Purpose Self-management is a dynamic process in which individuals actively manage a chronic illness. Self-management models are limited in their specification of the processes of self-management. The purpose of this article is to delineate processes of self-management in order to help direct interventions and improve health outcomes for individuals with a chronic illness. Design Qualitative metasynthesis techniques were used to analyze 101 studies published between January 2000 and April 2011 that described processes of self-management in chronic illness. Methods Self-management processes were extracted from each article and were coded. Similar codes were clustered into categories. The analysis continued until a final categorization was reached. Findings Three categories of self-management processes were identified: focusing on illness needs; activating resources; and living with a chronic illness. Tasks and skills were delineated for each category. Conclusions This metasynthesis expands on current descriptions of self-management processes by specifying a more complete spectrum of self-management processes. Clinical Relevance Healthcare providers can best facilitate self-management by coordinating self-management activities, by recognizing that different self-management processes vary in importance to patients over time, and by having ongoing communication with patients and providers to create appropriate self-management plans.

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Findings confirm earlier reports of the antidepressant efficacy and safety of tDCS. Vigilance for mood switching is advised when administering tDCS to individuals with bipolar disorder.

Abstract-Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research. Key Words: AHA Scientific Statements Ⅲ acute coronary syndrome Ⅲ stroke Ⅲ delivery of health care D espite major advances in identifying effective treatments for heart attack and stroke, there are substantial difficulties in applying these treatments to care. The weak link in the chain of events leading to prompt and effective treatment is patient delay in seeking care. More than 50% of the 1.2 million people who suffer an acute myocardial infarction (AMI) or coronary death each year in the United States die in an emergency department (ED) or before reaching a hospital within an hour of symptom onset. 1 About 700 000 individuals will have a stroke each year, 167 000 of those who have strokes will die, and more will suffer a major disability. 1 Of the stroke deaths that occur each year, almost half occur before the patient reaches the hospital. 2 Many of these deaths and significant disability could be prevented if patients received earlier treatment. 1,3 Although the benefits of early treatment of heart attack and stroke are clear, only a minority of eligible patients receive optimally timed treatment for their symptoms because of delay in seeking care. The development and use of appropriate interventions to decrease treatment-seeking delay by patients could produce important gains in reducing death and disability from heart attack and stroke. Unfortunately, efforts to date to develop effective interventions have met with disappointing results. 4 -6 Accordingly, the purpose of this statement is to summarize the evidence that demonstrates the benefits of early treatment, 1,2 describes the extent of the problem of patient delay, 3 identifies the factors related to patient delay in seeking timely treatment, and reveals the inadequacies of our current approaches to decreasing patient delay. 4 Finally, we offer suggestions for clinical practice and future research. Benefits of Early TreatmentThe burden of cardiovascular disease is growing worldwide. Ischemic heart disease is the No. 1 cause of death in the The findings and conclusions in this scientific statement are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the National Heart, Lung, and Blood Institute.The American Heart Association makes every effort to av...