scholarly journals Progetto per uno studio pilota per un ambulatorio di nefrologia narrativa: un approccio bio-psico-sociale alla malattia renale cronica

2020 ◽  
Vol 32 (1) ◽  
pp. 53-57
Author(s):  
Alessandro Toccafondi ◽  
Leonardo Mari ◽  
Umberto Caraccia ◽  
Silvia Lapini ◽  
Pietro Dattolo ◽  
...  
Keyword(s):  
Narrative Medicine ◽  
Active Role ◽  
Social Needs ◽  
Psychoeducational Groups ◽  
Chronic Patients ◽  
Mortality And Morbidity ◽  
Medical Visits ◽  
Effective Interventions ◽  
Main Challenge ◽  
Malattia Renale Cronica

Introduction: Poor medication adherence in CKD patients is associated with high mortality and morbidity and can reach up to 80%. The most effective interventions to increase patients’ adherence to treatments are conducted by a multi-professional team and with the active participation of patients and their families. Narrative evidence-based medicine has been proved as a useful methodology in the care of chronic patients also in promoting their adherence to treatments. Methods: Around 50-70% of CKD patients treated in our centre will follow clinical protocol based on a narrative medicine approach: (1) patients will be invited to write a brief history related to their experience with the CKD and treatments; (2) screening for depression (HADS; PHQ-9); (3) intervention of pharmaceutical counselling aimed to explore patients’ behaviours about taking their medications; (4) sharing of decision-making: the results of the narrative histories and of questionnaires will be discussed with the patients; (5) psychoeducational groups. Results: The pilot phase of the project will last 6 months. During these months, patients will be monitored for biochemical (e.g. anemia) and anthropometric (e.g. blood pressure) parameters and depression. Medical visits or diagnostic tests missed by patients will also be recorded. Conclusions: The development of an active role of patients in taking care of themselves is one of the main challenge of clinical nephrology. The present project aims to implement in the clinical routine a protocol based on the narrative medicine approach in which the biological, psychological and social needs of CKD patients are considered and discussed with them.

P0261NARRATIVE NEPHROLOGY: A BIO-PSYCHO-SOCIAL APPROACH WITH CDK PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marco Lombardi ◽  
Alessandro Toccafondi ◽  
Umberto Caraccia ◽  
Leonardo Mari ◽  
Pietro Claudio Dattolo
Keyword(s):  
Clinical Care ◽  
Narrative Medicine ◽  
Active Role ◽  
Social Needs ◽  
Medical Visit ◽  
Clinical Protocol ◽  
Chronic Patients ◽  
Mortality And Morbidity ◽  
Counseling Intervention ◽  
The Impact

Abstract Background and Aims Poor medication adherence in CKD patients can reach up to 80%. Non-adherence is associated with high mortality and morbidity and it is a negative criterion for the inclusion in the transplant waiting list. Poor adherence increases also the costs for health care in terms of diagnostic procedures, dialysis in emergency, etc. Therefore, to increase patients’ adherence to medical treatments is one of the priority of clinical nephrology. According to the WHO adherence behaviors are associated to several factors (e.g. organization of health services, doctor-patient relationship, patients’ psychosocial factors). The most efficacy interventions descried in the literature to increase patients’ adherence to treatments are conducted by a multi-professional team and with the active participation of patients. In the last years, narrative evidenced-based medicine has been proved as a useful methodology in the care of chronic patients also in promoting adherence to treatments. Aim of this clinical project is to obtain the best control of the evolution of chronic kidney disease through a multidisciplinary approach of narrative medicine. Method Within the pre-dialysis service of the Division of Nephrology and Dialysis Firenze 2, it has been integrated the clinical care for CKD patients with a protocol based on a narrative medicine approach (Fig.1). The clinical protocol is composed by the following procedures: Results This project begun around 2 months ago. In this period 15 patients were met, collecting stories by 12 of them (80%). Most of the stories were rich of contents and useful from a medical point of view. None patients refuse the medical consultation at the presence of psychologist, and 5 of them asked for psychotherapy sessions. In line with the literature, 30% of patients presented symptoms of depression. Due to logistic reasons we are going to start the pharmacy counseling intervention at the end of January. All patients were grateful to have been included in this protocol. In the following months we will be able to assess the impact of this protocol in terms of medical outcome. Conclusion To promote an active role of patients in taking care of themselves and follow medical prescriptions, it has been implemented a clinical protocol based on narrative medicine approach in which the biological, psychological and social needs of patients are considered and discussed with them. The empirical results obtained in these first months indicate a positive response from patients in terms of wish to write the experience with the disease and to receive the medical visit with the nephrologist at the presence of a psychologist.

scholarly journals Managing transition to ValueēBased hospital care pathways

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Scardoni ◽  
S Sancini ◽  
A Ambrosio ◽  
C Signorelli ◽  
A Odone
Keyword(s):  
Clinical Pathways ◽  
Therapeutic Process ◽  
Sustainable Use ◽  
Narrative Medicine ◽  
University Hospitals ◽  
Main Challenge ◽  
It Support ◽  
Hospital Transition ◽  
Work Model ◽  
Patient Related Outcome

Abstract Issue San Raffaele Hospital (OSR) is part of a European alliance of 9 University Hospitals (EUHA) which promotes comparison and excellence in the clinical, research and training strategies. Description of the Problem The development of Value-Based (VB) strategies has been active in OSR since March 2019, with multidisciplinary healthcare pathways and with the promotion of patient engagement. Results The prostate cancer pathway was identified as a pilot and replicable model to promote the VB culture in different areas, in particular in the field of digitalization, human resources, research, redesigning of paths and outcomes collection. The other clinical pathways progressively launched during 2019 were: breast cancer, stroke, heart failure and pancreatic cancer. The project was realized by: • setting up a Multidisciplinary disease teams; developing a training course on VB, involving all the healthcare professionals (clinicians and managers);involving patient associations in the development of the pathway;adopting sets of clinical outcomes, Patient-Related Outcome Measures (PROMs) and Patient-Related Experience Measures (PREMs) with a specific collection platform, currently under implementation;identifying new IT support tools, activated from March to December 2019 in 11 Disease Units: HealthMeeting, a platform supporting document and data sharing, connecting different Specialists and performing advanced digital multidisciplinary meetings; DNM-Digital Narrative Medicine, a platform connecting patients with their clinical team, supporting web-based storytelling and personalized therapeutic approach. Lessons The introduction of a new shared and patient-centred work model, with the reorganization of spaces, resources and dedicated IT tools, has improved the diagnostic-therapeutic process. Key messages The main challenge of hospital transition to VB pathways is organizational and cultural. For VB implementation is needed sustainable use of available resources and IT, to achieve better outcomes.

Disparities Across Time: Exploring Absenteeism Patterns between Cohorts of Students with Disabilities

2020 ◽  
Vol 122 (11) ◽  
pp. 1-32
Author(s):  
Michael A. Gottfried ◽  
Vi-Nhuan Le ◽  
J. Jacob Kirksey
Keyword(s):  
Students With Disabilities ◽  
Social Needs ◽  
Data Sets ◽  
Chronic Absenteeism ◽  
Data Set ◽  
Full Day Kindergarten ◽  
Effective Interventions ◽  
Nationally Representative ◽  
Single Data ◽  
Over Time

Background It is of grave concern that kindergartners are missing more school than students in any other year of elementary school; therefore, documenting which students are absent and for how long is of upmost importance. Yet, doing so for students with disabilities (SWDs) has received little attention. This study addresses this gap by examining two cohorts of SWDs, separated by more than a decade, to document changes in attendance patterns. Research Questions First, for SWDs, has the number of school days missed or chronic absenteeism rates changed over time? Second, how are changes in the number of school days missed and chronic absenteeism rates related to changes in academic emphasis, presence of teacher aides, SWD-specific teacher training, and preschool participation? Subjects This study uses data from the Early Childhood Longitudinal Study (ECLS), a nationally representative data set of children in kindergarten. We rely on both ECLS data sets— the kindergarten classes of 1998–1999 and 2010–2011. Measures were identical in both data sets, making it feasible to compare children across the two cohorts. Given identical measures, we combined the data sets into a single data set with an indicator for being in the older cohort. Research Design This study examined two sets of outcomes: The first was number of days absent, and the second was likelihood of being chronically absent. These outcomes were regressed on a measure for being in the older cohort (our key measure for changes over time) and numerous control variables. The error term was clustered by classroom. Findings We found that SWDs are absent more often now than they were a decade earlier, and this growth in absenteeism was larger than what students without disabilities experienced. Absenteeism among SWDs was higher for those enrolled in full-day kindergarten, although having attended center-based care mitigates this disparity over time. Implications are discussed. Conclusions Our study calls for additional attention and supports to combat the increasing rates of absenteeism for SWDs over time. Understanding contextual shifts and trends in rates of absenteeism for SWDs in kindergarten is pertinent to crafting effective interventions and research geared toward supporting the academic and social needs of these students.

scholarly journals Smoking habits among 5th and 6th degree medical students

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Erden Cengiz ◽  
P Ay ◽  
M Aigbovbiosa ◽  
K Yıldırım ◽  
S Guder
Keyword(s):  
Electronic Cigarettes ◽  
Active Role ◽  
Cross Sectional Study ◽  
Current Smoker ◽  
Electronic Cigarette ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
School Of Medicine ◽  
Study Population ◽  
Questionnaire Form

Abstract Smoking is the most common cause of preventable mortality and morbidity worldwide. In the fight against tobacco physicians take active role. The objective of this study is to determine the rate and patterns of tobacco use among students of Marmara University School of Medicine (MUSM). This is a cross sectional study carried out in MUSM. The study population were all students studying in the 5th and 6th grades. Data were collected through questionnaires. The questionnaire form included sociodemographics, tobacco usepatterns, quitting attitudes and experiences. Among 410 students, 328 participated. Among all 56.1% were 5th year and 43.9% were 6th year students. The median age was 24 and 55.8% were female. 22.6% of the participants were current smoker. 33.8% of males and 13.7% of females are smoking (p:0,001). Common reasons for starting to smoke were the influence of close friends (11.3%), curosity (8.2%), stress (4.6%). Of the participants, 8.5% had smoked waterpipe. 28.4% of the current smokers still smoke waterpipe, 46.2% had tried to quit more than once and 13.5% wished to quit but had never tried to quit. 40.2% of the participants whose close friend smokes and %44.4 whose partner smokes are current smokers (p:0.001). %70 of current smokers tried at least one time electronic cigarette (p:0.001). Approximately one fourt of the students are current smokers, higher in men. Those who smoked cigarettes had high affinity for waterpipe, electronic cigarettes. Electronic cigarette is fast rising trend daily. Starting smoking and quitting is influenced by close friends and partners. Key messages The primary goal should be to stop the smokers and prevent the start of the smokers. Information should be made on the harms of electronic cigarettes and the community should be informed.

Adolescent injuries

2018 ◽  
pp. 78-81
Author(s):  
Qingfeng Li ◽  
Adnan A Hyder
Keyword(s):  
Injury Prevention ◽  
Road Traffic ◽  
Cost Effective ◽  
Quality Data ◽  
Economic Activities ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Road Traffic Crashes ◽  
The Sustainable Development ◽  
Effective Interventions

Injuries are the leading cause of mortality and morbidity for children 10–19 years old globally. Low and middle-income countries account for a burden of injuries disproportionate to their population, vehicle possession, and economic activities. Common types of unintentional injuries include road traffic crashes, drowning, burns, and falls. Self-harm is the most common type of intentional injury globally. Major barriers to injury prevention are lack of quality data on injury epidemiology, misperception of injuries as ‘accidents’, insufficient funding, and the multi-sectorial nature of injury prevention. Previous studies and experience, mostly from high-income countries, have identified a set of effective and cost-effective interventions to prevent child injuries. Evidence-based and well-enforced legislation is a highly effective tool in preventing injuries. Enhanced multi-sectorial effort is required to achieve development goals on injuries, including the sustainable development goal (SDG) target 3.6: by 2020, halve the number of global deaths and injuries from road traffic injuries.

scholarly journals Economic Problems and Loneliness as Factors Related to Subjective Unmet Health Needs in People with Chronic Diseases and Dependency

2020 ◽  
Vol 17 (8) ◽  
pp. 2924
Author(s):  
Olga María López-Entrambasaguas ◽  
José Manuel Martínez-Linares ◽  
Miguel Sola-García ◽  
Carmen García-Redecillas ◽  
Ana María Díaz-Meco-Niño
Keyword(s):  
Chronic Diseases ◽  
Day Care ◽  
Care Center ◽  
Subjective Health ◽  
Psychological Needs ◽  
Social Needs ◽  
Health Needs ◽  
Chronic Patients ◽  
Continuous Increase ◽  
Worldwide Population

Background: The continuous increase of people with chronic diseases is one of the greatest challenges for healthcare systems worldwide. Population growth and life expectancy means that an increasing number of people with chronic diseases and dependency need some kind of assistance to meet their needs. Determining these subjective unmet needs helps to understand the situation of these people. The aim of this study was to explore the perceptions of chronic patients over 65 years of age from the day-care center toward subjective health needs that are not being met by the socio-health system. Methods: Qualitative exploratory-descriptive study. Through convenience sampling, we selected people with chronic diseases and dependency who used day-care centers and met the inclusion criteria. Focus groups were performed. The data were transcribed and a thematic analysis was carried out using Atlas.ti software. Results: The topics resulting from the analysis were classified into dissatisfaction of biological/physiological needs, psychological needs, social needs, and other issues that arose in both groups of participants which referred to the types of needs previously indicated. The issues related to social and psycho-social needs stood out. Conclusions: People with chronic diseases and dependency have their physiological needs covered with the help they receive, but their situation of dependency generates additional costs that worsen their economic situation. However, their greatest need is due to the loneliness they feel and the feeling they have of “being a burden” on their families.

scholarly journals The evolution of the Strategic role of Designers for Sustainable Development

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Brian BALDASSARRE ◽  
Giulia CALABRETTA ◽  
Nancy BOCKEN ◽  
Jan Carel DIEHL ◽  
Duygu KESKIN
Keyword(s):  
Sustainable Development ◽  
Business Models ◽  
Large City ◽  
Active Role ◽  
Main Challenge ◽  
Business Perspective ◽  
Strategic Role ◽  
The 1960S ◽  
Strategic Goal

Design for Sustainable Development refers to the application of a design process to solve a problem related to sustainability, such as creating a pair of shoes that can be recycled or managing waste collection in a large city. Since the origins of this concept in the 1960s, Design for Sustainable Development has been evolving, gradually broadening its scope over time from the design of products to the design of services, business models and wider ecosystems. In this evolution, designers have come closer and closer to business problems, thus becoming more strategic. In this paper, we explore this evolution from a business perspective. We visualize it into a framework and interview eight academic experts about the Strategic role of Designers for Sustainable Development. We find that the evolution can be framed around five topics: the strategic goal of designers, and their related perspective, language, key activities and main challenge. After discussing how the evolution took place around each topic, we draw implications for designers and managers who are willing to play an active role in the transition towards sustainable development.

scholarly journals Social innovation in cultural heritage management: a Neapolitan perspective

2021 ◽  
Vol 1 ◽  
pp. e4639
Author(s):  
Stefano Consiglio ◽  
Mariavittoria Cicellin ◽  
Adriana Scuotto ◽  
Daniela Ricchezza
Keyword(s):  
Cultural Heritage ◽  
Local Community ◽  
Social Innovation ◽  
Active Role ◽  
Organizational Form ◽  
Social Needs ◽  
Social Enterprises ◽  
Heritage Management ◽  
Public And Private ◽  
Cultural Heritage Management

Italy has one of the biggest cultural heritage in the world, but nowadays it is facing a strong crisis, concerning its management and key resources (economic, human, financial, etc). This article aims to contribute to social innovation studies by focusing on the emergence of new actors in cultural heritage management field, through an approach centered on hybrid organizational form. This is a preliminary study which analyze cultural initiatives carried out by social enterprises that have positive impacts, both social and economic, in terms of development of the local community and tourist attraction. According with the preliminary results, beyond public and private administration, Neapolitan social enterprises apply a hybrid organizational form in cultural heritage management, efficiently and effectively. Enterprises studied, in which social entrepreneurship and innovative business model emerge, play an active role responding to both individual and social needs through a cooperative and collaborative attitude.

scholarly journals Co-designing an mHealth tool in the New Zealand Māori community with a “Kaupapa Māori” approach

2020 ◽  
Author(s):  
Lisa Te Morenga ◽  
C Pekepo ◽  
C Corrigan ◽  
L Matoe ◽  
R Mules ◽  
...  
Keyword(s):  
New Zealand ◽  
Best Practice ◽  
Healthy Lifestyle ◽  
Well Being ◽  
Active Role ◽  
Health Interventions ◽  
Behaviour Change Techniques ◽  
Research Approach ◽  
Effective Interventions ◽  
Kaupapa Māori

© 2018, © The Author(s) 2018. Obesity rates in Aotearoa/New Zealand continue to rise, and there is an urgent need for effective interventions. However, interventions designed for the general population tend to be less effective for Māori communities and may contribute to increased health inequities. We describe the integration of co-design and kaupapa Māori research approaches to design a mobile-phone delivered (mHealth) healthy lifestyle app that supports the health aspirations of Māori communities. The co-design approach empowered our communities to take an active role in the research. They described a holistic vision of health centred on family well-being and maintaining connections to people and place. Our resultant prototype app, OL@-OR@, includes content that would not have been readily envisaged by academic researchers used to adapting international research on behaviour change techniques to develop health interventions. We argue that this research approach should be considered best practice for developing health interventions targeting Māori communities in future.

scholarly journals Could Protein Content of Urinary Extracellular Vesicles be Useful to Detect Alcoholic Liver Disease and Assess Hepatocarcinoma Risk?

2021 ◽  
Author(s):  
Gonzalez E. ◽  
Azkargorta M. ◽  
Garcia-Vallicrosa C. ◽  
Prieto-Elordui J. ◽  
Elortza F. ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
High Impact ◽  
Nanoparticle Tracking Analysis ◽  
Chronic Patients ◽  
Mortality And Morbidity ◽  
Cryo Electron Microscopy ◽  
Cirrhotic Patients ◽  
New Biomarkers

(1) Background: Alcohol abuse has a high impact on the mortality and morbidity related to a great number of diseases and is responsible for the development of alcoholic liver disease (ALD). It remains challenging to detect and evaluate its severity, which is crucial for prognosis. In this work, we studied if urinary EVs (uEVs) could serve in diagnose and evaluate cirrhosis in ALD. (2) Methods: uEVs characterization by cryo-electron microscopy (Cryo-EM), Nanoparticle Tracking Analysis (NTA) and Western blotting (WB) was performed in a cohort of 21 controls and 21 cirrhotic patients. Then, proteomics of urinary EVs (uEVs) was carried out in a second cohort of 6 controls and 8 patients in order to identify new putative biomarkers for cirrhosis in ALD. (3) Results: uEVs concentration, size and composition were altered in cirrhotic patients. A total of 1304 proteins were identified in uEVs, and 90 of them were found to be altered in cirrhotic patients. (4) Conclusions: uEVs could be considered as a tool and a supplier of new biomarkers for ALD, whose application would be especially relevant in chronic patients. Yet, further research is necessary to obtain more relevant result in clinical terms.

Sign in / Sign up

Export Citation Format

Share Document