Revisión de la literatura integradora acerca de intervenciones de la enfermería volcadas hacia el incremento del autocuidado entre pacientes con insuficiencia cardiaca

Objective: to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients.Methods: PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients).Results: this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints.Conclusions: these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.Objetivo:analisar e sintetizar o conchecimento relacionado aos componentes críticos das intervençoes que têm, sido propostas e implementadas por enfermeiros(as) com objetivo de optimizar o auto-cuidado de pacientes portadores de insuficiência cardíaca.Método:PubMed e CINAHL foram as bases de dados electrônicas utilizadas para investigar artigos revisados por pares (peer review), apresentando as descrições das intervenções dirigidas ao paciente ou ao paciente e sua familia, visando melhorar o auto-cuidado. Foram incluídos 42 estudos na amostra final (n=4799 pacientes).Resultados:esta revisão apontou variedade e complexidade das intervenções de enfermagem. Como o auto-cuidado envolve diferentes comportamentos, as intervenções visaram em média 3,6 comportamentos. As Atividades de educação e aconselhamento foram combinadas ou não com estratégias cognitivo-comportamentais, mas somente a metade dos estudos utilizaram suporte teórico para guiar as intervenções. A avaliação e o manejo clínico foram frequentemente associados às intervenções de auto-cuidado, as quais variam em número de sessões (1 a 30), duração do seguimento (2 semanas a 12 meses) e desfechos.Conclusão:estes resultados podem ser úteis para guiar os enfermeiros no que se refere à futuros estudos sobre intervenções de auto-cuidado, de maneira a propor a comparação de diferentes modalidades de intervenção, uso de suporte teórico e estabelecimento de desfechos para melhor avaliar sua eficácia.Objetivo:analizar y sintetizar el conocimiento relacionado a componentes críticos de intervenciones que han sido propuestas e implementadas por enfermeros(as) con el objetivo de optimizar el autocuidado entre pacientes con insuficiencia cardiaca.Método:PUBMED y CINAHL han sido las bases de datos electrónicas usadas para investigar artículos revisados por pares (peer review), presentando descripciones de intervenciones destinadas a perfeccionar el autocuidado dirigido al paciente o al paciente y a su familia. Se incluyeron 42 estudios en la muestra final (n=4799 pacientes).Resultados:esta revisión apuntó a una variedad y complejidad de intervenciones de enfermería. Como el autocuidado abarca varios comportamientos, las intervenciones tuvieron como blanco, en media, 3,6 comportamientos. Actividades de educación/consejería fueron combinadas o no con estrategias cognitivo-comportamentales, pero tan solo cerca de la mitad de los estudios tenían aporte teórico para guiar intervenciones. La gestión y la evaluación clínica fueron frecuentemente asociadas a intervenciones de autocuidado, las cuales oscilaron en número de sesiones (1 a 30), duración del seguimiento (2 semanas a 12 meses) y objetivos.Conclusiones:estos resultados pueden ser útiles para informar a las enfermeras acerca de nuevas investigaciones en intervenciones de autocuidado, de modo a proponer la comparación de distintas modalidades de intervención, el uso de un aporte teórico y el establecimiento de objetivos para evaluar su eficacia

Towards a decision-support procedure to foster stakeholder involvement and acceptability of urban freight transport policies

Abstract Purpose This paper addresses the complex problem of multi-stakeholder decisions in urban freight transport policy-making from a public authority perspective, by proposing a procedure based on a modelling approach to support stakeholder involvement in the decision-making process. The paper analyses the existing methods that can be used for participatory decision-support, with the intent of contextualizing and introducing the innovative modelling approach. Methods The modelling approach consists of a well-thought integration of discrete choice models (DCM) with agent-based models (ABM) as an effective way to account for stakeholders’ opinions in the policy-making process, while mimicking their interaction to find a shared policy package. The integrated modelling approach is able to combine the advantages of the two methods while overcoming their respective weaknesses. Since it is well grounded on sound microeconomic theory, it provides a detailed (static) stakeholders’ behavioural knowledge, but it is also capable of reproducing agents’ (dynamic) interaction during the decision-making process. The integration allows performing an ex-ante behavioural analysis, with the aim of testing the potential acceptability of the solutions proposed. The methodology is applied in a real case study to prove its feasibility and usefulness for participatory decision-making. Results The integrated modelling approach can be used for participatory decision-support and it can be casted in the overall UFT policy-making process. The results of the behavioural analysis, in terms of ranking of potentially accepted policies, linked with the technical evaluations from transport network modelling tools, provide a sound basis for active participation and deliberation with stakeholders and policy-makers. The aim is to guide an effective participation process aimed at consensus building among stakeholders, by proposing them a subset of policies that, as a result of a preliminary analysis, are likely to be accepted while performing well in terms of technical results. Conclusions This approach, integrating DCM and ABM, represents a promising way to tackle the complexity of multi-stakeholder involvement in UFT policy-making and to support an efficient and effective decision-making process. It produces an added value for UFT policy-making and it can be framed in the overall context of transport planning. In fact, together with technical and economic analyses, the stakeholder behavioural analysis proposed contributes to the ex-ante policy assessment needed to support decision-makers in taking well-thought decisions

Post-disaster multi-period road network repair: work scheduling and relief logistics optimization

We develop a multi-period bi-level programming model for the post-disaster road network repair work scheduling and relief logistics problem. A maximum relative satisfaction degree-based steady-state parallel genetic algorithm is designed to solve this model. In order to validate and test the effectiveness of the presented mathematical model and method, we use a network generator to create numerical examples with different scales and characteristics of road network. Our numerical analysis of the solutions shows that the proposed mathematical model and method can effectively assist the decision-makers to deal with the road network repair work scheduling and relief logistics optimization problem during the emergency response phase. This mathematical model and the approach being developed are applied to deal with the case of Wenchuan earthquake in China. The results show that the required CPU time is short enough such that it meets the time limitation in the emergency response phase, and the strategy of road network repair scheduling will allow repair of the damaged roads to be completed before the end of the planning time horizon by 14.93%. Furthermore, the strategy of relief logistics can provide an efficient relief allocation and transportation path