자연주의적 탐구조사(Naturalistic Inquiry)

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XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Introduction The progressive ageing and ever-increasing life expectancy of the world's population are accompanied by an increase in chronic pathologies. Italy continues to be the nation with the highest percentage of senior citizens. Recent economic crises and movements of social change have led to a gradual increase in the use of homecare workers for the territorial and family management of chronic illnesses. Contrary to what has happened in other countries, in Italy an informal logic has prevailed regarding the recruitment and the employment of homecare workers, hindering the evolution of this sector. Aims This narrative review focuses on the role of homecare workers, as it appears in Italian researches. Methods A narrative review was conducted using the following electronic databases: CINAHL Complete, MEDLINE, MEDLINE Complete, PsycINFO, and SocINDEX. Only studies conducted in the past 20 years with an Italian Homecare Worker (HCW) target population were considered. Data were extracted from each manuscript to allow for quick comparisons of information, such as research objectives, study methodologies, data collection tools, and relative results. Two reviewers independently extracted the following data for each study: region, setting context, participant characteristics, group description and sample, outcomes measured, and a description of the main results. Results From the analysis of heterogeneous Italian literature, the importance of homecare workers is clear. Their work not only influences assisted individuals but also informal caregivers and the direct costs of the Italian national health system. Conclusion Homecare workers are important in Italian society. The little attention that the scientific literature has paid to this population may be due to the difficulty of finding subjects with a legal status and, therefore, who are willing to participate in specific investigations. Investigating the dyad of care and extending these investigations to the surrounding family context, seem to be the major priorities that should be explored by future research.

Homecare workers in Italy: a narrative review

Background and aim: The progressive and constant aging of the global population together with the economy crises and the social variations within family contexts increasingly leads to the use of external resources (Home Care Workers, HCWs) for health care within one’s own family of origin. Purpose of the study is to describe Italian Home Care Workers’ (HCWs) living and working conditions and understand the interactions with outcomes of the patients and informal caregiver. Methods: Observational study with cross sectional design to evaluate the interaction of HCWs without specific training on patients and informal caregivers’ outcomes. Results: understand Italian HCWs’ condition and interaction between these conditions and outcomes of patients and informal caregiver. Conclusions: understanding how HCWs’ conditions can affect outcome about patient and informal caregivers, represents a fundamental step in order to increase QoL of these families. (www.actabiomedica.it)

Family assistants’ living and working conditions and their interaction with patient and family caregiver variables: a study protocol

PURPOSE
To develop and evaluate the psychometric properties of the Self-Care of Stroke Inventory (SCSI).


MATERIALS AND METHODS
A cross-sectional, instrument development and the psychometric testing study was conducted. A 23-item self-report Self-Care of Stroke Inventory with 3 separate scales was developed. This study involved three stages: (a) Initial items generation; (b) Content and face validation; (c) Psychometric properties evaluation. The SCSI was validated by content validity, construct validity, convergent validity, internal consistency, and test-retest reliability.


RESULTS
From the initial 80-item pool, 24 items of 3 scales in the SCSI were retained by the expert consultation and item analysis. The scale's content validity was 0.976, 0.966, and 0.973. The EFA showed the total variance explained by the 3 scales of the SCSI were 73.417%, 74.281%, and 80.207%, respectively. The models of the 3 scales identified by EFA were all confirmed by the CFA. The SCSI scale shows evidence of good convergent validity. Cronbach's αs were 0.830, 0.930, and 0.831. Test-retest reliability of the SCSI was excellent, with an intraclass correlation coefficient of 0.945, 0.907, and 0.837.


CONCLUSIONS
The final 23-item SCSI presents good psychometric properties and can be used to explore the self-care of stroke in community settings.IMPLICATIONS FOR REHABILITATIONThis study developed and validated the Self-Care of Stroke Inventory (SCSI).The SCSI contains the following 3 scales: the Self-care Maintenance of Stroke scale, the Self-care Monitoring of Stroke scale, and the Self-care Management of Stroke scaleThe 23-item SCSI demonstrated strong psychometric properties.The SCSI may be used to develop future programmes to promote self-care for stroke survivors and improve their rehabilitation outcomes.

Development and psychometric testing of the Self-Care of Stroke Inventory.

CN36 Informal caregivers’ contributions to self-care for patients treated with oral anticancer agents: A qualitative study


 Introduction:
 Stroke symptoms often predict disability and low quality of life (QOL) in stroke survivors. Stroke survivors’ QOL could have an influence on their caregivers’ variables, such as anxiety, depression or burden and consequently caregivers’ QOL.
 
 
 Hypothesis:
 The aims of this study were to: 1) identify the distinct trajectories of the stroke specific QoLs in stroke survivors; 2) examine the associations between the stroke survivors’ QoL trajectories and caregivers’ anxiety, depression and burden over time.
 
 
 Methods:
 A longitudinal, multicentre study was conducted. A sample of 415 stroke survivors and their caregivers, after the stroke survivors’ discharge from rehabilitation hospitals, were enrolled. Stroke Impact Scale (SIS) 3.0 was used to assess the QOL of the stroke survivor. Caregiver trajectories for anxiety and depression were assessed with the Hospital Anxiety Depression Scale (HADS) while caregiver burden with Caregiver Burden Inventory (CBI). The Latent Class Growth Analyses (LCGA) were used to define the trajectories of the dimensions of the QOL.
 
 
 Results:
 Stroke survivors had similar trajectories on physical QOL dimensions. Differently, for SIS communication, emotional and memory dimensions, we identified two distinct trajectories. The first trajectory, representing 86% of survivors, included those who started with higher QOL levels and improved slightly to markedly in all psychological domains, with this improvement decelerating over time. The second trajectory (14% of survivors) included those who started with low overall levels of psychological QoL and experienced linear worsening of Memory and Communication, starting in the third month, and no change in Emotion and Participation. Caregivers of those patients in the second class experienced worse anxiety, depression and burden over time, compared to caregivers of patients in the first one.
 
 
 Conclusions:
 Our results identified several important risk factors for specific survival patterns that reinforce the need for more tailored interventions in order to improve stroke survivors’ QOL and consequently the caregiver anxiety, depression and burden. This requires a shift from a stroke survivor-centered approach to a stroke survivor and caregiver-centered approach.


Abstract 13792: Different Trajectories of Specific-Disease QoL in Stroke Survivors and Their Associations With Caregiver Anxiety, Depression and Burden: A Longitudinal Study

Ercole Vellone

Papers

Homecare workers in Italy: a narrative review

Family assistants’ living and working conditions and their interaction with patient and family caregiver variables: a study protocol

Development and psychometric testing of the Self-Care of Stroke Inventory.

CN36 Informal caregivers’ contributions to self-care for patients treated with oral anticancer agents: A qualitative study

Abstract 13792: Different Trajectories of Specific-Disease QoL in Stroke Survivors and Their Associations With Caregiver Anxiety, Depression and Burden: A Longitudinal Study