Care Management Plan Research Articles

Effectiveness of implementing a Best Practice Guideline recommendations to manage pain in oncological hospitalized patients

ObjectiveTo evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) “Assessment and Management of Pain” recommendations for pain control in oncological/oncohaematological hospitalized patients. MethodsAmbispective cohort study. Sample and Setting: Adults admitted to oncological unit in Hospital of Albacete. InterventionImplementation of GBP recommendations. Variables: 1) Demographic data. 2)On implementation of GBP recommendations. 3) Outcome in patients: pain intensity in the first 24 h after admission and maximum intensity during admission Tools: Numeric and Visual Scales. Data collection: indicators exported from clinical history for evaluation of the BPSO® program. Ethical aspects: anonymous data. Data analysis (SPSS®): Descriptive during periods: baseline (T0 = December 2015); initial (T1 = 2017); consolidation (T2 = 2018–2019); sustainability (T3 = 2021–2022). Measurements of central tendency and dispersion, absolute and relative frequencies. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). Statistical significance: p < 0.05. ResultsIncluded 572 patients, 61.5% (352) men. Daily intervention of pain detection was performed in 94.6% (538) of patients (20%–T0; 98.3%–T1; 98.4%–T2; 91.2%–T3; p < 0.001), pain assessment using an appropriate scale in 97.6% (558) (0%–T0; 98.3%–T1; 99.2%–T2; 100%–T3; p < 0.001); 93.7% (535) had a care plan for assessment and management of pain (0%–T0; 98.3%–T1; 96.3%–T2; 92.3%–T3; p < 0.001). The percentage of patients who had severe pain (6–10) during the first 24 hours was reduced from T1 to T3 (5.1%–T1; 6.6%–T2; 2.1%–T3; p = 0.145), but throughout hospitalization increased from T1 to T3 (19.2%–T1; 17%–T2; 22.5%–T3; p = 0.21). ConclusionsImplementation of recommendations has led to a statistically significant improvement over the periods in the study; however, no effectiveness has been shown to reduce pain intensity.

A Study on Perception of Mutual Fund Investment

This study explores the performance, risks, and opportunities associated with mutual fund investments, particularly in the Indian market. It evaluates different mutual fund types, analyzing their historical returns and risk metrics to provide investors with data-driven insights. The research examines the factors influencing mutual fund performance, including market volatility, asset management strategies, and economic conditions. Additionally, the study assesses investor behaviour in response to mutual fund performance, emphasizing the role of financial literacy and risk tolerance. The findings suggest that mutual funds offer a viable investment option for wealth creation, with equity-based funds outperforming others over a long-term horizon. However, market risks remain significant, requiring careful management and strategic investment planning

Decoding prognosis: Unraveling physicians' responses in electronic treatment plans.

230 Background: Communicating prognosis to cancer patients is a critical aspect of shared decision making in healthcare. Practices in The US Oncology Network (The Network) use an electronic version of a treatment plan based on the Institute of Medicine (IOM) care management plan for patients receiving cancer treatment. Physicians document in their own words the prognosis section of the treatment plan. This study seeks to better understand the responses provided by physicians in the prognosis section. Methods: We evaluated word frequency analysis using FreqDist library, conducted sentiment analyses using the Natural Language Toolkit (NLTK) Sentiment Intensity Analyzer, and performed thematic analyses using Latent Dirichlet Allocation library on a random sample of 35,000 treatment plans developed in 2023 for practices in The Network. Results: 32% of the responses were 5 words or less, with 3.8% single word responses. Words like “excellent, good, fair, poor, guarded” or a combination thereof were commonly used to describe the prognosis. 26% of responses were ≥12 words in length, and generally were personalized to the patient’s disease, treatment, and/or contained situation specific narratives. Responses &lt;12 words generally contained templated phrases, or minimally customized responses. 38% of the responses contained a numerical value, representing either a percentage probability of survival, chance of response to treatment, or a quantification of time (months, years). Thematic analyses conducted on responses ≥12 words revealed that the predominant theme focused on survival represented in different ways, followed by response to therapy, probability of recurrence or relapse, and disease control. Sentiment analyses revealed that 60.6% of responses denoted a negative sentiment. 71.7% of responses ≤5 words in length had a negative sentiment, compared to 58.3% of responses ≥12 words in length. Conclusions: This study reveals that prognosis responses from physicians used on treatment plans shared with patients are very diverse. The manner in which prognosis is presented to patients can greatly influence their understanding, engagement, and involvement in making treatment decisions. To optimize shared decision making in cancer care, healthcare providers must strive to effectively communicate prognosis by using clear and empathetic language, ensuring patient comprehension, and tailoring the information to individual patient needs and preferences. The data set has high potential for further study to better understand the role and impact of written treatment plans to help physicians refine this documentation for better patient understanding.

Patient Experience Survey as a Tool to Support Quality Improvement of a Geriatric Service in the Emergency Department (ED)

Abstract Background The aim of this survey was to valuate patient’s satisfaction with a Frailty Intervention Therapy Team (FITT) and gain insight into their thoughts about the service. Patients’ feedback is a vital component in monitoring and improving the quality of care. The data collected will help develop the service ensuring it’s patient centred and tailored to their needs. Methods A qualitative approach was taken in the form of a patient satisfaction survey. To limit bias responses, non-patient facing clerical facilitated the completion of the questionnaire with the patient. Results 27 surveys were administered over a 5-week period with an 81% response rate (n=22). 91% of patients surveyed felt the purpose of the FITT service was clearly explained to them, the team member had clearly introduced themselves and the team used both written and verbal information well –indicating an effective and efficient style of communication. 100% of patients reported that FITT treated them with dignity and respect. 18% of patients reported they were not involved in decision making relating to the care they received. The ED environment was rated as poor by 14% of patients, long wait time to be seen was also a concern. While some areas of patient concerns cannot be directly targeted by the team alone, we have a duty of care to highlight these concerns to the wider ED staff and hospital group. Conclusion A ‘what matters to you’ question has been incorporated into the assessment paperwork, to ensure patients’ wishes are being formally captured and placed centrally within care management planning. Communication to the patient was supported by providing a FITT information leaflet. Additional seating was procured by FITT to promote improvements in comfort and facilitate safe transfers of older patients in the ED. Patient feedback was presented to the ED governance group, including major themes of patient concern.

PRADOC: A Multicenter Randomized Controlled Trial to Assess the Efficiency of PRADO-IC, a Nationwide Pragmatic Transition Care Management Plan for Hospitalized Patients With Heart Failure in France.

The PRADO-IC (Programme de Retour à Domicile après une Insuffisance Cardiaque) is a transition care program designed to improve the coordination of care between hospital and home that was generalized in France in 2014. The PRADO-IC consists of an administrative assistant who visits patients during hospitalization to schedule follow-up visits. The aim of the present study was to evaluate the PRADO-IC program based on the hypotheses provided by health authorities. The PRADOC study is a multicenter, controlled, randomized, open-label, mixed-method trial of the transition program PRADO-IC versus usual management in patients hospitalized with heart failure (standard of care group; NCT03396081). A total of 404 patients were recruited between April 2018 and May 2021. The mean patient age was 75 years (±12 years) in both groups. The 2 groups were well balanced regarding severity indices. At discharge, patients homogeneously received the recommended drugs. There was no difference between groups regarding hospitalizations for acute heart failure at 1 year, with 24.60% in the standard of care group and 25.40% in the PRADO-IC group during the year following the index hospitalization (hazard ratio, 1.04 [95% CI, 0.69-1.56]; P=0.85) or cardiovascular mortality (hazard ratio, 0.67 [95% CI, 0.34-1.31]; P=0.24). The PRADO-IC has not significantly improved clinical outcomes, though a trend toward reduced cardiovascular mortality is evident. These results will help in understanding how transitional care programs remain to be integrated in pathways of current patients, including telemonitoring, and to better tailor individualized approaches. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03396081.

Intensive care of a patient undergoing combined multi-organ cluster ("larynx-trachea-thyroid-hypopharynx-esophagus") transplantation: A case report.

The aim of this study was to summarize the intensive care experience of a patient undergoing combined multi-organ cluster ("larynx-trachea-thyroid-hypopharynx-esophagus") transplantation. The intensive care management plan for this case was developed by a multidisciplinary team, with focus on 6 aspects: (1) stabilizing the circulation and reducing anastomotic tension by position management to improve the survival chances of transplanted organs, (2) adopting goal-directed analgesia and sedation protocols, as well as preventing anastomotic fistula, (3) implementing a bedside ultrasound-guided nutrition plan, (4) employing "body-mind" synchronous rehabilitation to facilitate functional recovery, (5) taking antirejection treatment and protective isolation measures, (6) monitoring and nursing thyroid function. During the intensive care, the patient's vital signs were stable. The patient was successfully weaned from the ventilator and transferred to the general ward for further treatment at 9 days postoperatively, and discharged upon recovery at 58 days postoperatively. The patient was in good condition during follow-up. This study provides reference for the care of patients who undergo similar transplantation in the future.

A critically co-endangered feather louse Forficuloecus pezopori n. sp. (Phthiraptera: Philopteridae) detected through conservation intervention for the western ground parrot Pezoporus flaviventris (Psittaculidae)

Forficuloecus pezopori Martin, Keatley & Ash n. sp. from the western ground parrot Pezoporus flaviventris North, 1911 (Psittaculidae) is proposed based on combined evidence from morphology and COI mitochondrial DNA. Phylogenetically, the new species is closest to its two known congeners from Western Australia: F. josephi Price, Johnson & Palma, 2008 from Bourke's parrot Neopsephotus bourkii (Gould, 1841) and the scarlet-chested parrot Neophema splendida (Gould, 1841), and F. palmai Guimarães, 1985 from the Australian ringneck parrot Barnardius zonarius (Shaw, 1805). Morphologically it is distinguishable by abdominal chaetotaxy and characters of the male genitalia, and is most similar to F. josephi and F. greeni Guimarães, 1985; the latter has no representative sequence data. Forficuloecus pezopori is the eleventh species of its genus and the only metazoan parasite known from P. flaviventris, which is among Australia's most endangered vertebrates. The new louse is apparently restricted to P. flaviventris and is therefore co-endangered, facing at least the same likelihood of extinction as its host. We recommend ongoing translocation and field monitoring efforts for P. flaviventris include monitoring but not treatment for lice infestations in otherwise healthy individuals, and that the care management plan for captive P. flaviventris considers that F. pezopori is similarly imperilled.

Using Quality Improvement as a Mechanism for Fostering Partnerships and Promoting Equity in a Health System Change Model.

Quality improvement (QI) processes provide a framework for systematically examining target outcomes and what changes can be made to result in improvement and ensure equity. We present a case study of how QI processes were used as a means of partnership building to enhance equity in designing materials for a Medicaid pilot program, North Carolina Integrated Care for Kids (NC InCK). The NC InCK model addresses social determinants of health by providing structured care integration across core child health and social service areas and using an alternative payment model to incentivize high quality child outcomes. During the two-year planning period prior to the NC InCK model launch, we used Plan-Do-Study-Act (PDSA) cycles to conduct usability testing as a QI strategy for a component of the NC InCK model: the Shared Action Plan (SAP). We conducted usability testing with four Family Council members, nine care managers, and one physician. Participants reviewed the SAP and provided feedback via a survey. After reviewing feedback with InCK leadership and the Family Council, we implemented recommendations that led to a SAP that uses clear and accessible language, that highlights family strengths and family-identified goals, and that is distinct from other care management plans. Usability testing forced refinement of materials before NC InCK launched, created opportunities for building and enhancing community partnerships and promoted equity within the NC InCK team and Family Council by considering multiple perspectives when deciding on SAP revisions.

Care transition for patients admitted to hospital due to COVID-19 and its relationship with clinical characteristics

Objective To analyze care transition (CT) and its relationship with the clinical characteristics of patients admitted to hospital due to COVID-19. Methods This is a cross-sectional study, carried out in a general hospital, with 165 patients admitted to hospital due to COVID-19 and who were discharged home. Participants were those who had been admitted to hospital for at least 24 hours, over 18 years of age, with telephone access after discharge. Those who were discharged by transfer, who died or those without cognitive conditions were excluded. Data collected between March and July 2021, using a sociodemographic and clinical questionnaire as well as Care Transitions Measure-15. Descriptive and inferential statistical analysis was applied. Results The overall mean of Care Transitions Measure-15 was considered satisfactory (71.8±7.45). The Important preferences factor obtained the highest mean (80.5± 9.84) and the Care Plan factor the lowest (57.5± 11.4). Significant statistical differences were found when the CTM-15 factors were associated with the clinical variables: duration of chronic disease (p&lt;0.03); presence of clinical artifact (p&lt;0.040); use of continuous medication (p&lt;0.029). Readmission had a significant difference in the factors Health management preparation (p&lt;0.045), Important preferences (p&lt;0.027) and Care plan (p&lt;0.032). Conclusion Patients admitted to hospital due to COVID-19 assessed the general CT as satisfactory and the clinical variables, length of chronic illness, clinical artifact, continuous medication and readmission interfered in the CT of these patients.

Actioning usability study findings in the development of the ADLIFE integrated care digital tools.

Introduction: The ADLIFE project aims to improve the quality of life of older people with advanced chronic diseases by providing integrated intelligent personalised care via a digitally enabled holistic and integrated supportive care ICT Toolbox. The two interlinked user-facing tools are firstly, a Personalised Care Plan Management Platform (PCPMP) used by healthcare professionals; and secondly, a Patient Empowerment Platform (PEP) that patients and their informal caregivers use to promote patient self-management. &#x0D; The impact of the ADLIFE digital tools will be explored in a 12-month pilot study conducted across 7 clinical sites in 6 countries to evaluate their impact on a range of health-related, implementation and socio-economic outcomes.&#x0D; The development of digital tools needs to be done in continuous collaboration with target end-users. Feedback from prototype testing with typical user scenarios is crucial to identify any remaining issues to resolve ahead of the deployment of such tools. We present the findings from a pre-deployment usability study conducted on the ADLIFE Toolbox.&#x0D; Methods: Pilot sites recruited 3-5 participants for their feedback on the PCPMP and PEP tools. Usability data was collected using a standardised Questionnaire for User Interface Satisfaction (QUIS), administered online, following a training workshop and testing by the participants. One site collected feedback via a Patient and Public Involvement (PPI) approach for the PEP tool as an option for the activity timeline. The questionnaire responses were analysed to identify the key areas of improvement. The analysis includes a standard scoring system giving an indication of users’ satisfaction with each facet of interest. These scores identify specific features of the ADLIFE tools that have lower usability scores, allowing useful improvements to be made before deployment in the main ADLIFE pilot study. Additional free text comments are used to complement the QUIS scores and provide greater depth of understanding around specific usability issues. PPI responses were analysed separately as the group did not test the tool directly.&#x0D; Results: 13 responses were received for PCPMP and 18 for PEP. Overall, the study participants (excluding 10 PPI participants) scored both tools above average, with scores over 66% on average in all questionnaire categories (scores of over 6 out of 9, average score on this scale is 4.5). Some areas of usability scored lower, such as task progression and highlighting where input is required. Together with comments elaborating on scores given, those areas are being assessed further for prioritising updates to the tools and also to be considered in the study planning, such as training materials and communication channels. The PPI feedback provided insight into how ADLIFE tools can fit within the wider context of healthcare and technology. &#x0D; Conclusions: The usability studies have provided an opportunity to get feedback from participants similar to the ADLIFE study participants and make improvements to the ADLIFE tools, training and communication ahead of the pilot study start.&#x0D; Acknowledgements: ADLIFE has received funding from the EU Horizon 2020 research and innovation programme under grant agreement no. 875209. The authors thank all partners within ADLIFE for their cooperation and valuable contribution.

Deployment of SHARE model in ADLIFE project to boost Shared Decision Making in a patient-centered approach.

Introduction: Serious illness raises the stakes for engaging patients and families in healthcare decisions. They include those with critical life-threatening illnesses, advanced stages of major chronic diseases, or multi-morbidity and frailty. Patients confront debilitating symptoms and impending threats to function, decision-making capacity, and survival. Patients, caregivers, and health care practitioners identify communication and shared decision-making (SDM) as essential components of good care in serious illness. SDM is a process where clinicians and patients work together to clarify treatment, management, or self-management support goals, sharing information about options and preferred outcomes to reach a mutual agreement on the best course of action.&#x0D; ADLIFE is an EU-funded project to improve the quality of life of older people with advanced chronic diseases by providing integrated intelligent personalized care via a digitally enabled holistic and integrated supportive care ICT Toolbox. ADLIFE care model aims to respond to the individual patient's situation and improve the relationship between patients, carers, and professionals. This patient-centred approach, in which the patient's values and preferences are incorporated, enables the definition of an individualized and personalized treatment for the patient.&#x0D; Methods: The project seeks to promote, encourage, and offer the possibility of promptly integrating SDM through the Personalized Care Plan Management Platform (PCPMP). From more than 22 accepted definitions of shared decision-making, the project has implemented the adapted SHARE approach (https://www.ahrq.gov/) for exploring and comparing care options through meaningful dialogue about what matters most and benefits the patient. The model includes a five-task process:&#x0D; (i) Seeking the involvement of the patient (healthcare professional);&#x0D; (ii) Helping the patient explore and compare treatment options;&#x0D; (iii) Assessing the patient's values and preferences;&#x0D; (iv) Making a decision;&#x0D; (v)Evaluating the patient's decision after a period of time. &#x0D; The SHARE approach proposes the involvement of patients and professionals in different tasks such as information transfer, risk communication, and preference elicitation, tailoring options, or broader decision-making. The model offered in ADLIFE to healthcare professionals includes information and evidence that supports the approach, establishing the relation and connection between the tasks and actors involved in the process.&#x0D; Results: In ADLIFE the SDM process is suggested by the PCPMP. The suggestions appear in specific situations to engage in shared decision-making. Professionals can choose to engage in the process at any other moment. Based on the SHARE approach, professionals will be provided with quick help for each of the five tasks, including the definition of the task, aids for professionals and for patients, and support about how and when to carry out the task (information and materials).&#x0D; Discussion and Conclusions: The SDM model implemented boosts in a useful way how professionals and patients can be involved in a clinical decision. ADLIFE focuses on motivating healthcare professionals to engage in SDM routinely and promote patient autonomy, involvement, voice, emotions, and trust. The project can ultimately create an SDM culture and encourage and improve the ability and skills of clinicians to perform SDM activities. &#x0D; Acknowledgements: &#x0D; ADLIFE (GA 875209) received funding from the EU Horizon 2020. The authors thank all partners within ADLIFE.&#x0D;

A retrospective analysis of empathy-centric care strategies on negative emotional states and expectation levels in acute heart failure patients.

The objective of this research was to evaluate the impact of an empathy-centered care approach on the intensity of negative emotional states and levels of expectation in patients experiencing acute heart failure. A retrospective analysis was conducted on the clinical data of 106 patients presenting with emergent heart failure. The patients were bifurcated into a control group (53 patients) and an intervention group (53 patients) based on their respective care management plans. Following the intervention, the intervention group demonstrated decreased values in left ventricular end-systolic diameter and left ventricular end-diastolic diameter, and increased left ventricular ejection fraction compared to the control group (P < .05). Additionally, the 6-minute walk test used for cardiopulmonary rehabilitation and the 30 seconds sit-to-stand exercise revealed superior results in the intervention group (P < .05). Positive scores on the Positive Negative Affect Scale, the various dimensions of the Herth Hope Index Scale, the Psychological Resilience Scale, and the Chinese Cultural Modified Minnesota Living with Heart Failure Questionnaire were notably higher in the intervention group, whereas negative scores on the Positive Negative Affect Scale and scores on the Self-Assessment Scale of Anxiety were comparatively lower than those in the control group (P < .05). Implementing an empathy-based care approach can bolster cardiac function, augment functional fitness, mitigate negative emotional states, elevate expectation levels, enhance psychological resilience, improve quality of life, and decrease complication rates in patients with acute heart failure.

The Methodology and Outcomes of Adapting an Antibiotic Selection Decision Pathway (ASDPwy) for the Management of a Child with Cancer and Fever (CCF) in Pediatric Cancer Units in Latin America

Abstract Background A care pathway (CPW) is a standardized, evidence-based interdisciplinary care management plan, which identify an appropriate sequence of clinical interventions, timeframes, milestones and expected outcomes for a comparable patient group. We aimed to adapt an ASDPwy for management of CCF in Latin America (LA) Methods A working group (WG) of the St Jude Global ID network was established in June 2022. For a comprehensive review of the existing literature, the WG collaborated to identify usable care pathways for antibiotic selection during febrile episodes in children with cancer. We reviewed PubMed, Web of Science, Google were searched using the following terms: “Care Pathways, Critical Pathways Care Map, Clinical Paths, Clinical Pathways, Critical Paths” AND “Fever” OR "Anti-Inflammatory Agents" OR "Anti-Inflammatory Agents, “Non-Steroidal" OR "Heat-Shock Proteins" OR "Hyperthermia, Induced" OR "Malignant Hyperthermia" OR Pyrogens AND infections AND neutropenia OR neutrophil* AND cancer OR oncology OR tumor OR tumor OR neoplasm OR malignancy, filtered for the last 10 years, in individuals aged birth-18 years. To identify suitable care pathways, a rubric using available information was built and used to select the top CPWs. In a dedicated, virtual meeting, the WG discussed and selected top 3 CPW and the WG assessed how these CPWs could be use in a LA context. This discussion resulted in the selection of a CPW closest to the needs of LA, adapt and contextualize to LA reality. This was done by the following steps, based on Dizon [ref] and Ferver [ref] models. Results The WG followed the following timeline of events: The WG presented the ASDPwy as illustrated below Conclusion This is the first adaptation of a ASDPwy in CCF in LA. The next step before applying this ASDPwy is to evaluate the performance of the tool and the satisfaction of the users. The long-term plan is to disseminate the use of this tool in the Latin American region and if applicable share it globally.

Abstract 13366: Effectiveness and Safety of Short-Term Outpatient Amiodarone Followed by Catheter Ablation in Management of Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is the most common arrythmia with significant health system burden and emergency room/hospital admissions. We conducted this study to understand the efficacy of managing AF with first line short term outpatient amiodarone followed by catheter ablation (pulmonary vein isolation). Amiodarone was continued for 6 months post catheter ablation (CA). We looked at a primary end point of recurrence of AF and the drug side effects during the year post CA. Hypothesis: If this strategy of short-term amiodarone with early ablation of AF is effective, then we could incorporate this in an AF management care plan. Methods: In this retrospective cohort study, we used TriNetX database to collect data on patients with amiodarone initiation with CA and those who were given Dofetilide or Sotalol, followed by CA. We collected data between March 1, 2020, and June 1, 2021. We created a propensity score matching of a 1:1 to match on the covariates: Age, Male, Female, CAD, Heart Failure, Diabetes, COPD, BMI. The endpoint is occurrence of AF within 365 days of medication initiation. Results: A total of 40,640 patients were included in the analysis. Of those patients, Cohort 1 comprised amiodarone initiation with catheter ablation (n=176) compared to Dofetilide or Sotalol which had (n=40,474). After the propensity match, we included 176 individual patients in each cohort. The amiodarone group had more men (79.5% vs 58.8, P&lt;0.001) and were with higher comorbidities of CAD, Heart Failure, Diabetes, COPD. At 365 days Amiodarone group had a reduction of 12.6%, P&lt;0.001 of AF compared to Dofetilide or Sotalol patients. There has been no reported side effects requiring discontinuation of Amiodarone. Conclusions: We are excited to report a statistically significant 12.6% reduction in AF recurrence in Cohort 1 with short term outpatient Amiodarone initiation with CA compared to inpatient Dofetilide or Sotalol initiation with CA. There have been no safety issues with Amiodarone use for 6-12 months post PVI. This strategy avoids occupying beds for initiation of class III antiarrhythmic (Dofetilide or Sotalol), thus significantly reducing the burden on the health system.

Validation of Nursing Outcome Indicators in Patients with Postsurgical Delirium.

To validate the content of the indicators proposed from the Nursing Outcome Classification in a care plan for delirium management in older adults. Content validity study, conducted under the expert judgment technique. The procedure was developed in five moments: organization of indicators that respond to the nursing outcome classification for delirium management, support with literature of the indicators that responds to the result, selection of experts, establishment of agreements, and discussion. Quality criteria evaluated: pertinence and relevance, the Content Validity Coefficient and average scores assigned by the experts were calculated. The study had the participation of 14 experts. The indicators, according to criteria of pertinence and relevance evaluated by experts showed a global average content index value of 0.93; 97.05% (66) of the indicators had Content Validity Coefficient > 0.75. The quantitative findings of the indicator validation process showed high relevance and pertinence index, which favors their being applied to measure care changes in patients with delirium.

Enhancing multifunctionality in European boreal forests: The potential role of Triad landscape functional zoning

Land-use policies aim at enhancing the sustainable use of natural resources. The Triad approach has been suggested to balance the social, ecological, and economic demands of forested landscapes. The core idea is to enhance multifunctionality at the landscape level by allocating landscape zones with specific management priorities, i.e., production (intensive management), multiple use (extensive management), and conservation (forest reserves). We tested the efficiency of the Triad approach and identified the respective proportion of above-mentioned zones needed to enhance multifunctionality in Finnish forest landscapes. Through a simulation and optimization framework, we explored a range of scenarios of the three zones and evaluated how changing their relative proportion (each ranging from 0 to 100%) impacted landscape multifunctionality, measured by various biodiversity and ecosystem service indicators. The results show that maximizing multifunctionality required around 20% forest area managed intensively, 50% extensively, and 30% allocated to forest reserves. In our case studies, such landscape zoning represented a good compromise between the studied multifunctionality components and maintained 61% of the maximum achievable net present value (i.e., total timber economic value). Allocating specific proportion of the landscape to a management zone had distinctive effects on the optimized economic or multifunctionality values. Net present value was only moderately impacted by shifting from intensive to extensive management, while multifunctionality benefited from less intensive and more diverse management regimes. This is the first study to apply Triad in a European boreal forest landscape, highlighting the usefulness of this approach. Our results show the potential of the Triad approach in promoting forest multifunctionality, as well as a strong trade-off between net present value and multifunctionality. We conclude that simply applying the Triad approach does not implicitly contribute to an overall increase in forest multifunctionality, as careful forest management planning still requires clear landscape objectives.

219: Nursing Care Plan for ECMO Patient Management: Early Experience from a Single Center Program in Ecuador

219: Nursing Care Plan for ECMO Patient Management: Early Experience from a Single Center Program in Ecuador

Overall comorbidities in functional neurological disorder: A narrative review

IntroductionThe importance to assess and include the frequent comorbidities in the personalised care management plan of patients with functional neurological disorders (FND) has arisen through the years. FND patients are not only complaining from motor and/or sensory symptoms. They also report some non-specific symptoms that participate to the burden of FND. In this narrative review, we aim to better describe these comorbidities in terms of prevalence, clinical characteristics and their variability depending on the subtype of FND. MethodsThe literature was searched for on Medline and PubMed. The search was narrowed to articles between 2000 and 2022. ResultsFatigue is the most common symptom reported in relation to FND (from 47 to 93%), followed by cognitive symptoms (from 80 to 85%). Psychiatric disorders are reported in 40 to 100% FND patients, depending on the FND subtype (functional motor disorder [FMD], functional dissociative seizures [FDS]…) but also on the type of psychiatric disorder (anxiety disorders being the most frequent, followed by mood disorders and neurodevelopmental disorders). Stress factors such as childhood trauma exposure (emotional neglect and physical abuse predominantly) have also been identified in up to 75% of FND patients, along with maladaptive coping strategies. Organic disorders are commonly reported in FND, such as neurological disorders (including epilepsy in FDS [20%] and FMD in Parkinson's Disease [7%]). Somatic symptom disorders including chronic pain syndromes are frequently associated to FND (about 50%). To be noted, recent data also suggest a high comorbidity between FND and hypermobile Ehlers Danlos Syndrome (about 55%). ConclusionPut together, this narrative review highlights the high burden of FND patients, not only due to somatosensory alterations but also by considering the frequent comorbidities reported. Thus, such comorbidities must be taken into consideration when defining the FND personalised care management strategy for the patients.

Paediatric acute respiratory infections: a case series based clinical analysis and recommendations in accordance with WHO guidelines

Pneumonia is one of the most common respiratory disorder across the globe. Pneumonia is a leading cause of morbidity and mortality in children younger than the age of 5 years. Bronchopneumonia is one of the typically seen presentation of pneumonia occurring mainly in the pediatric population. If not treated promptly, it might become life-threatening. Since pneumonia is associated with significant morbidity and mortality, promptly diagnosing pneumonia, correctly recognizing any complications or underlying conditions, and appropriately treating patients are of prime importance. This case series aims at providing a discussion of the diagnosis, management and comprehensive plan of care for bronchopneumonia in pediatric population.

Chronic pain management during the COVID-19 pandemic: Can telemedicine replace in-person consultation? A prospective clinical study

IntroductionThe COVID-19 pandemic forced numerous pain clinics to suspend their services. For chronic pain patients, even a temporary closure and inability to connect with their healthcare providers may result in adverse outcomes. There are serious concerns regarding worsening of physical and emotional suffering and a surge in substance abuse. Therefore, telemedicine, also called telehealth, would seem to be a reasonable alternative to in-person clinic visits during the lockdowns. However, it remains unclear whether a telemedicine consultation is adequate for diagnostic purposes and subsequent intervention planning. MethodsThis study was conducted as an open-label cohort study on new patients referred to an interdisciplinary community pain clinic focused on image-guided interventions. The primary outcome was to determine whether a video consultation was sufficient to make an initial diagnosis and plan subsequent interventions. Secondary variables included technical feasibility, patient satisfaction, calculated nonincurred cost and time-saving. Video consultations were performed using a secure videoconference system consistent with routine clinic practice. ResultsSixty-five participants were recruited, and 49 (75.4%) completed the study. Patients for whom interventional approaches were not recommended elected not to continue with clinic visits. The intra-observer agreement rate between the telemedicine and in-person encounter was 93.9% (95% CI 87.2-100) for the diagnostic codes and treatment plan. The median satisfaction score from the telemedicine encounter was seven on a scale of 0–7, and it remained 6 when the remote care experience was later compared with the in-person visit. There were considerable savings in travel time and expenses. DiscussionThe study experimentally validated the ability of telemedicine encounters to establish a diagnosis and formulate an interventional pain management plan of care. The validity of virtual consultation for complex pain care remains to be determined. It is unreasonable to expect telemedicine to completely replace clinic visits in the foreseeable future. However, judicious use of technology may facilitate timely scheduling, save time and resources, and improve satisfaction without jeopardizing the quality of care.