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Canadian HealthCare News
Asthma education, action plans, psychosocial issues and adherence: ACTION PLANS (1)
The specific impact of action plans on asthma morbidity is difficult to determine. Although their introduction has been associated with reduced morbidity indexes, only selected patient groups were studied, and, thus, the results may not be generalizable. Control groups are often lacking, and the extent to which improvements are due to other factors, such as regular or higher doses or more appropriate use of inhaled steroids , is difficult to assess. Action plans vary, and no single plan is likely to be suitable for every patient; it must be feasible and applicable to the indvidual patient. (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (8)
Finally, the likelihood of a desirable outcome depends on the patient’s stage in the continuum of behaviour change ; different messages are appropriate at different stages and a strong argument in favour of an individualized approach. However, personal education does not guarantee an individualized approach, especially if the same unmodified information is delivered to every patient in the same manner. (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (7)
On the basis of current evidence, it is not possible to determine the most effective format of patient education. There is some limited evidence that group education may be more effective for some outcomes , but a recent meta-analysis failed to provide a conclusive answer . Certainly, group education provides social support, allows interaction with others with similar medical problems, and may help to validate the patients’ experiences and to solve some selfmanagement problems. (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (6)
Timing, setting and form of education: There is insufficient evidence to decide upon the optimal timing, delivery setting and form of asthma education . Initiating the educational strategies while the patient is still in hospital has advantages. The individual has already been identified as being at ‘high risk’ for severe life-threatening asthma or death , they are accessible and (arguably) amenable to intervention, and it is possible to initiate a therapeutic relationship involving the patient’s physician. (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (5)
A variety of psychological, health-care and socioeconomic factors had powerful and differential influences on self-management knowledge and behaviour (Figure 2). However, there was encouraging evidence that the factors associated with appropriate educational initiatives and good quality of ongoing medical care were positively associated with both knowledge and behaviour scores, providing support for current asthma educational initiatives. Self-management errors: Despite the widespread use of asthma education, patients commonly make serious selfmanagement errors during an acute attack, including no or delayed use of oral corticosteroids and/or no or delayed summoning of emergency services . (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (4)
In a recent systematic review on behalf of the Cochrane collaboration, Gibson et al found that interventions that consisted of education only did not bring about improvements in morbidity indexes. Conversely, interventions in which education was combined with self-monitoring and/or regular medical review and/or a written action plan improved a variety of health outcomes. Thus, asthma education should not be provided in isolation but as part of an integrated program of good quality care. Determination of the effects of specific components of educational programs has proved difficult. (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (3)
Efficacy: Following a meta-analysis of 11 randomized clinical trials of self-management teaching programs, Bernard-Bonnin et al concluded that educational programs improve knowledge but do not reduce morbidity, consistent with the results of the randomized studies conducted by Garrett et al and Cote et al . These data, as well as those showing the discrepancy between knowledge and behaviour , indicate that relying on an assessment of knowledge as the sole outcome measure may grossly overestimate the effectiveness of an educational strategy. (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (2)
The following discussion of asthma education is based on the paradigm shown in Figure 1. Briefly, there are available, effective management strategies for the on-going treatment of asthma and the management of acute exacerbations. With effective education, patients with asthma can acquire the appropriate knowledge and skills to self-manage asthma appropriately. However, to achieve an improvement in indexes of morbidity (or mortality), a change in self-management behaviour is required; specifically, improved knowledge has to be translated into a change in behaviour. (more…)
Asthma education, action plans, psychosocial issues and adherence: ASTHMA EDUCATION (1)
International consensus guidelines have stressed asthma education and patient self-management as integral components of asthma management . In a recent editorial, Blessing-Moore defined the aims of asthma education as to provide knowledge and find effective motivational techniques that can assist in the translation of knowledge into (positive action) behavioural practices that will improve decision making skills and eventually improve therapeutic outcomes. (more…)
Intractable diarrhea in a newborn infant: DISCUSSION Part 2
While the basic defect is unknown, it has been proposed that the ultrastructural lesion that characterizes MID is best explained as an example of a normal cell component assembled in an abnormal location. The microvilli appear to be assembled on the inner surface of the intracytoplasmic vesicles rather than at the apical cell surface. Furthermore, the prominent periodic acid-Schiff staining of the apical cytoplasm (rather than the brush border), the immunofluores-cent staining of specific brush border enzymes in the apical cytoplasm and the accumulation of secretory granules in the apical region of some cells all suggest that an abnormality of exocytosis exists. Brush border proteins normally reach the plasma membrane at the base of the apical microvilli. They are synthesized in the rough endoplasmic reticulum, processed and assembled as membrane proteins in the Golgi apparatus, and transported to the cell surface along a chain of connecting intracytoplasmic vesicles. However, against this theory, normal exocytosis and localization of two brush border-targeted enzymes (sucrase-isomaltase and dipeptidylpeptidase intravenous) have been demonstrated in biopsies and organ cultures from MID patients. These studies suggested that both direct and indirect constitutive pathways of exocytosis were intact in MID. It was hypothesized that there may be an as yet uncharacterized regulated pathway of exocytosis in enterocytes that is abnormal in MID.
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