Tailoring eHealth design to support the self-care needs of patients with cardiovascular diseases:a vignette survey experiment

Self-care support is a key cornerstone of treatment for patients with a cardiovascular disease. The success of any supportive intervention requires adaptation to the distinct needs of individuals. This requirement also applies to eHealth interventions. This study investigates how experts from multiple fields of science assess the potential success of different eHealth design strategies when matched to key self-care needs. An online vignette survey experiment was conducted. Nine vignettes representing different combinations of self-care needs (maintenance, monitoring, management) and eHealth persuasive design strategies (primary task support, dialogue support, social support) were evaluated. In total, 118 experts from 18 different countries participated in the survey. Their evaluations show primary task support as a promising design strategy across all self-care needs. In contrast, dialogue support and social support showed more promise for specific self-care needs. Above all, according to experts, the success of design strategies could be enhanced by (i) personalising the pacing of the intervention and (ii) tailoring the information to the literacy and culture of the person. Adding to that, self-care support should distinctly (iii) support the three self-care needs, be (iv) patient-centered, (v) support the collaboration with caregivers, and (vi) be aligned to the life goals and values of individuals

Use of negative pressure therapy in the management of complex wounds initial experience of 4 years

Background: Wound management with negative pressure therapy has been used in the treatment of complex wounds in both inpatient and outpatient settings, and is increasingly used in primary care and outpatient management, as it helps to reduce patient days of hospital stay. We describe the initial 4-year experience in the use of negative pressure therapy in the management of complex wounds.Methods: A retrospective, cross-sectional and descriptive study of our experience of the use of negative pressure therapy for the management of complex wounds in 5 years.Results: A total of 89 patients with complex wounds managed with TPN were analysed, of which 53 were men (62.9%) and 33 were women (37.1%). Suprafacial therapy was used in 64 cases (73%). The ABTHERA® system was used in 25 cases (27%). Among the etiology of complex wounds, vulvar abscess was recorded in 1 case (1.1%), firearm wound in 1 case (1.1%), Fournier's gangrene in 1 case (1.1%), septic arthritis in 1 case (1.1%), burn wounds in 1 case (1.1%), septic arthritis in 1 case (1.1%), and burn wounds in 1 case (1.1%). 1%), burn wounds in 5 cases (5.6%), pressure ulcer wound in 6 cases (6.7%), necrotizing fasciitis in 19 cases (21.3%), abdominal sepsis in 26 cases (29.2%), surgical wound infection in 29 cases (32.5%).Conclusions: The use of negative pressure therapy and protocolized management has provided patients in our institution with a viable therapeutic option

Changes in the ankle muscles co-activation pattern after 5 years following total ankle joint replacement

© 2018 Elsevier Ltd Background: The Hintegra® arthroplasty provides inversion-eversion stability, permits axial rotation, ankle flexion-extension, and improvements of the gait patterns are expected up to 12 months of rehabilitation. However, sensorimotor impairments are observed in ankle flexors/extensors muscles after rehabilitation, with potential negative effects on locomotion. Here we determined the timing and amplitude of co-activation of the tibialis anterior and medial gastrocnemius muscles during gait by assessing non-operated and operated legs of patients with total ankle replacement, 5 years after surgery. Methods: Twenty-nine patients (age: 58 [5.5] years, height: 156.4 [6.5] cm, body mass: 72.9 [6.5] kg, 10 men, and 19 women) that underwent Hintegra® ankle arthroplasty were included. Inclusion criteria included 5 years prosthesis survivorship. The onset and offset of muscle activation (timing), as well as the amplitude of activation, were determined during barefoot walkin

Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies:Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development

Background: Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the use of different terms and concepts to explain the same phenomena and lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A review of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts. Objective: This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to achieve an understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods. Methods: The metaethnography approach was used to review and synthesize researchers' reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, Association for Computing Machinery Digital Library, and Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters. Results: Of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) applied by the projects were identified. Key ingredients (n=293) of the included articles were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) it targets behavior change; (7) it targets technology adoption; and (8) it targets health-related outcomes. Conclusions: The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modeling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches

Participación, solidaridad, autoridad y bien común

Se presentan algunos puntos de cívica, se trata la participación en la vida del país y el compromiso individual con el desarrollo del país, deber solidario y búsqueda del bien común.There are some points of civic, it is the participation in the life of the country and the individual commitment with the development of the country, duty of solidarity and search of the common good.Organización del país, autoridad y bien común – Solidaridad – Participación en el desarrollo del paísn