapy (n = 29). We have made the following recommendations: (1) Diet: Consumption of diets rich in vegetables, fruit and soluble fiber may be beneficial in IBD. A trial of a low FODMAP diet can be considered in those patients with functional gastrointestinal symptoms. Restrictive diets are lacking in evidence and should be avoided; (2) PA/E: Regular low-moderate intensity activity, including cardiovascular and resistance exercise, has been shown to improve quality of life (QOL) and may improve inflammation; and (3) psychotherapy: Therapies such as cognitive-behavioural interventions, mindfulness, hypnosis, and stress management have been shown to improve QOL, but evidence is limited on their impact on anxiety, depression, and disease activity. Overall, these complementary therapies are promising and should be used to treat patients with IBD from a more holistic perspective.
-
4.
Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme.
Alvarado, MM, Kum, HC, Gonzalez Coronado, K, Foster, MJ, Ortega, P, Lawley, MA
Journal of medical Internet research. 2017;(2):e28
Abstract
BACKGROUND Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. OBJECTIVE The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes. METHODS The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified. RESULTS A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%). CONCLUSIONS The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability.
-
5.
A Systematic Review and Meta-Analysis on Self-Management for Improving Risk Factor Control in Stroke Patients.
Sakakibara, BM, Kim, AJ, Eng, JJ
International journal of behavioral medicine. 2017;(1):42-53
-
-
Free full text
-
Abstract
PURPOSE The aims of this review were to describe the self-management interventions used to improve risk factor control in stroke patients and quantitatively assess their effects on the following: 1) overall risk factor control from lifestyle behaviour (i.e. physical activity, diet and nutrition, stress management, smoking, alcohol, and medication adherence), and medical risk factors (i.e. blood pressure, cholesterol, blood glucose) and (2) individual risk factors. METHOD We systematically searched the PubMed, PsycINFO, CINAHL and Cochrane Database of Systematic Reviews databases to September 2015 to identify relevant randomized controlled trials investigating self-management to improve stroke risk factors. The self-management interventions were qualitatively described, and the data included in meta-analyses. RESULTS Fourteen studies were included for review. The model estimating an effect averaged across all stroke risk factors was not significant, but became significant when four low-quality studies were removed (SMD = 0.10 [95 % CI = 0.02 to 0.17], I 2 = 0 %, p = 0.01). Subgroup analyses revealed a significant effect of self-management interventions on lifestyle behaviour risk factors (SMD = 0.15 [95 % CI = 0.04 to 0.25], I 2 = 0 %, p = 0.007) but not medical risk factors. Medication adherence was the only individual risk factor that self-management interventions significantly improved (SMD = 0.31 [95 % CI = 0.07 to 0.56], I 2 = 0 %, p = 0.01). CONCLUSION Self-management interventions appear to be effective at improving overall risk factor control; however, more high-quality research is needed to corroborate this observation. Self-management has a greater effect on lifestyle behaviour risk factors than medical risk factors, with the largest effect at improving medication adherence.
-
6.
Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association.
Riegel, B, Moser, DK, Buck, HG, Dickson, VV, Dunbar, SB, Lee, CS, Lennie, TA, Lindenfeld, J, Mitchell, JE, Treat-Jacobson, DJ, et al
Journal of the American Heart Association. 2017;(9)
Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.
-
7.
Psychological Reactions Associated With Continuous Glucose Monitoring in Youth.
Patton, SR, Clements, MA
Journal of diabetes science and technology. 2016;(3):656-61
-
-
Free full text
-
Abstract
Glucose monitoring is prerequisite to all other diabetes self-care behaviors and helps patients to reduce their risk for diabetes-related complications due to elevated glycemia. Because of the amount of information available and the ability to deliver glucose results in real-time, continuous glucose monitoring (CGM) has the ability to improve on self-monitoring blood glucose. However, epidemiologic data demonstrate slow uptake of CGM by patients, especially among youth. Several new diabetes therapies rely on CGM for feedback on patients' glucose levels to optimize treatment (eg, the low-glucose suspend insulin pump) and there are new technologies currently in development that will also need this information to work (eg, the artificial pancreas). To help patients to realize the potential benefits of these new treatments, it is essential to explore patients' psychological and behavioral reactions to CGM and then target device enhancements and/or the development of behavioral therapies to minimize negative reactions and to improve patients' CGM adoption rates. Limited research is available examining the psychological and behavioral reactions of CGM use in youth exclusively, but there are more studies examining these reactions in mixed samples of youth, parents, and adults. The purpose of this review is to summarize the available literature examining psychological and behavioral reactions to CGM use in young people with diabetes and to highlight how the results of past and future studies can inform device updates and/or behavioral intervention development to minimize barriers.
-
8.
Measuring Self-Care in Persons With Type 2 Diabetes: A Systematic Review.
Lu, Y, Xu, J, Zhao, W, Han, HR
Evaluation & the health professions. 2016;(2):131-84
-
-
Free full text
-
Abstract
This systematic review examines the characteristics and psychometric properties of the instruments used to assess self-care behaviors among persons with type 2 diabetes. Electronic databases were searched for relevant studies published in English within the past 20 years. Thirty different instruments were identified in 75 articles: 18 original instruments on type 2 diabetes mellitus self-care, 8 translated or revised version, and 4 not specific but relevant to diabetes. Twenty-one instruments were multidimensional and addressed multiple dimensions of self-care behavior. Nine were unidimensional: three focusing exclusively on medication taking, three on diet, one on physical activity, one on self-monitoring of blood glucose, and one on oral care. Most instruments (22 of 30) were developed during the last decade. Only 10 were repeated more than once. Nineteen of the 30 instruments reported both reliability and validity information but with varying degrees of rigor. In conclusion, most instruments used to measure self-care were relatively new and had been applied to only a limited number of studies with incomplete psychometric profiles. Rigorous psychometric testing, operational definition of self-care, and sufficient explanation of scoring need to be considered for further instrument development.
-
9.
Self-Weighing: Helpful or Harmful for Psychological Well-Being? A Review of the Literature.
Pacanowski, CR, Linde, JA, Neumark-Sztainer, D
Current obesity reports. 2015;(1):65-72
-
-
Free full text
-
Abstract
Conflicting views as to the helpfulness or harmfulness of self-weighing for the control of body weight have been presented in the fields of obesity and eating disorders. Because self-weighing is increasingly being considered as an intervention to promote weight loss or prevent weight gain, it is timely to consider unintended psychological outcomes and behavioral correlates of this behavior. Twenty articles from the published literature examining self-weighing and psychological outcomes or weight control behaviors were reviewed. In evaluating self-weighing and affect (ten studies), self-esteem (four studies) and body evaluation (ten studies), and eating behaviors/cognitions (13 studies), in total, most studies found a negative relationship between self-weighing and outcomes (affect: 4/10, self-esteem: 3/4, body evaluation: 4/10, eating behaviors/cognitions: 6/13). Themes that emerged included relationships between self-weighing and negative outcomes for women and younger individuals, and lack of a relationship or positive outcomes for overweight, treatment seeking individuals. Though self-weighing has shown promise in aiding weight control, the degree to which weight loss, and not self-weighing, affects psychological outcomes is not clear. Further assessment of psychological outcomes in self-weighing research may be warranted, as this review suggests the potential for adverse effects of self-weighing in some individuals.
-
10.
Is self-monitoring an effective option for people receiving long-term vitamin K antagonist therapy? A systematic review and economic evaluation.
Sharma, P, Scotland, G, Cruickshank, M, Tassie, E, Fraser, C, Burton, C, Croal, B, Ramsay, CR, Brazzelli, M
BMJ open. 2015;(6):e007758
Abstract
OBJECTIVES To investigate the clinical and cost-effectiveness of self-monitoring of coagulation status in people receiving long-term vitamin K antagonist therapy compared with standard clinic care. DESIGN Systematic review of current evidence and economic modelling. DATA SOURCES Major electronic databases were searched up to May 2013. The economic model parameters were derived from the clinical effectiveness review, routine sources of cost data and advice from clinical experts. STUDY ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) comparing self-monitoring versus standard clinical care in people with different clinical conditions. Self-monitoring included both self-management (patients conducted the tests and adjusted their treatment according to an algorithm) and self-testing (patients conducted the tests, but received treatment recommendations from a clinician). Various point-of-care coagulometers were considered. RESULTS 26 RCTs (8763 participants) were included. Both self-management and self-testing were as safe as standard care in terms of major bleeding events (RR 1.08, 95% CI 0.81 to 1.45, p=0.690, and RR 0.99, 95% CI 0.80 to 1.23, p=0.92, respectively). Self-management was associated with fewer thromboembolic events (RR 0.51, 95% CI 0.37 to 0.69, p ≤ 0.001) and with a borderline significant reduction in all-cause mortality (RR 0.68, 95% CI 0.46 to 1.01, p=0.06) than standard care. Self-testing resulted in a modest increase in time in therapeutic range compared with standard care (weighted mean difference, WMD 4.4%, 95% CI 1.71 to 7.18, p=0.02). Total health and social care costs over 10 years were £7324 with standard care and £7326 with self-monitoring (estimated quality adjusted life year, QALY gain was 0.028). Self-monitoring was found to have ∼ 80% probability of being cost-effective compared with standard care applying a ceiling willingness-to-pay threshold of £20,000 per QALY gained. Within the base case model, applying the pooled relative effect of thromboembolic events, self-management alone was highly cost-effective while self-testing was not. CONCLUSIONS Self-monitoring appears to be a safe and cost-effective option. TRIAL REGISTRATION NUMBER PROSPERO CRD42013004944.