Validation of the patient assessment of chronic illness care (PACIC) short form scale in heart transplant recipients: The international cross-sectional bright study

Background: Transplant recipients are chronically ill patients, who require lifelong follow-up to manage co-morbidities and prevent graft loss. This necessitates a system of care that is congruent with the Chronic Care Model. The eleven-item self-report Patient Assessment of Chronic Illness Care (PACIC) scale assesses whether chronic care is congruent with the Chronic Care Model, yet its validity for heart transplant patients has not been tested. Methods: We tested the validity of the English version of the PACIC, and compared the similarity of the internal structure of the PACIC across English-speaking countries (USA, Canada, Australia and United Kingdom) and across six languages (French, German, Dutch, Spanish, Italian and Portuguese). This was done using data from the cross-sectional international BRIGHT study that included 1378 heart transplant patients from eleven countries across 4 continents. To test the validity of the instrument, confirmatory factor analyses to check the expected unidimensional internal structure, and relations to other variables, were performed. Results: Main analyses confirmed the validity of the English PACIC version for heart transplant patients. Exploratory analyses across English-speaking countries and languages also confirmed the single factorial dimension, except in Italian and Spanish. Conclusion: This scale could help healthcare providers monitor level of chronic illness management and improve transplantation care. Trial registration: Clinicaltrials.gov ID: NCT01608477, first patient enrolled in March 2012, registered retrospectively: May 30, 2012

Diagnósticos e intervenciones de enfermería en el paciente ambulatorio con cardiopatía isquémica

• Background: Patients with coronary heart disease (CHD) account a high percentage of the global population attended in outpatient cardiology clinic. Those patients need frequent following visits. In our center we used taxonomy NANDA, according to the Virginia Henderson model. • Aims: To determine the nursing diagnosis of the hospital discharge that need continuity of cares. To identify the nurse’s interventions outpatient cardiology clinic. • Material and method: Descriptive, cross-sectional, prospective study. We included: patients with medical diagnosis of CHD submitted to the clinic and with a Report of Continuity Nurse’s care given by nurse staff at hospital discharge, and with the same diagnosis in following revisions from 1-10-2007 to 31-1-2008. Statistical analysis was made using SPSS 9.0. • Results: A total of 943 patients were attended at the clinic; 464 were men (49,20%) and 479 women (50,80%). Average age: 61.4± 3.80. First appointments 386 (40,93%) and 557 (59,07%) revisions; 282 patients presented medical diagnosis of CHD (29,91%); 50 patients were first appointments (12,95%) and 156 patients were revisions (28,007%). The nursing diagnosis (ND) which need continuity cares were: 00132- Thoracic Pain: 92 patients (32,62%); 00092-Intolerancia to activity: 79 patients (28,01% ); 00126- Deficient knowledge: disease, self-care and therapeutic regime:198 patients (70,21% ); Inefficient handling of the therapeutic regime: 86 patients (30,49%). Interventions in outpatient clinic focus in: Thoracic pain: 4040-Care cardiac .Intolerance to the activity: 1800 Aid to the self-care one. 4490 Aid to stop smoking. Deficient knowledge: disease, self-caring and therapeutic regime: 5612-Education: activity/prescribed exercise. 5614-Education prescribed diet. 5616-Education: prescribed medicines. Inefficient handling of the therapeutic regime. 4050-Precaution cardiac. • Conclusions: The information of continuity of care is an effective instrument for the ambulatory follow up of patients. The nursing diagnosis according to the continuity care Nursing Report at discharge which need continuity cares, constitute the basis of our interventions in the outpatient clinic. In spite of the limitation of the time, nurses using outpatient concrete interventions, can consolidate the continuity of the cares.• Introducción: Los pacientes con cardiopatía isquémica (CpI) precisan revisiones ambulatorias frecuentes, esto supone un porcentaje elevado en la consulta. En nuestro centro utilizamos la taxonomía NANDA, según el modelo de Virginia Henderson. • Objetivos: Determinar qué diagnósticos enfermeros al alta hospitalaria precisan continuidad de cuidados. Identificar las intervenciones de enfermería en la consulta. • Material y método: Estudio descriptivo, transversal, prospectivo. Incluimos: pacientes con diagnóstico médico de CpI derivados a consulta y con Informe de Continuidad de Cuidados de Enfermería al alta hospitalaria, y con el mismo diagnóstico en revisiones sucesivas desde 1-10-2007 a 31-1-2008. Tratamiento estadístico con SPSS. • Resultados: Se han atendido 943 pacientes; 464 son hombres (49.20%) y 479 mujeres (50.80%). Edad media: 61.4+ 3.80. Primeras citas 386 (40.93%) y 557 (59.07%) revisiones. La CpI global supone 29.91 % (282 pacientes); el 12.95% de las primeras citas (50 pacientes) y 156 pacientes (28.007%) de las revisiones. Los diagnósticos de enfermería (DxE) que precisan continuidad de cuidados son: 00132-Dolor torácico 32.62% (92 pacientes); 00092-Intolerancia a la actividad 28.01% (79 pacientes); 00126- Conocimientos deficientes: enfermedad, autocuidados y régimen terapéutico: 70.21% (198 pacientes); Manejo inefectivo del régimen terapéutico: 86 pacientes (30.49%). Las intervenciones en consulta se enfocan a: Dolor torácico: 4040-Cuidados cardiacos Intolerancia a la actividad:1800 Ayuda al autocuidado. 4490 Ayuda para dejar de fumar. Conocimientos deficientes :enfermedad, autocuidados y régimen terapéutico: 5612-Enseñanza: actividad/ejercicio prescrito. 5614-Enseñanza dieta prescrita. 5616-Enseñanza: medicamentos prescritos. Manejo inefectivo del régimen terapéutico. 4050-Precauciones cardiacas . • Conclusiones: Los informes de continuidad de cuidados son un instrumento eficaz para el seguimiento ambulatorio del paciente. Los diagnósticos enfermeros que según el Informe de Enfermería al alta necesitan continuidad de cuidados, constituyen la base de nuestras intervenciones en consulta. Enfermería en consultas externa a pesar de la limitación del tiempo, con intervenciones enfermeras concretas puede consolidar la continuidad de los cuidados

La telemedicina, herramienta para mejorar nuestros cuidados a los pacientes trasplantados de corazón

La posibilidad de controlar extrahospitalariamente a los pacientes trasplantados de corazón con el uso de la telemedicina, posibilita mayor comodidad al paciente, ahorro del gasto sanitario, evita la realización de biopsias cardíacas y mejora la calidad de los cuidados de enfermería en estos pacientes

La telemedicina, herramienta para mejorar nuestros cuidados a los pacientes trasplantados de corazón

La posibilidad de controlar extrahospitalariamente a los pacientes trasplantados de corazón con el uso de la telemedicina, posibilita mayor comodidad al paciente, ahorro del gasto sanitario, evita la realización de biopsias cardíacas y mejora la calidad de los cuidados de enfermería en estos pacientes

Heart transplant centers with multidisciplinary team show a higher level of chronic illness management \u2013 Findings from the International BRIGHT Study

Objectives The objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM). Background The International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow-up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers with a multidisciplinary team may offer higher levels of CIM, a care model that has the potential to improve outcomes after HTx. Methods We conducted a secondary analysis of the BRIGHT study, a cross-sectional study in 11 countries. Multidisciplinarity in the 36 HTx centers was assessed through HTx director reports and was defined as having a team that was composed of physician(s), nurse(s), and another healthcare professional (either a social worker, psychiatrist, psychologist, pharmacist, dietician, physical therapist, or occupational therapist). CIM was assessed with the Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression assessed the relationship between multidisciplinarity and the level of CIM. Results Twenty-nine (80.6%) of the HTx centers had a multidisciplinary team. Furthermore, multidisciplinarity was significantly associated with higher levels of CIM (\u3b2 = 5.2, P = 0.042). Conclusion Majority of the HTx centers follows the ISHLT recommendation for a multidisciplinary approach. Multidisciplinarity was associated with CIM and point toward a structural factor that needs to be in place for moving toward CIM

Multifocal epithelial hyperplasia: A potentially precancerous disease? (Review)

Multifocal epithelial hyperplasia (MEH), also known as Heck’s disease, manifests as a papulonodular lesion in the oral mucosa and has been associated with the human papillomavirus, a virus related to various precancerous diseases in the oral cavity. It has a predisposition for the female gender and for children. Although the majority of reported cases have been among American Indians and Eskimos, it has been described in multiple ethnic groups in various geographical locations. The objective of this review was to report on the clinical characteristics and epidemiology of MEH and its possible correlation with oral cancer. It is based on a search of articles in international journals published prior to April 2011, using the PubMed database and selecting articles related to the epidemiology and clinical characteristics of MEH. The review revealed a higher number of cases in individuals of American Indian origin and a predilection of the disease for the female gender and for patients between the 1st and 2nd decades of life. The most frequent lesion site was the lower lip. The disease has been associated with socio-economic and genetic factors, among others. No cases of malignant transformation have been reported

Health literacy in heart transplantation: Prevalence, correlates and associations with health behaviors - Findings from the international BRIGHT study

Background Health literacy (HL) is a major determinant of health outcomes; however, there are few studies exploring the role of HL among heart transplant recipients. The objectives of this study were to: (1) explore and compare the prevalence of inadequate HL among heart transplant recipients internationally; (2) determine the correlates of HL; and (3) assess the relationship between HL and health-related behaviors. Methods A secondary analysis was conducted using data of the 1,365 adult patients from the BRIGHT study, an international multicenter, cross-sectional study that surveyed heart transplant recipients across 11 countries and 4 continents. Using the Subjective Health Literacy Screener, inadequate HL was operationalized as being confident in filling out medical forms none/a little/some of the time (HL score of 0 to 2). Correlates of HL were determined using backward stepwise logistic regression. The relationship between HL and the health-related behaviors were examined using hierarchical logistic regression. Results Overall, 33.1% of the heart transplant recipients had inadequate HL. Lower education level (adjusted odds ratio [AOR] 0.24, p < 0.001), unemployment (AOR 0.69, p = 0.012) and country (residing in Brazil, AOR 0.25, p < 0.001) were shown to be associated with inadequate HL. Heart transplant recipients with adequate HL had higher odds of engaging in sufficient physical activity (AOR 1.6, p = 0.016). HL was not significantly associated with the other health behaviors. Conclusions Clinicians should recognize that almost one third of heart transplant participants have inadequate health literacy. Furthermore, they should adopt communication strategies that could mitigate the potential negative impact of inadequate H