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Probation is a key component contemporary penal systems and socio-pedagogical sanction. Probation implementation aims the re-adaptation of convict to society without breaking his or her social environment during determined probation period. In general application, those under probation have to sign at the police station on the certain days of the month, join training, improvement activities, and work in cleaning, repair or landscaping jobs in a public institution. While healthy people fulfil these tasks smoothly, convicts with chronic illness might be unable to fulfil these tasks because of their health problems. For detection of this situation, a report assessing the clinical state of convict is requested from forensic experts. In this context, there might be malingering convicts that need to be examined in detail for differential diagnosis. In order to draw attention and increase the awareness of physicians to similar cases, this paper aims to report a patient transferred to forensic medicine clinic because of suspicion of malingering by probation directorate for evaluation of the ability of working in cleaning, repair or landscaping works in a public institution four hours/day.

RESUMEN Introducción: la espiritualidad es un concepto muy amplio para la humanidad, su consenso para los diversos grupos se encuentra en estudio permanente. La importancia de introducir su abordaje en la salud integral del paciente es cada vez más significativa en la práctica médica. Objetivos: validar la escala MLQ de Steger de bienestar espiritual en idioma guaraní y evaluar el bienestar espiritual en pacientes de los servicios de oncología y hemodiálisis de dos centros de referencia. Métodos: la población enfocada fueron los pacientes en tratamiento oncológico y en diálisis de los servicios de oncología del Hospital de Clínicas (San Lorenzo) y de hemodiálisis del Sanatorio Español-NefroServ (Asunción) durante los meses de mayo, junio y julio de 2021. Se utilizó como instrumento la escala MLQ de Steger. El cuestionario evalúa dos dimensiones del significado de la vida utilizando 10 elementos clasificados en una escala de siete puntos. Se respetaron los aspectos éticos de la investigación en humanos. Resultados: se realizaron 107 cuestionarios, siendo 54 mujeres y 53 varones, 64 fueron tomados en el servicio de hemodiálisis y 41 en el servicio de oncología, 42 fueron realizados en guaraní y 65 en español, según preferencia del encuestado. El promedio de edad de la muestra fue 54,6 ± 14 años. De los encuestados, 11,2% (12) tenían formación primaria incompleta, 25,2% (27) primaria completa, 14,01% (15) secundaria incompleta, 13,08% (14) secundaria, 25,2% (27) terciario y 11,2% (12) no respondieron a esta pregunta. En relación con la religión, 99 manifestaron profesar la religión católica (92,5%). Se utilizó la medición de confiabilidad alfa de Cronbach para medir el grado de fiabilidad de la escala realizada en idioma guaraní, arrojando un valor de 0,87 (alta confiabilidad). Conclusión: se ha logrado probar la validez del instrumento en el idioma guaraní para la comunidad paraguaya guaraní-parlante. Además, se han observado las tendencias en términos de medición del bienestar espiritual entre las muestras estudiadas y sus diferentes perfiles, lo que permite un abordaje más integral en el tratamiento, con las repercusiones que este bienestar pueda generar también en el aspecto físico, más allá de la medicina tradicional. ABSTRACT Introduction: Spirituality is a very broad concept for humanity, its consensus for the various groups is under permanent study. The importance of introducing its approach in the comprehensive health of the patient is increasingly significant in medical practice. Objectives: To validate the Steger MLQ scale of spiritual well-being in the Guarani language and evaluate the spiritual well-being in patients of the oncology and hemodialysis services of two referral centers. Methods: The target population was patients undergoing cancer treatment and dialysis from the oncology services of the Hospital de Clínicas (San Lorenzo) and the hemodialysis services of the Sanatorio Español-NefroServ (Asunción) during the months of May, June and July 2021. The Steger MLQ scale was used as the instrument. This questionnaire assesses two dimensions of meaning in life using ten items rated on a seven-point scale. The ethical aspects of human research were respected. Results: One hundred seven questionnaires were completed, 54 women and 53 men, 64 were taken in the hemodialysis service and 41 in the oncology service, 42 were done in Guarani and 65 in Spanish, according to the respondent's preference. The average age of the sample was 54.6 ± 14 years. Of those surveyed, 11.2% (12) had incomplete primary education, 25.2% (27) completed primary, 14.01% (15) incomplete secondary, 13.08% (14) secondary, 25.2% (27) tertiary and 11.2% (12) did not answer this question. In relation to religion, 99 stated that they profess the Catholic religion (92.5%). Cronbach's alpha reliability test was used to measure the degree of reliability of the scale carried out in the Guarani language, yielding a value of 0.87 (high reliability). Conclusion: It was possible to test the validity of the instrument in the Guarani language for the Guarani-speaking Paraguayan community. In addition, trends have been observed in terms of measuring spiritual well-being in the samples studied and their different profiles, which allows a more comprehensive approach to treatment, with the repercussions that this well-being can also generate in the physical aspect, beyond traditional medicine.

Various care processes have been affected by COVID-19. One of the most dramatic has been the care of chronic patients under medical supervision. According to the World Health Organization (WHO), a chronic patient has one or more long-term illnesses, and must be permanently monitored by the health team.. In fact, and according to the Chilean Ministry of Health (MINSAL), 7 out of 10 chronic patients have suspended their medical check-ups, generating critical situations, such as a more significant number of visits to emergency units, expired prescriptions, and a higher incidence in hospitalization rates. For this problem, health services in Chile have had to reschedule their scarce medical resources to provide care in all health processes. One element that has been considered is caring through telemedicine and patient prioritization. In the latter case, the aim was to provide timely care to those critical patients with high severity and who require immediate clinical attention. For this reason, in this work, we present the following methodological contributions: first, an unsupervised algorithm that analyzes information from anonymous patients to classify them according to priority levels; and second, rules that allow health teams to understand which variable(s) determine the classification of patients. The results of the proposed methodology allow classifying new patients with 99.96% certainty using a three-level decision tree and five classification rules.

Within the framework where overlap therapeutic alliance, patient-centred consultation and shared decision-making, the strategies to increase compliance during the consultation in general medicine are inserted. A strategy is, in a strict sense, an organized, formalized and oriented procedure to obtain a clearly established goal. Its application in daily practice requires the improvement of procedures and techniques whose detailed choice and design are the responsibility of the doctor. To achieve the goal of improving compliance in general medicine, within this model of patient-centred medicine / therapeutic alliance / shared decisions, a number of strategies can be cited: 1) Establish rapport and continuity of care that allows building trust; 2) Ensure confidentiality; 3) Sensitive exploration of adverse drug reactions and prevention of their effects on compliance; 4) Simplify the therapeutic regimen; 5) Self-monitoring; 6) Avoid giving the impression that the drug replaces the need for changes in habits (such as diet, exercise and smoking cessation); 7) Know the patient's agenda, explore perceptions of the disease, and assess the importance that the patient attaches to compliance, and their confidence in achieving it; this also includes understand and tolerate that the chronic patient sometimes gets tired and abandons the treatment that is necessary; 8) Involve the patient in the decision; and, 9) Motivational Interviewing and negotiation of therapeutic objectives, although they seem minimal from doctor point of view. Finally, it must be remembered that the patient always has the last word to accept our indications or not.

A major concern in the management of Inflammatory Bowel Disease (IBD) is the absence of accurate and specific biomarkers to drive diagnosis and monitor disease status timely and non-invasively. Fibroblast activation protein (FAP) represents a hallmark of IBD bowel strictures, being overexpressed in stenotic intestinal myofibroblasts. The present study aimed at evaluating the potential of circulating FAP (cFAP) as an accessible blood biomarker of IBD. Quantitative determination of cFAP was performed by enzyme-linked immunosorbent assay on plasma samples prospectively collected from patients with IBD and control subjects. A discrimination model was established on a training set of 50% patients and validated on independent samples. Results showed that cFAP concentration was reduced in patients with IBD when compared to controls (p < 0.0001). Age, sex, smoking, disease location and behavior, disease duration and therapy were not associated with cFAP. The sensitivity and specificity of cFAP in discriminating IBD from controls were 70 and 84%, respectively, based on the optimal cutoff (57.6 ng mL−1, AUC = 0.78). Predictions on the test set had 57% sensitivity, 65% specificity, and 61% accuracy. There was no strong correlation between cFAP and routine inflammatory markers in the patients' population. A subgroup analysis was performed on patients with Crohn's disease undergoing surgery and revealed that cFAP correlates with endoscopic mucosal healing. In conclusion, cFAP deserves attention as a promising blood biomarker to triage patients with suspected IBD. Moreover, it might function as a biomarker of post-operative remission in patients with Crohn's disease.

Chronic patients could benefit from the technological advances, but the clinical approaches for this kind of patients are still limited. This paper describes a system for chronic patients monitoring both, in home and external environments. For this purpose, we used novel technologies as big data, cloud computing and internet of things (IoT). Additionally, the system has been validated for three use cases: cardiovascular disease (CVD), hypertension (HPN) and chronic obstructive pulmonary disease (COPD), which were selected for their incidence in the population. This system is innovative within e-health, mainly due to the use of a big data architecture based on open-source components, also it provides a scalable and distributed environment for storage and processing of biomedical sensor data. The proposed system enables the incorporation of non-medical data sources in order to improve the self-management of chronic diseases and to develop better strategies for health interventions for chronic and dependents patients. Spanish Ministry of Science and Innovation through the National Programme for Research Aimed at the Challenges of Society (IPHealth, TIN-2013-47153-C3-1). 2.934 JCR (2021) Q3, 60/109 Health Care Sciences & Services 0.652 SJR (2021) Q2, 45/104 Health Informatics No data IDR 2021 UEM

We describe the technological development of a web platform named CHRONIC-PHARMA that integrates three prescription support tools for patients with chronic diseases: Anticholinergic Burden Calculator (ABC), LESS-CHRON criteria and TRIGGER-CHRON. They focus on the optimization and evaluation of pharmacotherapy in patients with chronic diseases, resulting in a useful, single platform that can facilitate the review of pharmacotherapy and improve the safety of chronically ill patients. This is achieved by estimating and reducing the anticholinergic risk (ABC), detecting opportunities for deprescribing drugs and monitoring its success (LESS-CHRON criteria), as well as calculating the risk of adverse drug events (TRIGGER-CHRON). The platform is freely accessible online (https://chronic-pharma.com/) as well as through a mobile application, and therefore easily accessible among the healthcare community.

La dependencia es parte de la condición humana y los que lleguen a la vejez experimentarán más dificultades de funcionamiento. La mayoría de las familias tienen algún integrante en esas condiciones, y existen personas que asumen el rol de cuidador informal cuyas implicaciones tienen una repercusión a nivel socioeconómico y psicológico. El objetivo caracterizar el trabajo no remunerado del cuidador informal del paciente crónico en un hospital de alta complejidad de Bogotá Colombia entre agosto de 2020 y diciembre de 2020. Se realizó un estudio descriptivo de corte transversal con componente de análisis econométrico. Se recolectó información de manera prospectiva a través de Encuesta sociodemográfica, Escala de ZARIT e Inventario de Habilidad de Cuidado (CAI). Los datos se analizaron en cuatro etapas, construyendo un indicador de vulnerabilidad y utilizando el método de costo de reemplazo. Se concluyó que los cuidadores informales dado sus características manejan niveles de estrés alto cuando son solteros (44,4%), mujeres (42,9%) entre 46 y 60 años (52,3%), parentesco hijo (a) (43,9%), alto nivel educativo (56,3%) y si tienen personas a cargo (55,8%). Estrés Moderado-bajo si devengan menos de 1 Salario mínimo mensual vigente (SMMLV) (60,9%) cuando realizan labores domésticas (53,3%), cuando llevan menos de 1 año de cuidado (62,2%) y dedican más de 12 horas al día (54%), pero han decidido hacerlo por voluntad propia (65%) y motivación (56,9%). Por lo tanto, en el 2102 el Salario mínimo mensual vigente (SMMLV) $624.500 incluyendo auxilio de transporte indicaba que la hora/día valía $2.361,25, entonces el precio valoración del Trabajo doméstico y de cuidado no remunerado (TDCNR) 2012 de los ingresos/hora era equivalente a $3.373, observándose un incremento del 42,85%; trasladando ese valor a precios Salario mínimo mensual vigente (SMMLV) 2020 $980.657, el precio valoración Trabajo doméstico y de cuidado no remunerado (TDCNR) sería $ 5.224,75. Este valor/hora permitiría inferir con base en el Salario mínimo mensual vigente (SMMLV) 2020 que el cuidador informal dejaría de percibir entre $1.265.625 y $5.062.500 /mes. Dependence is part of the human condition and those who reach old age will experience more functioning difficulties. Most families have a member of these conditions, and there are people who assume the role of informal caregiver whose implications have an impact on the socioeconomic and psychological level. The objective is to characterize the unpaid work of the informal caregiver of the chronic patient in a hospital of high complexity of Bogota Colombia between August 2020 and December 2020. A descriptive cross-sectional study with econometric analysis component was carried out. Information was collected prospectively through Sociodemographic Survey, ZARIT Scale, and Care Skill Inventory (CAI). The data was analyzed in four stages, building a vulnerability indicator, and using the replacement cost method. It was concluded that informal caregivers, given their characteristics, handle high levels of stress when they are single (44.4%), women (42.9%) between 46 and 60 years (52.3%), child relationship (43,9%), high educational level (56.3%) and if they have dependents (55.8%). Moderate-low stress if they earn less than 1 current monthly minimum wage (SMMLV) (60.9%) when they perform housework (53.3%), when they have less than 1 year of care (62.2%) and dedicate more 12 hours a day (54%), but they have decided to do it of their own free will (65%) and motivation (56.9%). Therefore, in 2102 the current monthly minimum wage (SMMLV) $ 624,500 including transportation assistance indicated that the hour / day was worth $ 2,361.25, then the price valuation of unpaid domestic and care work (TDCNR) 2012 of income / hour was equivalent to $ 3,373, observing an increase of 42.85%; transferring that value to prices Current Minimum Monthly Salary (SMMLV) 2020 $ 980,657, the valuation price Unpaid Domestic and Care Work (TDCNR) would be $ 5,224.75. This value / hour would allow inferring based on the current monthly minimum wage (SMMLV) 2020 that the informal caregiver would stop receiving between $ 1,265,625 and $ 5,062,500 / month. Magíster en Economía de la Salud Maestría

This research was supported by the Andalusian CICYE project AP-0105-2016., Results belong to one of the objectives for a Doctoral Tesis study of the Clinic Medicine and Public Health Doctoral Program of the University of Granada. We would like to thank all the participants and professionals who participated., Background: Proper planning of Palliative Care in nursing homes requires advanced knowledge of the care needs that residents show. The aim of the study was to evaluate Palliative Needs and other conditions such as fragility, complexity, and prognosis and also to suggest new indicators for the establishment of the resident's advanced chronic condition. Methods: Cross-sectional study conducted in 149 nursing homes Complex Chronic residents evaluated by trained professionals. Palliative Care Needs, assessed by the NECPAL ICO-CCOMS (c) tool, and fragility, case and palliative complexity and prognosis were evaluate through a comprehensive assessment. Descriptive analyses and association measures were performed setting the statistical significance at 0.05. Results: More than 50% of the residents had positive Surprise Question and other Palliative Needs and were classified as Advanced Chronic Patients. Distress and/or Severe Adaptative Disorder was the most frequent need shown by the residents and significant differences in levels of frailty and other characteristics, were found between the Positive and the Negative Surprise Question Groups. Statistically significant correlations were also found between aspects of both groups. Conclusions: Nursing homes residents show Palliative Needs regardless of the response to the Surprise Question of the NECPAL tool. Other characteristics such as presence of an intermediate level of frailty are suggested as a new perspective to identify advanced chronic patients among nursing homes residents., Junta de Andalucia AP-0105-2016

Los programas de atención domiciliaria constituyen una valiosa herramienta de los sistemas de salud para la atención del paciente crónico, estos han estado en auge durante los últimos años, debido a su importancia en los sistemas sanitarios. Esta investigación tuvo como objetivo generar recomendaciones para la articulación de los programas de atención domiciliaria del paciente crónicos en la red pública y privada de Bogotá en miras al fortalecimiento de la atención integral del paciente crónico. La muestra estuvo compuesta por 6 IPS de la ciudad de Bogotá, 3 del sector público y 3 del sector privado, las cuales participaron en una entrevista semiestructurada de 50 preguntas divididas en 7 categorías. Los resultados se presentaron teniendo en cuenta las categorías de los modelos utilizados en el instrumento: EUROHOMAP y ciclo PVHA del sistema de gestión de calidad ISO. El análisis incluyo los conceptos de las ciencias contemporáneas plateados por Ostrom en el gobierno de los bienes comunes y otras teorías de las ciencias contemporáneas como: la teoría de la racionalidad, la teoría de redes y la teoría de los súper-cooperadores, adicionalmente se realizó un análisis desde la política pública. Las conclusiones reportaron la necesidad de utilizar nuevas teorías para analizar las dinámicas de los programas domiciliarios para pacientes crónicos y confirman la desarticulación presente en estos programas. Finalmente, el presente trabajo estableció unas recomendaciones desde el modelo EUROHOMAP y las ciencias contemporáneas para mejorar el funcionamiento de los programas domiciliarios frente a la atención integral del paciente crónico en la ciudad. Magíster en Salud Pública Maestría Home care programs are a valuable tool of health systems for the care of chronic patients, they have been on the rise in recent years, due to their importance in health systems. This research aimed to generate recommendations for the articulation of home care programs for chronic patients in the public and private network of Bogotá with a view to strengthening comprehensive care for chronic patients. The sample consisted of 6 IPS from the city of Bogotá, 3 from the public sector and 3 from the private sector, who participated in a semi-structured interview of 50 questions divided into 7 categories. The results were presented taking into account the categories of the models used in the instrument: EUROHOMAP and PVHA cycle of the ISO quality management system. The analysis included the concepts of contemporary sciences plated by Ostrom in the government of the commons and other theories of contemporary sciences such as: the theory of rationality, the theory of networks and the theory of super-cooperators, additionally it was carried out an analysis from public policy. The conclusions reported the need to use new theories to analyze the dynamics of home programs for chronic patients and confirm the disarticulation present in these programs. Finally, the present work established some recommendations from the EUROHOMAP model and contemporary sciences to improve the functioning of home programs in the face of comprehensive care of chronic patients in the city.

La Enfermedad Renal Crónica (ERC) fase 5 es catalogada como una enfermedad de alto costo que representa un gasto en salud importante para el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Este trabajo tiene por objeto revisar información estadística de la ERC durante el periodo 2015 a 2018 en la ciudad de Bogotá con el fin de hacer un análisis en relación con la incidencia y prevalencia de la ERC y sus principales enfermedades precursoras la Diabetes Mellitus (DM) y la Hipertensión Arterial (HTA) relacionando estos resultados con la gestión de riesgo en salud para esta enfermedad. Se tomó como fuente única de información la Cuenta de Alto Costo (CAC), se incluyeron pacientes de todas las edades y ambos sexos con ERC, HTA, DM y adicional a ello se tuvo en cuenta los pacientes en tratamiento con Terapia de Reemplazo Renal (TRR). Se encontró que la HTA es la enfermedad precursora más predominante, su prevalencia fue tres veces superior a la DM. En ambas enfermedades se observó que la incidencia estuvo en ascenso cada año. La población femenina en general fue las más afectada y se encontró mayor presencia de estas enfermedades en el grupo de edad de 60 a 74 años, resaltando que el 92% de la población total tanto en HTA como en DM correspondió a personas mayores de 45 años y el 8% restante están por debajo de esa edad. Para la ERC el panorama fue diferente en relación a la incidencia, ya que para el año 2017 y 2018 su tendencia fue hacia el descenso. Se concluyó que la ERC en todas sus fases durante el periodo 2015 a 2018 a diferencia de la HTA y la DM fue controlada, pero se deben hacer más esfuerzos en mejorar la gestión de riesgo para las patologías precursoras de la ERC reforzando las acciones preventivas en toda la población, especialmente los jóvenes y haciendo un mejor seguimiento a los que ya padecen estas patologías, es decir, se debe apuntar a mejorar la prevención secundaria con miras a evitar la progresión a ERC y enfermedad renal terminal con requerimiento de TRR. Especialista en Auditoría de Salud http://unidadinvestigacion.usta.edu.co Especialización

Mortality rates among pluripathological patients are significantly higher in the hospital setting, with advanced age and dependence on certain vital functions the main clinical aspects. Other features involved in the care, such as the loss of autonomy and social problems, have important ethical implications. The aim of this article is to analyze the health problems and the functional and social situation of chronic patients after hospital admission in order to determine their care needs and the ethical implications these might have. For this, a cross-sectional descriptive study is being carried out with a sample of 111 chronic pluripathological patients admitted to the internal medicine service and discharged later. Overall, 96.6% of the patients in the sample were dependent, 91.7% had social problems or were at social risk and 36.9% had cognitive impairment. Among dependent patients, 59.4% had social problems (p = 0.029), 19.2% lived alone (p = 0.13), and in 73.3% of cases the housing was inadequate (p = 0.47). Among those with cognitive impairment, 79.5% of patients had social problems (p = 0.001), and 10.3% lived alone (p = 0.038). The results of the study confirm the presence of dependence and social problems at hospital discharge in a high proportion of chronic patients. Planning their care can lead to ethical conflicts related to the use of information technologies, which are destined to promote the patients&rsquo, autonomy, and to the social problems associated with the illness.

Este documento, plantea la relación entre el paciente crónico, su tratamiento y las redes de apoyo que se ven involucradas en el proceso de salud posterior al diagnóstico. Como metodología, se relacionan informes, artículos y diferentes documentos desde el año 2000, conexos en varias bases de datos. Dentro de los resultados, se observa la relación del paciente, el tratamiento y las redes con herramientas como el trabajo en equipo, liderazgo y comunicación asertiva, ya que para lograr garantizar que el paciente goce de calidad de vida se deben involucrar todos los actores del Sistema de Salud y generar nuevas estrategias que faciliten esta nueva etapa de vida del paciente. Se puede concluir que la implementación de estrategias, no solo beneficia al paciente, sino que también reduce costos al Sistema de Salud, aumenta adherencia al tratamiento y hace más efectivo el trabajo de los actores involucrados en el proceso de salud del paciente crónico. This document presents the relationship between the chronic patient, his treatment and the support networks that are involved in the post-diagnosis health process. As a methodology, reports, articles and different documents since 2000, connections in various databases, are related. Among the results, observe the relationship of the patient, treatment and networks with tools such as teamwork, leadership and assertive communication, since in order to control that the patient enjoys quality of life, all the actors in the Health system and generate new strategies that facilitate this new stage of the patient's life. It can be concluded that the implementation of strategies, not only beneficiaries to the patient, but also reduces costs to the Health System, increases adherence to treatment and makes the work of the actors involved in the chronic patient's health process more effective. Especialización

O objetivo deste estudo é conhecer como os adolescentes hospitalizados se sentem em relação à sua vivência como um paciente crônico grave, excetuando-se aqui os pacientes neurológicos severos e os com problemas psicológicos graves, e que saberes esses sujeitos desenvolvem durante o período de hospitalização. Trabalhou-se com cinco adolescentes com cânceres de diferentes etiologias, com idades compreendidas entre 13 e 19 anos. Todos os adolescentes foram atendidos no hospital seguindo o método das Conversas Fenomenológicas (FERNANDES, 2017). O objetivo foi questionar as diferentes hipóteses possíveis sobre o papel da escolarização para o adolescente gravemente doente e sua relação com o saber neste momento de dificuldade física e de supressão do direito à escola. Como resultado, percebeu-se que o estudo regular não lhes faz falta, pois o que eles querem é falar sobre si mesmos, sobre tudo o que lhes acontece, sobre a doença, seus sentimentos, sua maneira de ver o mundo e tudo sobre o que nunca pensaram. Sua relação com a classe hospitalar parece inaugurar uma nova relação com o saber escolar, ainda não inaugurada pela escola.

Background When novel treatments prove to be better than conventional therapy there is a need for effective introduction, both for cost-effectiveness and to minimize patient suffering. Effective implementation is a challenge in patients with chronic diseases who may be treated both in primary care and/or specialist clinics. Studies have shown that introduction is often unnecessary delayed. Our aims were to develop a model for systematic introduction and to test the feasibility of this model on a new treatment of a chronic disease. We also investigated how such an approach would be received by the patients. Methods The systematic introduction approach is a seven step procedure; Step 1 - define a few main criteria for the specific therapy, Step 2 – primary scan patients with the one or two main criteria using computerised medical records, databases or clinical registries, Step 3 – identify patients applying the other predefined criteria, Step 4 - evaluate if any examinations or laboratory test updates are required, Step 5 - summon identified patients to the clinic with an information letter, Step 6 – discuss treatment with the patient and prescribe to appropriate patients, Step 7 – follow-up on initiated therapy and evaluate the applied process. The model was tested in a case study during introduction of the new drug sacubitril-valsartan in a heart failure population. Patient experiences with the approach were investigated in an interview study with general inductive approach using qualitative content analysis. Results By applying the systematic introduction approach in the case study, 76 out of 1924 patients were identified to be eligible for sacubitril-valsartan and summoned to the clinic to discuss treatment. The content analysis resulted in three final categories of how the model was received by the patients; A good approach , Role of the information letter , and Trust in care . Conclusions The systematic introduction approach ensures that strict criteria are used in the selection process and that a treatment can be implemented in eligible patients within a specified population with limited resources and time. The model was effective in our case study and maintained the patient’s confidence in health care.

Over the last 2 decades, advances in the diagnosis and management of pituitary diseases have made it possible to attain an endocrine "cure"in a large proportion of patients. In other words, tumors can be excised or controlled with drugs, mass effects of the lesion on surrounding structures can be solved, and pituitary deficiencies can be substituted with all relevant hormones. While this is considered a satisfactory outcome for health care providers, patients often suffer from an aftermath of prior endocrine dysfunction exposure, with irreversible effects, both physically and psychologically, which have a great impact on their everyday life. Diagnostic delay, often of several years, adds a negative impact on health perception. This affects their social, professional, and family domains and determines their future life. Understanding that this may occur is important, and health care providers should offer information to prepare the patient for this difficult journey, especially in the case of acromegaly, Cushing disease, or hypopituitarism. In order to maintain a good quality of life (QoL) in the long-term, patients need to adapt to this new situation, something that may be difficult, since they often cannot continue with all the activities and rhythm they used to do. Depression is often the consequence of maladaptation to the new situation, leading to impaired QoL. © 2020 S. Karger AG, Basel. All rights reserved.

The aims of this cross-sectional survey were to evaluate the knowledge, attitudes, and self-reported adherence to recommended vaccinations among a random sample of patients with chronic conditions presenting for a medical visit in out-patient clinics in Italy. Patients who were healthcare workers (HCWs), those with diabetes, those who had received information by Internet, physicians, and friends/relatives, and those who needed more information were more likely to know that the influenza vaccine is recommended for patients with chronic diseases. More than half (58.2%) and 8.9% self-reported to have received at least one recommended vaccination and more than one, respectively. Patients who believed that vaccine-preventable diseases (VPDs) were dangerous for them, those who had received information by physicians, and those who needed information were more likely to have received at least one recommended vaccination. This behavior was less likely in married patients, those who were worried about the side effects of the vaccines, and those who suffered from renal failure. The results highlight the need to implement effective vaccination programs in order to decrease the complication of VPDs in at-risk population.

El cuidador del paciente crónico es un agente fundamental para el manejo de la enfermedad crónica y los cambios que implica su atención. No obstante, los esfuerzos del sistema suelen centrarse en el paciente. El objetivo de este estudio es describir, a partir de una revisión de la literatura, los hallazgos más relevantes respecto al cuidador de este tipo de pacientes con discapacidad, su abordaje, desarrollo e implicaciones para su gestión desde el sistema de salud. Para ello, se incluyeron estudios publicados en la última década, se discuten sus resultados y se analizan los principales retos y oportunidades de mejora para una gestión integral que incluya al cuidador. Al atender al cuidador se favorece la calidad de vida del paciente crónico en cuanto al mejorar la calidad de la atención, se puede prevenir la aparición de trastornos secundarios, contribuyendo al bienestar no solo del paciente sino del cuidador, todo lo cual ayudará a optimizar los recursos del sistema de salud. The chronic patient caregiver in a fundamental agent when handling a chronic disease and the changes that its attention implies. Nevertheless, the system efforts tend to be patient-focused. The objective of this study is to describe, based on the literature, the most relevant findings related to the caregiver in these type of disabled patients, its way of working, development and implications for its management from the health care system perspective. Studies from the past decade are included, where its results are discussed and the main challenges and improvement opportunities for a management view that involves the keeper are analyzed. By meeting the keeper needs, the chronic patient's quality of life improves due to a better care, secondary disease can be prevented helping not only the patient but the keeper. All these impact would help optimizing the health care system resources.

espanolRESUMEN El proceso de envejecimiento y las enfermedades cronicas implican cambios vitales en el adulto mayor que suponen, en muchas ocasiones, acontecimientos estresantes que derivan en un malestar psicologico y un deterioro de la calidad de vida. La vejez es una etapa caracterizada por sentimientos de perdidas y disminucion de capacidades funcionales y afectivas. Se investiga la serenidad como estrategia de afrontamiento en relacion con el apoyo psicologico y emocional para mejorar las capacidades del adulto mayor para afrontar los problemas o dificultades que conllevan las consecuencias del envejecimiento. Objetivo: Analizar el concepto de serenidad en relacion con el apoyo psicologico y emocional del paciente cronico. Metodologia: Revision de la bibliografia. La busqueda se realizo en PubMed, CINAHL, Cochrane Library y Medline. Se acoto al periodo 1999-2017, incluyendo aquellos estudios que solo aplican el concepto de serenidad para la promocion de la salud mental. Resultados: De los 40 estudios revisados, 8 hacian referencia al envejecimiento y la cronicidad; 15 a trastornos afectivos en la cronicidad; 13 al apoyo emocional y psicologico en el paciente mayor cronico, y 4 a la serenidad y cuidado enfermero. Posteriormente al analisis se identificaron tres temas relacionados: apoyo emocional en la cronicidad, concepto de serenidad y bienestar psiquico y emocional, definiendo atributos y niveles de serenidad, apoyo emocional en la cronicidad. Conclusiones: El concepto de serenidad puede representar una herramienta que fomente el bienestar psiquico y emocional del paciente mayor cronico, ayudando a aceptar y manejar la situacion de salud. Resulta necesaria una mayor evidencia cientifica sobre el concepto y su uso en los profesionales enfermeros. EnglishABSTRACT The aging process and chronic diseases involve vital changes in the elderly that, in many cases, involve stressful events that lead to psychological discomfort and a deterioration in the quality of life. Old age is a stage characterized by feelings of loss and decreased functional and affective abilities. Serenity is investigated as a coping strategy in relation to psychological and emotional support to improve the abilities of the elderly to face the problems or difficulties that entail the consequences of aging. Objective: To analyze the concept of serenity in relation to the psychological and emotional support of the chronic patient. Methodology: Review of the literature. The search was performed in PubMed, CINAHL, Cochrane Library, Medline. The 1999-2017 period was included, including those studies that only apply the concept of serenity for the promotion of mental health. Results: Of the 40 studies reviewed, 8 referred to aging and chronicity; 15 to affective disorders in the chronicity; 13 to emotional and psychological support in the chronically elderly patient; 4 to serenity and nursing care. Three related topics were identified: emotional support in chronicity, the concept of serenity and psychic and emotional well-being, defining attributes and levels of serenity, emotional support in chronicity. Conclusions: The serenity can represent a tool that promotes the psychic and emotional well-being of the chronic elderly patient, helping to accept and manage the health situation. Greater scientific evidence on the concept and its use in nursing professionals is necessary.

The present study wants to bring to light a new type of crutch designed for a chronic patient with perennial limited mobility, who must use this support every time a move is needed. The main purpose of the project consists in recommending a correct use of the crutch through technology, limiting the damage normally caused by a bad use of crutches and giving a support both for the patient and for the doctor. All of the features of the crutches were defined through relationship matrices and a benchmarking, which helped us for defining the requirements, other important features were defined, taking a look to the technological progresses applied to new, patented crutches. The result is a sensorized crutch, functional and oriented to meet the user&rsquo, s needs in order to prevent an incorrect use of the support avoiding the growth of other pains.

La Insuficiencia Venosa Crónica es una patología progresiva, la cual es más prevalente entre el sexo femenino. Ciertos estudios demuestran que la enfermedad venosa altera la movilidad, el sueño, provoca efecto psicológico negativo y una disminución de la calidad de vida del paciente. Se presenta el caso clínico de una paciente de 65 años con diver-sas patologías, entre ellas Insuficiencia Venosa Cónica, que presenta baja adherencia terapéutica, sobrepeso, problemas de autoimagen, disconfort y déficit de conocimientos. El objetivo planteado fue proporcionar cuidados enfermeros que aporten al paciente conocimientos sobre su enfermedad, aumenten la adherencia terapéutica a su tratamien-to y mejoren su autoimagen y confort. Gracias a una adecuada planificación de cuidados, la paciente expresó gran satisfacción tras ampliar sus conocimientos y habilidades de autocuidado. Además presentó cambios significativos en su piel, mostró mejoría en su descanso y mayor aceptación hacia su imagen. Como conclusión, la educación para la salud en el paciente crónico es esencial para lograr un adecuado automanejo de su enfermedad y, así, aumentar la satisfacción con su proceso de salud.

Background Electronic health records may present laboratory test results in a variety of ways. Little is known about how the usefulness of different visualizations of laboratory test results is influenced by the complex and varied process of clinical decision making. Objective The purpose of this study was to investigate how clinicians access and utilize laboratory test results when caring for patients with chronic illness. Methods We interviewed 10 attending physicians about how they access and assess laboratory tests when following up patients with chronic illness. The interviews were audio-recorded, transcribed verbatim, and analyzed qualitatively. Results Informants preferred different visualizations of laboratory test results, depending on what aspects of the data they were interested in. As chronic patients may have laboratory test results that are permanently outside standardized reference ranges, informants would often look for significant change, rather than exact values. What constituted significant change depended on contextual information (e.g., the results of other investigations, intercurrent diseases, and medical interventions) spread across multiple locations in the electronic health record. For chronic patients, the temporal relations between data could often be of special interest. Informants struggled with finding and synthesizing fragmented information into meaningful overviews. Conclusion The presentation of laboratory test results should account for the large variety of associated contextual information needed for clinical comprehension. Future research is needed to improve the integration of the different parts of the electronic health record.

For the prevention and management of diseases in chronic patients, attention has been directed at ubiquitous healthcare systems in order to reduce medical expenses and provide high-quality medical services at different places, including hospitals and homes. In this paper, a ubiquitous healthcare system has been proposed in order to care for a chronic patient, to be used by a nurse or a care professional at the patient’s residence. It comprises a portable bio-signal acquisition device, smartphone application, and ubiquitous health server. The smartphone application collects the patient information, including lifelog and the bio-signals from the device, and transfers the patient information through bio-signals to the ubiquitous health server. The ubiquitous health server monitors the bio-signals with the help of lifelog, analyzes the patient’s health state, and alerts medical staff on symptoms of any illness. The proposed system collects five types of bio-signals from patients using the acquisition device, automatically monitors and analyzes their bio-data with lifelog, displays the state of their health as determined by the analysis, using graphical representation, such that the doctor can understand the patient’s condition and undertake an appropriate medical treatment procedure.

A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management.We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators.Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices.First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.Pilotni projekt na področju družinske medicine v Sloveniji je leta 2011 uvedel novo metodo dela v družinski medicini, pri čemer je nov član tima postala diplomirana medicinska sestra, prav tako pa se je uvedel nadzor kakovosti s pomočjo kazalnikov kakovosti. Namen tega članka je bil oceniti kakovost vodenja bolnikov s sladkorno boleznijo in hipertenzijo.V analizo smo vključili vse ambulante družinske medicine, ki so sodelovale v projektu konec decembra 2015. Iz avtomatične baze poročil smo izluščili in analizirali naslednje podatke: spol in specializacijo zdravnika, status zdravnika (javni uslužbenec, koncesionar), trajanje sodelovanja v projektu, regijo, v kateri je ambulanta, število prebivalcev na območju, ki ga pokriva ambulanta, računalniško hišo, ki nudi program, in raven izbranih kazalnikov kakovosti.Od 584 ambulant družinske medicine jih je imelo 568 (97,3%) popolne podatke in so bile vključene v analizo. Najvišja vrednost kazalnikov kakovosti je bila opazovana pri kazalnikih kakovosti pogojev (register diabetikov), najnižja pa pri kazalnikih procesa in izida. Vrednosti izbranih kazalnikov kakovosti so bile neodvisno povezane s trajanjem sodelovanja v projektu, nekaterimi regijami Slovenije in nekaterimi računalniškimi hišami, ki nudijo elektronsko podporo.Prva analiza podatkov kazalnikov kakovosti za diabetes in arterijsko hipertenzijo je pokazala na probleme, ki trenutno onemogočajo doseganje višje kakovosti obravnave bolnikov na primarni ravni zdravstvenega varstva.