Therapeutic Sessions Research Articles

Comparative Study of Pain Relief in Two Non-Pharmacological Treatments in Patients with Partial Rotator Cuff Tears: A Randomized Trial.

BackgroundPain induction is the primary characteristic of a rotator cuff tear while muscle weakness appears as a secondary feature, leading to further disability.ObjectivesThe study aimed to determine the effectiveness of physiotherapeutic interventions through transcutaneous electrical nerve stimulation (TENS) or microcurrent electrical nerve stimulation (MENS) in conjunction with kinesiotherapy in patients with partial thickness rotator cuff tear.MethodsThis was a blinded randomized prospective study. The study recruited 42 outpatients with partial rotator cuff tear under conservative treatment selected from the 401 General Military Hospital of Athens and the University General Hospital ‘Attikon’ during 2015 - 2017. Patients were assessed for pain and disability using the SPADI (shoulder pain and disability index), a numerical rating scale (NRS) for pain, and the EuroQoL-5 questionnaire for the evaluation of the quality of life. The first group received TENS and kinesiotherapy while the second group received MENS and kinesiotherapy. Three measurements were recorded. The first assessment was performed during the initial patient visit; the second after completion of the physiotherapeutic sessions, and the third one three months after the initial assessment. A follow-up ultrasound scan was performed three months after the completion of the therapeutic sessions to assess the anatomical healing of the rotator cuff tear.ResultsRepeated measurements analysis indicated a significant improvement in pain scores, functionality, and patients’ quality of life (P value < 0.001). Comparison of the two treatment methods did not reveal any significant differences (P value > 0.05) despite the fact that the MENS was associated with a greater improvement in pain intensity and TENS with a greater improvement in functionality and quality of life.ConclusionsUsing MENS and TENS appears to be equally effective in terms of pain relief, functional improvement, and quality of life enhancement in patients.

Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial

Animal-assisted therapy (AAT) is increasingly used to address impaired social competence in patients with acquired brain injury. However, the efficacy of AAT has not been tested in these patients. We used a randomised, controlled within subject trial to determine the effects of AAT on social competence in patients undergoing stationary neurorehabilitation. Participants received both AAT sessions and paralleled conventional therapy sessions. The patients’ social behaviour was systematically coded on the basis of video recordings of therapy sessions. Moreover, mood, treatment motivation and satisfaction was measured during each therapy session. We analysed 222 AAT and 219 control sessions of 19 patients with linear mixed models. Patients showed a significantly higher amount of social behaviour during AAT. Furthermore, patients’ positive emotions, verbal and non-verbal communication, mood, treatment motivation and satisfaction were increased in the presence of an animal. Neutral emotions were reduced but no effect was found regarding negative emotions. Our results show that AAT increases aspects of social competence and leads to higher emotional involvement of patients with acquired brain injury, reflected in higher social engagement, motivation and satisfaction during a therapeutic session.

Effects of Therapeutic Alliance and Metacognition on Outcome in a Brief Psychological Treatment for Borderline Personality Disorder

Objective: The therapeutic alliance is possibly a crucial factor in treatment for borderline personality disorder (BPD). Among predictors of therapeutic alliance, aspects that have not yet been considered are metacognition or the patient’s capacity to be aware of mental states. We therefore explored whether metacognition predicted alliance and if metacognition and therapeutic alliance together predicted outcome in brief treatment for BPD.Method: In a secondary analysis of a randomized controlled trial, we included N = 36 patients with BPD in the current study. The original trial assessed the effects of a 10 session psychiatric standard treatment with or without the added the Plan Analysis and the Motive Oriented Therapeutic Relationship. We assessed the therapeutic alliance session by session (Working Alliance Inventory), metacognition at session 1 (using the Metacognitive Assessment Scale-Revised) and outcome (using residual gains on the Outcome Questionnaire-45.2 between sessions 1 and 10).Results: A more differentiated capacity to understand the mind of the others at treatment onset predicted an increase of therapist-rated alliance over time. Therapist rated alliance was the only significant outcome predictor (B = −0.85, R Squared = .12).Conclusions: More differentiated metacognition predicted therapeutic alliance which in turn affected outcome, thus making metacognition a relevant therapy target early in therapy for BPD. Future studies should expand this investigation to patients with better functioning, treated with different modalities and with longer treatments.

Implementación de un dispositivo de datos leíbles por máquina para el apoyo de la adquisición de lenguaje en la infancia

Language is a fundamental tool for human interaction. Through communication an individual may obtain and transmit information, emotions and wishes. However, language is an acquired skill that requires a development process, in which the critical phase of development occurs during childhood an individual may encounter social, cognitive and emotional problems during the aforementioned and later stages of life if this skill has not fully matured. This impact may be reduced or eliminated through therapy, with the aid of tools such as Augmentative and Alternative Communication (AAC) systems, along with techniques such as music therapy and articulation therapy. These techniques are employed to aid the patient fully develop their linguistic abilities. A platform which incorporates the aforementioned therapeutic elements with current technological advances is proposed in this research paper, which combines them with a label system readable by machine. The results of experimental therapeutic sessions are be addressed in this research paper.

Hypertensive patients: Evaluation of a therapeutic education program

Evaluation of a therapeutic education program for hypertensive patients over a 6-month period with personalized objectives. A prospective single-center study conducted in 106 patients, the study was conducted as follows: – an initial collection of epidemiological, clinical and paraclinical data from patients in normal consultation; – each patient received a therapeutic education session -personalized- with education in the use of the “hypertension follow-up notebooks” developed by the work team ( Fig. 1 ); – the monitoring of the effectiveness of the education program was carried out over three evaluation consultations over the 6 months of the survey. One hundred and six patients participated in the study: mean age 47 ± 10 years; 62.26% of them were male (66 patients). Essential hypertension in 95.28% of patients, grade II to III, uncontrolled in approximately 70% of them. With an average evolution period of 9.5 ± 7.5 years. At 6 months, a significant decrease of SAP (from 154 ± 3 to 143 ± 3 mmHg, P less than 0.01) and DAP (from 95 ± 2 to 87 ± 2 mmHg, P less than 0.01) was notified. 50.7% versus 33.8% of patients have SAP and DAP in the therapeutic objectives. The monitoring of dietary and physical activity objectives is correlated with the decrease in BP ( P < 0.05). A significant increase in self-monitoring with therapeutic decision-making ( P < 0.01). A significant decrease in hypertension-related distress and feelings of failure ( P < 0.01). Success rate among patients who chose the objective “reduce salt”: 53%, “reduce fat”: 50%, “walk several times/week (30 min)”: 88%, “exercise at least once/week”: 22%. 67% have at least one physical activity objective in place. No significant decrease in weight (−0.6 ± 4.1 kg) but 39% lost at least 2 kg. A therapeutic education program with personalized objectives can give significant results at 6 months in terms of BP figures, dietetics and physical activity, self-monitoring of hypertension while reducing feelings of distress.

Helpful and hindering events in art therapy as perceived by art therapists in the educational system

This study examined significant events in therapeutic sessions as perceived by art therapists working in the school system. Sixteen female art therapists employed by the Israeli educational system filled in the Helpful Aspects of Therapy (HAT) questionnaire each week during the 2015–2016 school year immediately after the therapy session about a specific pupil they had selected. We implemented an open-ended qualitative analysis based on a thematic analysis. The findings were compiled into five main categories according to the main source generating the events: (1) Helpful and hindering events originating from the therapist, (2) Helpful and hindering events originating from the client, (3) Helpful and hindering events originating from the group, (4) Helpful events originating from the creative work, (5) Helpful and hindering events originating from the surrounding environment. The findings suggest that the human factors in therapy, that is, the interactions and relationships between the therapist, the client and the group all entered prominently into the meaningful events across categories. In addition, the joint observation of the artwork was perceived as an important element in the art therapy sessions.

MAINTAINING SERENITY IN THE THERAPEUTIC RELATIONSHIP: AROMATHERAPY, INDIVIDUALIZED MUSIC OR BOTH TO PROMOTE ENGAGEMENT AND EMPOWER CHOICE

Introduction The use of complementary and integrative methods in the care of older adults is increasingly popular. Elderly persons who suffer from chronic, persistent or severe mental illness are less likely to be offered or encouraged to utilize these interventions. Engagement in treatment is an issue that plagues the mental health system and is associated with better outcomes and less use of costly inpatient hospital stays when involvement and empowerment of patients is integrated into care. Aromatherapy is a popular cultural and spiritual intervention. Many elderly people utilize components of aromatherapy as part of developmental and family rituals with strong historical roots. Individualized music is one of the most powerful forms of complementary interventions being utilized as part of treatment regimes for disorders ranging from acute psychosis to anxiety to dementia. Compliance with medications and treatment regimes is considerably higher when patients are allowed to make choices regarding care. This project describes the use of aromatherapy with and without individualized music to enhance patient engagement in therapeutic sessions and treatment discussions. Methods A convenience sample of older adults being treated in diverse clinical areas: the psychiatric emergency department, a 31-bed acute inpatient unit and an outpatient clinic; each part of a large urban tertiary care hospital were offered options prior to being involved in therapy sessions or clinical interviews. Patients were offered of three essential oils: Lavender (Lavendula angustifolia), Grapefruit (Citrus paradisi) or Peppermint (Mentha piperita) prior to clinical interviews or therapy appointments. Oils were provided on individual wood sticks that were immersed in the oil and given to the patient with instructions to hold under the nose and inhale deeply for at least 3 deep breaths. They were also offered the ability to listen to individual music choices for brief periods of up to 3 minutes in a variety of genres that included classical, jazz, showtunes, latin, soft rock, dance and easy listening. Music was offered via wireless headphones that could be worn over the ear for several minutes in a waiting area. This was offered both separately and in combination with aromatherapy. Rating of satisfaction with the intervention using a 5-point Likert type scale, likelihood of recommending to others and decision to return for further care. Results The aromatherapy was widely accepted with >90% of patients choosing an oil and utilizing the intervention. Average age of the patients was 77 years old with range from 55 years to 95 years. Our sample included patients from very diverse cultural backgrounds that are present in a urban New York City population. The majority were not native English speakers and the population as a whole included those speaking more than 20 different languages. Diagnostic diversity was also quite enriched and included those with Anxiety disorders and issues related to life stress as well as many with Schizophrenia and Bipolar disorder. Most patients made a choice of an oil for aromatherapy (75%) or took a recommendation from the therapist (25%). Impact on acceptability, satisfaction with the intervention and likelihood to recommend to others was rated on a 5-point Likert type FACES scale that allowed patients to identify their response without language barriers. More than 90% of patients reported being Very Satisfied with the aromatherapy. Music was less likely to be chosen as a brief intervention (55%) both with or without aromatherapy. Most patients felt that the brief time period of 5 minutes or less was not long enough for their preference although among those that accepted the intervention, 85% reported being Very Satisfied with the use. No participant reported a negative response or adverse effect from with or both interventions. Conclusions Use of individualized aromatherapy greatly increases sense of engagement and appreciation of care. Our patient sample included a diverse sample of very acute patients many of whom entered the hospital on an involuntary basis, as well as those who were presenting for follow up outpatient visits. The clinical acuity was extremely diverse but also included a Comprehensive Psychiatric Emergency Program (CPEP) where the need for care was urgent. The interventions had widespread acceptability in a variety of clinical services and with patient form very cultural diverse backgrounds. Brief music was not as widely accepted, in part because the use of headphones as a delivery mechanism was not as well received by patients. Use of choice with both interventions was felt to be inherently empowering to patients. Most patients were very satisfied with being more involved in making choices that affected their ability to engage with care and treatment in an open manner. Patients expressed a clear desire to recommend and share these interventions with others. This research was funded by Mount Sinai Beth Israel

Effet de la thérapie des schémas sur la dépression de la personne âgée institutionnalisée : 3 études de cas uniques de type AB en lignes de bases multiples

IntroductionSchema therapy has confirmed its effectiveness in caring for depression. However, few studies have evaluated its effectiveness of an institutionalized elderly population. ObjectiveThe aim of this pilot study is to evaluate the efficiency of this therapy for the treatment of depression in 3 elderly people, with no neurocognitive disease, living in a nursing home. MethodClinician conducted a single case experimental protocol AB with multiple baseline for 3 participants who were experiencing depressive symptoms. Participants were randomized in 3 baselines and performed respectively 8, 7, and 6 intervention sessions. ResultsThe results highlight progressive effectiveness for two of the three residents. From baseline to the end of the therapeutic sessions (11 weeks), the improvement was significant and clinically observable for the activation of the schemas (–1.4 and –2 points on average) as well as for the level of depression (–8 and –9 points to the GDS). ConclusionThis pilot study indicates the effectiveness and replicability of schema therapy as therapeutic intervention for depression in elderly people.

Development of a Serious Game to Enhance Assistive Rehabilitation

The aim of this study is to investigate novel assistive technologies based on serious gaming for the assessment of postural control and motor rehabilitation. Previous research already demonstrated that rehabilitation and physical activities can improve the quality of life of patients, and virtual reality applications may act as good additional companions during the therapeutic sessions. Indeed, workout routines supported by serious gaming encourage patients to train harder, bringing the therapy towards a pleasant game into a virtual environment. During the game, sensors track the movements of the players and transfer the data to software components that record a database from which patients' progress can be determined. The acquired measures are interpreted in the form of new biomarkers, which enable the assessment of postural control. Such biomarkers are based on a probabilistic approach and show the capability to discriminate between well-performed exercises and incorrect movements. A long-term experimentation on a specific exercise is proposed, showing a considerable improvement, ranging from 5% to 30%, in the performance of patients.

TEACHING OF THERAPEUTIC PLAY AT THE UNDERGRADUATE LEVEL IN NURSING: DIDACTIC ACTIONS AND STRATEGIES USED BY PROFESSORS

ABSTRACT Objective: to present and discuss actions and strategies used by professors who teach therapeutic play in the Undergraduate Courses in Nursing. Method: qualitative research, that used symbolic interactionism as its theoretical framework, and Grounded Theory as its methodological framework. The scenario was the courses involving the theoretical-practical teaching of pediatric nursing, included in the curriculums of the Undergraduate Courses in Nursing. A total of 18 lecturers and three nurses participated, all involved in the process of teaching therapeutic play in the theoretical-practical scenario. Data were collected through participant observation and semistructured interviews. Results: it was revealed that the mobilization of the professors to teach therapeutic play in the Undergraduate Courses is permeated by a constant concern with offering and promoting significant learning to the student. They seek to do this through teaching strategies that involve: dramatization of therapeutic play sessions, the recovery of infancy and of playing, the use of audiovisual resources that raise awareness of learning, realistic simulation as innovation, the extending of possibilities of using Therapeutic Play, the re-presenting of therapeutic play to the student at the start of the practical activity, the providing of material for this practice, and the inclusion of the issue in the assessment process. Conclusion: the results contribute to assisting the lecturers in the task of awakening and introducing the student to the universe of therapeutic play, promoting her learning and systematic incorporation into academic life and, in the future, as a nurse, when she shall promote the inclusion of therapeutic play in the care provided to the child - in order to preserve and protect the child’s right to receive qualified care.

Psychometric properties of Profile of Mood States (POMS) in people with dementia and its application in the evaluation of the effects of therapeutic creative dance

There is a growing need for scientific studies and tools that allow the evaluation of the effects at an affective level of some non-pharmacological therapies for people with dementia such as the creative therapeutic dance. To explore the validity and reliability of the Profile of Mood States (POMS) in people with dementia and to analyse the possible differences in the scores of the participants before and after sessions of creative therapeutic dance. POMS was administered to 36 people with dementia before and after four group sessions of creative therapeutic dance. To verify the construct validity, PANAS and STAXI-2 were also administered. The POMS presented a good internal consistency for each factor and an excellent one for the total scale. The temporal stability was medium-high. Convergent validity results support construct validity. After the creative therapeutic dance sessions, POMS factors tension, depression and confusion were reduced, while vigour increased significantly. There was no effect on fatigue and anger. The validity and reliability of POMS have been demonstrated in a population with dementia. Creative therapeutic dance can offer emotional benefits for people with dementia.

Recreational Therapy for Dementia-Related Symptoms in a Long-Term Care Setting: A Case Study

As the population ages, more individuals with dementia are admitted to long-term care (LTC) settings, uprooted from familiar routines and home environments. Therapeutic programming must prioritize the provision of opportunities for individualized leisure experiences to aid in this transition. This case study examines a recreational therapy-based, therapeutic gardening treatment for a 76-year-old female with dementia presenting with behavioral disturbances, depression, anxiety, and difficulty acclimating to LTC. Over six weeks, the resident participated in 40- to 60-minute therapeutic gardening sessions three to four times per week to improve mood, decrease behavioral disturbances, and improve acclimation to the facility. By discharge, the resident met each treatment goal and significantly decreased symptoms of depression and anxiety as measured by the Geriatric Depression Scale (GDS) and Beck Anxiety Inventory (BAI). Implications for practice are discussed.Subscribe to TRJ

The impact of therapeutic patient education and physical activity programs on the fall risk of elderly people

Objective: The objective of this study is to evaluate the effectiveness of a combined therapeutic education/physical activity program on risk factors for falls in elderly fall patients hospitalized in a rehabilitation healthcare service. This combined program is compared to a control program, which offers physical activity only. Method: Thirty fall patients are evaluated on the TUG, Tinetti, and FES-I tests and randomly assigned either to the group consisting of 24 sessions of physical activity alone, with endurance, stretching, balance and muscle strengthening exercises, or to the physical activity group combined with four therapeutic fall prevention education sessions. Results: For both programs, results reveal significant differences between the pre-tests and post-tests on each balance score and equally on fear of falling. An interaction effect (group × time) is observed on the FES only, which means that fear of falling decreases significantly more in the Physical Activity and Patient Education group than in the Physical Activity alone group. Conclusion: Therapeutic patient education seems to reduce fear of falling. This highlights the potential impact that such programs could have on elderly people who have had a previous fall/falls in terms of regaining self-confidence when going about their daily activities.

Perceptions and Therapeutic Challenges in the Management of Chronic STIs in Africa: Comparing HIV and Hepatitis B in the University Teaching Hospital Yaounde, Cameroon

Sub-Saharan Africa and Cameroon in particular are experiencing a persistence and consistency in the incidence rates in chronic sexual infections such as HIV and HBV. The prevalence rates stands between 8-10% for HBV and 4.3% for HIV in the general population. Surveys on therapeutic results show more challenges in the management of HIV than HBV. This disparity is due to the differences in perceptions and representations, although similar in pathogenic forms, modes of transmission and chronicity. A call to compare these differences that creates fear, shame and guilt towards HIV compared to HBV, thus, preventing many patients from disclosing their HIV statuses and exposing uninfected partners. A health education system that embraces health beliefs highly needed to demystify the mystery around HIV. This study explains the reasons for negative perceptions with stigma resulting to therapeutic challenges in the management process. A qualitative study that uses in-depth interviews and participant observations on a sample population of about 250 patients undergoing therapeutic education sessions, collected data, analyzed and interpreted using the content analyzes model. Findings show that, negative perceptions towards HIV are the cause of therapeutic challenges. Need to integrate socio-cultural realities in strategies to demystify this prejudice around HIV.

Using technology to scale-up training and supervision of community health workers in the psychosocial management of perinatal depression: a non-inferiority, randomized controlled trial.

The Thinking Healthy Programme (THP) is an evidence-based psychological intervention endorsed by the World Health Organization, tailored for non-specialist health workers in low- and middle-income countries. However, training and supervision of large numbers of health workers is a major challenge for the scale-up of THP. We developed a 'Technology-Assisted Cascaded Training and Supervision system' (TACTS) for THP consisting of a training application and cascaded supervision delivered from a distance. A single-blind, non-inferiority, randomized controlled trial was conducted in District Swat, a post-conflict area of North Pakistan. Eighty community health workers (called Lady Health Workers or LHWs) were randomly assigned to either TACTS or conventional face-to-face training and supervision by a specialist. Competence of LHWs in delivering THP post-training was assessed by independent observers rating a therapeutic session using a standardized measure, the 'Enhancing Assessment of Common Therapeutic factors' (ENACT), immediately post-training and after 3 months. ENACT uses a Likert scale to score an observed interaction on 18 dimensions, with a total score of 54, and a higher score indicating greater competence. Results indicated no significant differences between health workers trained using TACTS and supervised from distance v. those trained and supervised by a specialist face-to-face (mean ENACT score M=24.97, s.d.=5.95 v. M=27.27, s.d.=5.60, p=0.079, 95% CI 4.87-0.27) and at 3 months follow-up assessment (M=44.48, s.d.=3.97 v. M=43.63, s.d.=6.34, p=0.53, CI -1.88 to 3.59). TACTS can provide a promising tool for training and supervision of front-line workers in areas where there is a shortage of specialist trainers and supervisors.

Neurocognitive Assessment Software for Enrichment Sensory Environments

In cases with sensory processing dysfunctions like autism spectrum disorder (ASD) and cognitive decline like Alzheimer's disease (AD), optimistic neurological improvements have been recorded after systematic sensorimotor enrichment stimulation and art therapeutic procedures. While art therapy may offer a cognitive-behavioral breakthrough, several latest studies have explored the effectiveness of brain signals representations through audio and visual transformations of electroencephalography (EEG) measurements and the necessity of neurological evaluation of sensory integration therapies. In this technical report, new software based on the JAVA and processing programming language is presented, that detects, displays and analyzes EEG signals for individual or a group of patients. This neuroinformatics software offers a digital painting environment and a real time transformation of EEG signals into adjustable music volume and octave configuration per electrode, for the real time observation and evaluation of therapeutic procedures. The EEG acquisition is wireless, therefore, brain data can also be collected from the application of other sensory or sensorimotor therapeutic sessions as well. The Neurocognitive Assessment Software for Enrichment Sensory Environments (NASESE) includes two main functionalities, organized in five different modules. The first functionality includes recording, filtering and visualization of the EEG signals exported to a rotating 3D brain model and a real-time transformation of brain activity to sound sculptures, while the second functionality generates statistical tests and coherence calculation in a fully customizable computerized environment.

O uso do genograma como recurso expressivo e objeto mediador em grupo de crianças e adolescentes

A prática do genograma familiar demonstra ser uma fonte significativa de investigação sobre as dinâmicas familiares, para além do manifesto, principalmente quando empregado como objeto mediador dentro do espaço de uma sessão terapêutica. Auxilia na descrição das relações familiares, estruturas vinculares, funções e papéis ocupados pelos membros de uma família ou grupo e facilita o acesso à figuração da transmissão psíquica inter e transgeracional. Com o objetivo de compreender como o genogramatem sido empregado em grupo de crianças e adolescentes, incluindo o de irmãos, realizou-se uma revisão narrativa da literatura nas principais bases de dados com as palavras chaves: genograma, grupo e crianças. Os resultados demonstraram que o genograma apresenta-se como um instrumento flexível, criativo, que se adapta a vários referenciais teóricos e contextos a ser utilizados.

High‐intensity exercise is associated with a better nutritional status in anorexia nervosa

Our aim is to investigate the links between duration and intensity of exercise and the nutritional status in terms of body composition in acute anorexia nervosa (AN) patients. One hundred ninety-one hospitalized women suffering from AN were included. Exercise duration and intensity were assessed using a semistructured questionnaire. Body composition was measured using bioelectrical impedance. Linear multiple regression analyses were carried out using body mass index, fat-free mass index, and fat mass index as dependent variables and including systematically exercise duration, exercise intensity, and other confounding variables described in the literature that were significantly associated with each dependent variable in univariate analysis. A lower BMI was linked to lower exercise intensity, AN restrictive type, and presence of amenorrhea. A lower FFMI was linked to lower exercise intensity, older age, AN restrictive type, and premenarchal AN. Duration of exercise was not linked to the nutritional status. Exercising at higher intensity in AN is associated with a better nutritional status, thus, a better resistance to starvation. The impact of therapeutic physical activity sessions, adapted in terms of exercise intensity and patient's clinical status, should be evaluated during nutrition rehabilitation.

Setting up of pharmaceutical consultations on oral anticoagulants: A personal session supplemented by a patient follow-up

Collective therapeutic education sessions are already in place in our hospital. However, these collective sessions only concern a minority of patients (those included in a program) and are infrequent. The purpose of pharmaceutical consultations on oral anticoagulants (Vitamin K antagonists and direct oral anticoagulants) is to give advice to patients and to provide them with all necessary information for the proper use of the medicine in question, systematically during the hospital stay. Some patients will never benefit from therapeutic education sessions, so those pharmaceutical consultations are a way of reaching them. Patients who benefit from those consultations are patients with an oral anticoagulant, hospitalized in the medicine department. Patients with severe cognitive disorders are not included. Patients answer a questionnaire before and after the consultation, in order to see the evolution of the score. A printed summary of the main points is given at the end of the consultation. A phone call is made to patients one month after the consultation, in order to take stock, to re-evaluate the score and to answer patients’ further questions. During 6 months, 54 patients benefited from consultations in their hospital room. The average knowledge score is 10.7/20 before the consultation and 18.4/20 after the consultation. 37 patients answered the questionnaire one month after the consultation (over the phone): they obtained an average score of 16.3/20. Pharmaceutical consultations on oral anticoagulants have made it possible to reach more patients than our therapeutic education program. Our method is effective since patients have a knowledge score, which is higher after the consultation, and one month after the consultation the score remains higher than it initially was.

Setting up the program ‘PRADO Insuffisance Cardiaque’ (back home program for heart failure patients): Perception by health professionals and patients

Re-hospitalizations and deaths are particularly high during the first month following hospitalization for IC. Thus, several programs have been proposed in recent years, including the ‘Programme d’Accompagnement du Retour à Domicile(PRADO)’. The objectives of this program are to reduce the re-hospitalization and death of IC patients and to improve their quality of life. This is a monocentric observational retrospective study whose main objective was to evaluate the feeling of general practitioners,cardiologists and community nurses in the implementation of the PRADO IC program. The secondary objectives were to determine the impact of the program on the number of re-hospitalizations and deaths within 6 months following hospitalization. It was also to evaluate the feelings of the patients included.60 physicians and 36 community nurses participated in our study as well as 56 patients. The knowledge of the protocol concerned only 28% of general practitioners and 80% of cardiologists (significant difference between specialties). The majority of health professionals seem to favor this program. The 6-month re-hospitalization rate for IC was 21.6%. None of the triggering factors corresponded to a therapeutic break or a difference in diet, suggesting that the therapeutic education sessions of the program have borne fruit. An advanced age,outpatient BNP ≥ 400 pg/mL, and impaired LVEF were correlated with increased risk of re-hospitalization (no statistically significant link). We also found a trend toward shorter re-hospitalizations. Mortality at 6 months was 18.2%. Older age (> 85 years) was statistically associated with a higher risk of cardiovascular mortality. The majority of patients reported having felt a benefit to carry out this program, because it was accessible in its content and easy to set up at home. In conclusion, the low knowledge of the program should allow for new effective dissemination methods for this type of program as the prevalence of HF will continue to grow in the coming years.