A core outcome set for evaluating self-management interventions in people with comorbid diabetes and severe mental illness : study protocol for a modified Delphi study and systematic review

BACKGROUND: People with diabetes and comorbid severe mental illness (SMI) form a growing population at risk of increased mortality and morbidity compared to those with diabetes or SMI alone. There is increasing interest in interventions that target diabetes in SMI in order to help to improve physical health and reduce the associated health inequalities. However, there is a lack of consensus about which outcomes are important for this comorbid population, with trials differing in their focus on physical and mental health. A core outcome set, which includes outcomes across both conditions that are relevant to patients and other key stakeholders, is needed. METHODS: This study protocol describes methods to develop a core outcome set for use in effectiveness trials of self-management interventions for adults with comorbid type-2 diabetes and SMI. We will use a modified Delphi method to identify, rank, and agree core outcomes. This will comprise a two-round online survey and multistakeholder workshops involving patients and carers, health and social care professionals, health care commissioners, and other experts (e.g. academic researchers and third sector organisations). We will also select appropriate measurement tools for each outcome in the proposed core set and identify gaps in measures, where these exist. DISCUSSION: The proposed core outcome set will provide clear guidance about what outcomes should be measured, as a minimum, in trials of interventions for people with coexisting type-2 diabetes and SMI, and improve future synthesis of trial evidence in this area. We will also explore the challenges of using online Delphi methods for this hard-to-reach population, and examine differences in opinion about which outcomes matter to diverse stakeholder groups. TRIAL REGISTRATION: COMET registration: http://www.comet-initiative.org/studies/details/911 . Registered on 1 July 2016

Yksilövastuinen hoitotyö : Vastuuhoitajuuden kehittäminen Vihdin kotihoidossa

Tämän opinnäytetyön tarkoituksena oli selvittää yksilövastuisen hoitotyön toteutumisen nykytilaa Vihdin kotihoidossa. Tavoitteena oli laatia yksilövastuiseen hoitotyöhön pohjautuvan vastuuhoitajan työnkuvasta selkeä ohjeistus ja tuoda esille työyksikön mahdollisia kehittämistarpeita. Ohjeistuksen tavoitteena oli selkeyttää vastuuhoitajan työnkuvaa. Kehittämistyön kohderyhmänä oli työyksikön henkilökunta. Teoreettisessa viitekehyksessä kerrotaan yksilövastuisesta hoitotyöstä ja kotihoidosta. Yksilövastuisesta hoitotyöstä kerrotaan tarkemmin perusperiaatteiden vastuullisuuden, autonomian, koordinoinnin, kattavuuden ja potilaskeskeisyyden näkökulmasta. Kotihoidosta kerrotaan määritelmästä aina vaikuttaviin lakeihin asti. Teoreettinen viitekehys rakennettiin kirjallisuuden, artikkelien ja internetlähteiden avulla. Opinnäytetyö toteutettiin toiminnallisena opinnäytetyönä, jossa hyödynnetään laadullista tutkimusmenetelmää toimintaympäristön nykytilan selvittämisessä. Aineistonkeruumenetelmänä käytettiin teemahaastattelua. Teemahaastattelurunko rakentui teoreettisesta viitekehyksestä. Analyysi toteutui teorialähtöisenä sisällönanalyysinä. Tuloksia hyödynnettiin tuotoksen kokoamisessa ja kehittämistarpeiden esille tuomisessa. Opinnäytetyömme tuotoksena syntyi "Vastuuhoitajuuden puu", joka tuo esille toimintaympäristön vastuuhoitajan työnkuvan selkeästi. Vastuuhoitajuudenpuu -tuotoksen arviointi toteutui toimintaympäristön henkilökunnan arvioimana, joka toteutettiin kyselylomakkeella. Vastausten perusteella tuotosta kuvailtiin selkeäksi, ja lisäksi sen kerrottiin sisältävän yksikön vastuu-hoitajuuden työnkuvan erittäin hyvin. Tuotosta voidaan käyttää työyksikköön perehdyttämisessä ja työnkuvan selkeyttämisen apuvälineenä. Tuloksista mahdollisina kehittämistarpeina esiintyi työnjakomallin yhtenäistäminen, tiedonkulun parantaminen ja korvaavan hoitajan työnkuvan määritteleminen. Vastuuhoitajan tulisi myös saada mahdollisuus hoitaa työvuorollaan omia asiakkaitaan.The purpose of this thesis was chart how primary nursing is carried out in residential care in Vihti’s home care services. The aim of this thesis was to make a guide for nurses about primary nursing which supports primary care in home care services. The aim of this thesis was also to find out the development needs. The aim of guide was make primary nursing easier to understand. The guide was made for the staff in home care services. The theoretical framework of this thesis is about primary nursing care and home care. Primary nursing care include principles which are responsibility, autonomy, coordination, coverage and patient centricity. Home care includes facts about definitions of laws. The theorectical framework has been built with the aid of literature, articles and internet sources. The thesis was carried out as an action research which was made with qualitative research method. The data were collected with a theme interview. The theme interview structure followed the theorectical framework. Analysis was made with theorectical content analysis. The results of interview were used in the guide and proposals for improvement. The guide "Primary nurse tree" clarifies primary nurse's job description in home care services. The guide was rated by home care services staff who answered an inquiry. According to the results the guide clarified primary nurse job description very well. The guide can be used in orientation and to clarify primary nurse job description. Proposals for improvement that arose from the interview were to standardize distribution of work, improve flow of information and to define the job description associate nurse and the primary nurse should be allowed to take care of his/her own patients work

Análise da eficácia do metilfenidato usando a versão abreviada do questionário de conners em transtorno de déficit de atenção/hiperatividade Analysis of the methylphenidate's efficacy using the abbreviated version Conners' questionnaire in attention deficit hyperactivity disorder

O transtorno de déficit de atenção/hiperatividade (TDAH) é quadro diagnóstico bastante complexo, de início precoce, com evolução crônica que repercute em diversos contextos. Três a 5% das crianças em idade escolar apresentam esse transtorno. O questionário de Conners vem sendo utilizado como instrumento de levantamento epidemiológico para o TDAH. OBJETIVO: Este estudo visa a utilização deste instrumento para a análise da eficácia do tratamento com metilfenidato em crianças com TDAH. MÉTODO: Foram selecionadas 21 crianças do gênero masculino, com TDAH do tipo combinado, idade cronológica entre sete anos completos a 10 anos e 11 meses e todos foram tratados com metilfenidato. A versão abreviada do questionário de Conners para pais e professores foi aplicada em dois momentos: um antes da medicação e outro entre seis a oito meses após o seu início. RESULTADOS: Obteve-se redução na pontuação no questionário de Conners em todas as crianças com TDAH concomitante à melhora clínica. CONCLUSÃO: Observou-se que o questionário de Conners mostrou-se útil não só como auxílio diagnóstico, mas também como um instrumento de avaliação da eficácia do tratamento do TDAH.<br>The attention deficit/hyperactivity disorder (ADHD) is a complex diagnosis. Its installation is precocious, with chronic evolution that impacts on the subject's performance in several contexts. Three to 5% of the school aged children present this disorder. The Conners' questionnaire has been used as an instrument of epidemiological survey for ADHD children. OBJECTIVE: This study aimed to investigate if this instrument could be an useful tool for the analysis of the methylphenidate's treatment efficacy in ADHD's children. METHOD: Twenty-one male children were selected, with ADHD combined type, chronological ages ranging from seven to 10 years and 11 months and all were treated with methylphenidate. The Conners' questionnaire abbreviated version for parents and teachers was applied in two moments, one without medication and another between six to eight months after the beginning of the methylphenidate. RESULTS: Results pointed to a reduction in punctuation in Conners' questionnaire in all children with ADHD concomitant to clinical improvement. CONCLUSION: Conners' questionnaire revealed to be useful not only for diagnosis, but also as an instrument to evaluate the effectiveness of the treatment of ADHD