Marco Clari

Self-Care of People with Chronic Obstructive Pulmonary Disease: A Meta-Synthesis

BackgroundSelf-care in people with chronic obstructive pulmonary disease (COPD) can improve health-related quality of life, reduce hospital admissions and decrease dyspnoea.ObjectiveThis review aimed to systematically identify, evaluate and synthesise the qualitative literature on the self-care behaviours and strategies used by people with COPD.MethodsThe Joanna Briggs Institute (JBI) meta-aggregative method was followed. An electronic search of six relevant databases was conducted. The search was limited to articles published from January 1996 to January 2016. Reference lists of all identified articles were searched to find additional literature. Two independent reviewers analysed the studies against the inclusion criteria, extracted the data and assessed the methodological quality of the 14 identified papers using the JBI qualitative assessment and review critical appraisal instrument. Findings were synthesised using a meta-aggregation process.ResultsFour synthesised findings emerged from the aggregation of 114 findings: self-care is directed towards the prevention, control and management of the physical consequences of COPD; self-care focuses on the management of the psychological effects of COPD; self-care is aimed at reducing the impact of COPD on social life; and self-care is influenced by contact with healthcare services and requires the acquisition of knowledge and skills.ConclusionsThis meta-synthesis provides evidence on the self-care behaviours and strategies that people with COPD perform to prevent, control and manage the physical, psychological and social consequences of the disease. The findings of this meta-synthesis could help healthcare professionals to tailor self-care educational programmes to the experiences, preferences and priorities of people with COPD.

An Innovative Model to Predict Pediatric Emergency Department Return Visits

Objectives Return visit (RV) to the emergency department (ED) is considered a benchmarking clinical indicator for health care quality. The purpose of this study was to develop a predictive model for early readmission risk in pediatric EDs comparing the performances of 2 learning machine algorithms. Methods A retrospective study based on all children younger than 15 years spontaneously returning within 120 hours after discharge was conducted in an Italian university childrens hospital between October 2012 and April 2013. Two predictive models, artificial neural network (ANN) and classification tree (CT), were used. Accuracy, specificity, and sensitivity were assessed. Results A total of 28,341 patient records were evaluated. Among them, 626 patients returned to the ED within 120 hours after their initial visit. Comparing ANN and CT, our analysis has shown that CT is the best model to predict RVs. The CT model showed an overall accuracy of 81%, slightly lower than the one achieved by the ANN (91.3%), but CT outperformed ANN with regard to sensitivity (79.8% vs 6.9%, respectively). The specificity was similar for the 2 models (CT, 97% vs ANN, 98.3%). In addition, the time of arrival and discharge along with the priority code assigned in triage, age, and diagnosis play a pivotal role to identify patients at high risk of RVs. Conclusions These models provide a promising predictive tool for supporting the ED staff in preventing unnecessary RVs.

Measurement properties of instruments evaluating self-care and related concepts in people with chronic obstructive pulmonary disease: A systematic review

The use of valid and reliable instruments for assessing self-care is crucial for the evaluation of chronic obstructive pulmonary disease (COPD) management programs. The aim of this review is to evaluate the measurement properties and theoretical foundations of instruments for assessing self-care and related concepts in people with COPD. A systematic review was conducted of articles describing the development and validation of self-care instruments. The methodological quality of the measurement properties was assessed using the COSMIN checklist. Ten studies were included evaluating five instruments: three for assessing self-care and self-management and two for assessing self-efficacy. The COPD Self-Efficacy Scale was the most studied instrument, but due to poor study methodological quality, evidence about its measurement properties is inconclusive. Evidence from the COPD Self-Management Scale is more promising, but only one study tested its properties. Due to inconclusive evidence of their measurement properties, no instrument can be recommended for clinical use.

Adaptation and validation of the Caregiver Burden Inventory in Spinal Cord Injuries (CBI-SCI)

DesignValidation cross-sectional study.ObjectivesEven though caregiver burden (CB) represents a well-recognised concern among caregivers of people with a spinal cord injury (SCI), there are no specific questionnaires designed for its evaluation. This study aimed to assess the psychometric properties of the Caregiver Burden Inventory in Spinal Cord Injury (CBI-SCI), which was modified from its original version, and specifically its construct and reliability.SettingMulticentre study in four urban spinal units across Italy. The CBI-SCI was administered to family caregivers in outpatient clinics.MethodsCBI-SCI was administered in a toolset composed of a sociodemographic questionnaire, the Family Strain Questionnaire-Short Form (FSQ-SF), the Short Form-36 (SF-36), and the Modified Barthel Index (MBI). The CBI-SCI construct validity was assessed through an exploratory factor analysis. The internal consistency of the questionnaire was examined using Cronbach’s alpha (α) coefficient for the total scale and its subscales. Concurrent validity was evaluated performing Pearson’s correlation coefficient with all instruments included in the toolset.ResultsThe CBI-SCI was administered to 176 participants from February 2016 to September 2017. Factor analysis highlighted the five-factored structure of the questionnaire. The total scale Cronbach’s α was 0.91 (p < 0.001). All the five subscales of CBI-SCI showed an acceptable internal consistency, ranging from 0.76 to 0.91 (p < 0.001). Pearson’s correlation coefficients of the CBI-SCI with all the administered instruments were statistically significant (p < 0.001), showing congruent relations.ConclusionThe CBI-SCI, due to its validity and reliability, may represent a valuable instrument to evaluate the CB longitudinally in SCI.

Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: an actor–partner interdependence model analysis

PurposeWe aimed to assess the influence of anxiety and depression on the physical and mental quality of life (QoL) in patient with chronic obstructive pulmonary disease (COPD) and caregiver dyads, detect the simultaneous effect of anxiety and depression of each partner on the other’s QoL and determine the dyadic patterns.MethodsA cross-sectional descriptive design was used. The actor–partner interdependence model estimated by structural equation modeling was used for the dyadic analysis. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and 12-Item Short-Form Health Survey (SF-12) were used to measure depression, anxiety and QoL, respectively.ResultsEighty COPD dyads were enrolled in the study. Patients presented higher depression symptoms and poorer physical and mental QoL than their caregivers, whereas comparable levels of anxiety were found in patients and caregivers. The model exploring the effects of depression and anxiety on mental QoL found that patients’ depressive symptoms negatively influence their mental QoL, and caregivers’ anxiety and depression symptoms negatively impact their mental QoL. The model exploring the effects of anxiety and depression on physical QoL detected one statistically significant actor effect with patients’ depressive symptoms negatively influencing their physical QoL, and two partner effects with caregivers’ anxiety worsening patients’ physical QoL and caregivers’ depression improving patients’ physical QoL.ConclusionsThe results suggest that caregivers’ psychological distress influences caregivers’ mental QoL and patients’ physical QoL. Therefore, health-care professionals should assess and treat anxiety and depression in both members of the COPD dyad to improve their QoL.

The Unmet Needs of People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Qualitative Findings

ABSTRACT The complexity of chronic obstructive pulmonary disease (COPD) can negatively impact the lives of people with the condition and compromise their capacity to take care of their needs. Unmet needs can then lead to significant morbidity, unpleasant emotional experiences and a poor quality of life; thus this systematic review aimed to identify, evaluate and synthesise the qualitative literature on the unmet needs of people with COPD. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. A systematic search of five databases was conducted, searching for articles published from January 1995 to May 2017. Eight papers were identified. Two researchers extracted the data and independently assessed their quality. The total sample of people with COPD included was 108. Nine categories were derived from 49 findings, and aggregated into three synthesised findings: (1) people with COPD have unmet needs regarding information about the disease; (2) people with COPD have unmet physical, emotional and social needs, due to the disease symptoms and treatments; and (3) people with COPD have unmet care needs. This review showed qualitative evidence regarding the dimensions in which people with COPD express their unmet needs. The needs that are mainly unsatisfied include physical, psychosocial, informational and practical aspects, as well as the need for healthcare professional care. A global approach, which includes the areas identified by our findings, could lead to an improvement in the care of people with COPD and could improve the self-care management of those individuals who do not correctly identify their needs.

Patient knowledge on COPD

Background: The literature showes that COPD patients with adequate knowledge of the disease perform appropriate self-care and have better health outcomes. Therefore, testing the patient knowledge of the disease is a starting point for planning self-care education programs. Aim: To determine the knowledge of COPD in a sample of Italian COPD patients. Method: The Bristol COPD Knowledge Questionnaire (BCKQ) is an instrument that assesses knowledge of COPD in thirteen areas: epidemiology, etiology, symptoms, breathlessness, phlegm, chest infections, exercise, smoking, vaccination, bronchodilators, antibiotics, oral and inhaled steroids. BCKQ was translated in Italian using the forward/backward translation process and its content was validated by a sample of Italian healthcare professionals. In and outpatients were recruited at a University teaching hospital from October 2016 to January 2017. Results: A sample of 103 COPD patients was investigated. The sample mean age was 76 years (range 45-90); 62% were men; 76% had a low education level and 30% of them suffered from severe to very severe COPD. The overall percentage of correct knowledge was 49% with very different percentages in the investigated areas. Symptoms, exercise, phlegm, smoking were the areas in which our sample showed more knowledge, whereas less knowledge were showed on all the areas related to the medications. Knowledge of COPD was not related to patient education, age and severity of disease. Conclusion: The knowledge of COPD in the Italian patients sample is quite limited. Educational interventions are needed focused mainly on the use of medication.

I disegni di ricerca con metodo misto: un approccio metodologico innovativo per la ricerca infermieristica

Mixed methods designs: an innovative methodological approach for nursing research. The mixed method research designs (MM) combine qualitative and quantitative approaches in the research process, in a single study or series of studies. Their use can provide a wider understanding of multifaceted phenomena. This article presents a general overview of the structure and design of MM to spread this approach in the Italian nursing research community. The MM designs most commonly used in the nursing field are the convergent parallel design, the sequential explanatory design, the exploratory sequential design and the embedded design. For each method a research example is presented. The use of MM can be an added value to improve clinical practices as, through the integration of qualitative and quantitative methods, researchers can better assess complex phenomena typical of nursing.