Design of a case management model for people with chronic disease (Heart Failure and COPD). Phase I: modeling and identification of the main components of the intervention through their actors: patients and professionals (DELTA-ICE-PRO Study

Background Chronic diseases account for nearly 60% of deaths around the world. The extent of this silent epidemic has not met determined responses in governments, policies or professionals in order to transform old Health Care Systems, configured for acute diseases. There is a large list of research about alternative models for people with chronic conditions, many of them with an advanced practice nurse as a key provider, as case management. But some methodological concerns raise, above all, the design of the intervention (intensity, frequency, components, etc). Methods/Design Objectives: General: To develop the first and second phases (theorization and modeling) for designing a multifaceted case-management intervention in people with chronic conditions (COPD and heart failure) and their caregivers. Specific aims: 1) To identify key events in people living with chronic disease and their relation with the Health Care System, from their point of view. 2) To know the coping mechanisms developed by patients and their caregivers along the story with the disease. 3) To know the information processing and its utilization in their interactions with health care providers. 4) To detect potential unmet needs and the ways deployed by patients and their caregivers to resolve them. 5) To obtain a description from patients and caregivers, about their itineraries along the Health Care System, in terms of continuity, accessibility and comprehensiveness of care. 6) To build up a list of promising case-management interventions in patients with Heart Failure and COPD with this information in order to frame it into theoretical models for its reproducibility and conceptualization. 7) To undergo this list to expert judgment to assess its feasibility and pertinence in the Andalusian Health Care. Design: Qualitative research with two phases: For the first five objectives, a qualitative technique with biographic stories will be developed and, for the remaining objectives, an expert consensus through Delphi technique, on the possible interventions yielded from the first phase. The study will be developed in the provinces of Almería, Málaga and Granada in the Southern Spain, from patients included in the Andalusian Health Care Service database with the diagnosis of COPD or Heart Failure, with the collaboration of case manager nurses and general practitioners for the assessment of their suitability to inclusion criteria. Patients and caregivers will be interviewed in their homes or their Health Centers, with their family or their case manager nurse as mediator. Discussion First of a series of studies intended to design a case-management service for people with heart failure and COPD, in the Andalusian Health Care System, where case management has been implemented since 2002. Accordingly with the steps of a theoretical model for complex interventions, in this study, theorization and intervention modeling phases will be developed.This research was carried out with the support of one research grant, awarded by the Regional Health Ministry of Andalusia (Exp. 0222/2008

Investigación científica en los centros regionales: UNAH-VS

DOI: http://dx.doi.org/10.5377/pc.v5i0.1848 Revista Portal de la Ciencia, No. 5, diciembre 2013: 9-15DOI: http://dx.doi.org/10.5377/pc.v5i0.1848 Revista Portal de la Ciencia, No. 5, diciembre 2013: 9-1

Utopía y proyecto gráfico a finales del XVI: las trazas para el retablo mayor y reja de un convento sevillano

Despite the importance which altarpiece architecture had in Sevillian artistic life in the 16th and 17th centuries, little evidence remains of the sketches and plans for these religious pieces. This makes the sketches which were made between 1585 and 1593 for the high altar of the convent of the Gracious St. Mary, which no longer exists, ali the more significan!. The altarpiece is characterized by the Romanistic preferences of the artists of the time, while the screen is in the mannerist style. Neither of these projects was in fact carried out, although they were of interest to such artists as Francisco Pacheco, Juan Martínez Montañés, Juan de Oviedo, Andrés de Ocampo, Diego López Bueno and others. These studies may have been kept in the care of the grand master of Cathedral works in Granada, Asensio de Maeda.A pesar .de la importancia que la arquitectura de retablos tiene en el panorama artístico sevillano de los siglos XVI y XVII , escasean las trazas y proyectos utilizados para la confección de esas piezas. Las trazas ejecutadas entre 1585 y 1593, para el retablo mayor y reja del desaparecido Convento de Sta. María de Gracia, vienen a subsanar en parte esta carencia. El retablo es una obra orientada por los caracteres romanistas de la retablística de esos momentos, mientras la reja responde al estilo manierista. Ninguno de ambos proyectos debió ser puesto en práctica, si bien despertaron el interés de destacados artistas como Francisco Pacheco, Juan Martínez Montañés, Juan de Oviedo, Andrés de Ocampo, Diego López Bueno, etc. Es posible que la confección de las mismas estuviera al cuidado del maestro mayor de obras de la Catedral, el granadino Asensio de Maeda