We explored the effects of continuation care based on trans-theoretical model (TTM) in adult patients with acute leukemia (AL). Patients with AL who had been discharged from our hospital were randomly assigned to the control group (n = 68) and intervention group (n = 74). The control group received routine nursing, while the intervention group received a structured psychoeducational follow-up program based on the Transtheoretical Model (TTM). 2 months after intervention, the quality of life (QoL), mood, self-care ability, and incidence of complications were assessed and compared. The patients were then followed up for 18 months to observe their long-term survival. The incidence of complications was significantly lower in the intervention group than in the control group, whereas the QoL scores, positive mood scores, and self-nursing ability scores were higher (P<0.05). At a median follow-up of 18 months, the overall survival was significantly better in the intervention group than in the control group (P = 0.013). The Program effectively reduced the incidence of complications and improved the QoL, emotional well-being, and self-nursing ability, thereby offering certain advantages in enhancing the AL patients' survival rates. The TTM-based continuation care can be implemented to improve the QoL in patients with AL, and is worth promoting.

The effect of early mobilization program on changes in hemodynamic symptoms in patients with acute myocardial infarction.

Evaluation of a street medicine based post-discharge care program for patients experiencing homelessness.

BackgroundWe aimed to determine whether a nurse-led digital care program improves postoperative outcomes compared to usual care in patients receiving external fixation. Specifically, we assessed its impact on complication rates, pain, function, psychological well-being, patient satisfaction, and adherence.MethodsWe conducted a single-center, parallel-group randomized controlled trial involving 100 adult patients (aged 18–75) undergoing external fixation for trauma or reconstructive procedures. Participants were randomized 1:1 to receive either a nurse-led digital care program or standard postoperative care. The digital intervention included daily symptom logging, structured educational modules, video consultations, and in-app nurse communication. The primary outcome was the occurrence of at least one postoperative complication by 24 weeks. Complication burden, defined as the number of postoperative complications per participant, was assessed as a supportive summary. Secondary outcomes included pain (VAS), function (LEFS), psychological status (HADS), and patient satisfaction. Data were collected at baseline, 4, 12, and 24 weeks. Analyses were performed using linear mixed-effects models.ResultsAt 24 weeks, complication rates were similar between the digital and control groups (difference: -0.02; 95% CI, -0.205 to 0.165; p=0.829). Improvements in pain, LEFS scores and HADS were also similar between groups at 24 weeks. Patient satisfaction, particularly regarding ease of use and communication with nurses, was significantly higher in the digital group. Per-protocol analysis confirmed these findings.ConclusionsThe nurse-led digital care program did not reduce postoperative complications by 24 weeks. It was associated with modest improvements in pain and function at 4 and 12 weeks, with no sustained differences at 24 weeks. Patient satisfaction favored the digital care program. As a single centre trial among smartphone users, these findings should be interpreted as preliminary evidence of acceptability in this specific clinical context. Multicenter evaluation across diverse settings and patient populations is needed before broader implementation can be considered.

Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a highly complex procedure involving intensive conditioning regimens, immunosuppressive therapy and extensive supportive care. To assess the impact of a comprehensive pharmaceutical care programme on medication adherence in allo-HSCT patients. Early survival and clinical and patient-reported outcomes will also be explored. Prospective interventional study with a historical control group. The primary outcome is medication adherence. Secondary outcomes will include the incidence of grade I-IV acute graft-versus-host disease (aGVHD); acute graft-versus-host disease-free, relapse-free survival (aGRFS); relapse-free survival (RFS) and overall survival (OS) by day+100; hospital readmissions; acute renal and liver failure; engraftment time; drug-related problems (DRPs); pharmaceutical interventions and patient-reported outcomes. Patients will be enrolled over a 12-month period in the intervention group and compared with a historical cohort of patients undergoing allo-HSCT. The intervention will include a structured pharmacist-led programme including: (1) a pre-admission interview, (2) in-hospital follow-up with daily medication review and DRP identification, (3) patient education at discharge and (4) post-transplant pharmaceutical follow-up to day+100. The study protocol was approved by the hospital Clinical Research Ethics Committee (CEIm code: 245/23). Written informed consent will be obtained from all participants. Data will be handled in accordance with the EU General Data Protection Regulation (2016/679) and Spanish Organic Law 3/2018 on Data Protection and Digital Rights.

The impact of inclusion in a palliative care program for patients with advanced dementia.

Patients with colorectal cancer undergoing enterostomy often encounter complex physical, psychological, and social challenges after discharge. Effective continuity of care is essential to support postoperative recovery and long-term adaptation. However, existing care programs frequently lack a comprehensive and theoretically grounded framework. Guided by Heider's balance theory, this study developed a continuity of care program for postoperative enterostomy patients with colorectal cancer, thereby providing a reference for clinical nursing practice. A comprehensive search of domestic and international databases, guideline networks, and professional association websites was conducted to identify publicly available clinical practice guidelines, evidence summaries, and systematic reviews related to postoperative enterostomy care in patients with colorectal cancer. Two reviewers independently performed literature screening, quality appraisal, and data extraction, followed by cross-verification to develop a preliminary program draft. Using Heider's balance theory as the conceptual framework, a preliminary continuity of care program was formulated through evidence synthesis and qualitative analysis, and subsequently refined through a two-round Delphi expert consultation process. A total of 512 records were initially identified, and seven high-quality articles were ultimately included after screening and quality appraisal. A preliminary continuity of care program was developed through evidence synthesis and refined using a two-round Delphi expert consultation. In each round, 20 questionnaires were distributed and all were returned, yielding response rates of 100.0%. Fourteen experts provided comments in the first round, and six provided additional feedback in the second round. The expert authority coefficients were 0.805 and 0.809, respectively, while Kendall's W coefficients were 0.162 and 0.163, both statistically significant. After iterative revision, the final program consisted of 4 first-level indicators, 10 second-level indicators, and 24 third-level indicators. This study developed a theoretically grounded and expert consensus-based continuity of care program for postoperative enterostomy patients with colorectal cancer. The program may serve as a reference for clinical nursing practice, as well as for feasibility studies and intervention research.

Background: Best-evidence recommendations guide the non-pharmacological management of patients diagnosed with hand osteoarthritis (OA) to manage function, quality of life, and pain based on the European League Against Rheumatism (EULAR) in their updated guidelines and recommendations. The current management approaches and use of these recommendations by occupational therapists and physiotherapists in South Africa for this condition have not yet been investigated. This study investigated the knowledge, patient load, and management practices used by occupational therapists and physiotherapists in South Africa, for individuals diagnosed with hand OA. Methods: This quantitative, cross-sectional study, included 34 postgraduate occupational therapists and physiotherapists in public and private sectors in South Africa. Participants completed the questionnaire after providing informed consent on the first question of a Research Electronic Data Capture (REDCap) questionnaire. The questionnaire data were exported to Excel and analysed using descriptive statistics in STATA. Results: Participants included 19 occupational therapists and 15 physiotherapists, 31 of whom were females. More occupational therapists obtained education in hand rehabilitation from accredited continuing education courses and reported more referrals and a higher patient load. Both occupational therapists and physiotherapists followed EULAR guidelines with a high percentage of occupational therapists providing intervention using splinting, activity modification, grip adjustment in activities of daily living, and exercise. Physiotherapists managed hand OA with exercise, pain education and joint mobilisations. Both professions provide education and home care programmes for patients with hand OA. Assessments for quality of life, and standardised outcome measures were infrequently used with limited referral of patients to a varied multidisciplinary team. Conclusion: Best-evidence practice for hand OA according to international EULAR guidelines and recommendations were implemented by a higher percentage of occupational therapists. Implications for practice: Best-evidence hand OA management recommendations are advocated and implemented by occupational therapists and physiotherapists in South Africa but further research on context specific intervention is required. Standardised hand function and quality of life assessments should be included in management approaches. Interdisciplinary practices, where the strengths of both occupational therapists and physiotherapists are highlighted, benefit individuals diagnosed with hand OA

Introduction: Individuals undergoing haemodialysis face multiple physical and emotional demands that may increase perceived stress. Coping strategies influence how patients manage this experience and may affect their adaptation to treatment.Objective: To analyse the relationship between perceived stress and coping strategies in individuals undergoing haemodialysis at a health centre in Santiago, Chile.Material and Method: A quantitative, cross-sectional study with a correlational-explanatory design was conducted with 68 participants during 2025. The Perceived Stress Scale (PSS-10) and the Coping Strategies Inventory (CSI-SF) were administered. Descriptive analyses, independent-samples t tests, and a multiple linear regression model were performed.Results: Most participants exhibited moderate levels of perceived stress (80.8%, n=55). In the multiple linear regression model, emotion-focused engagement was negatively associated with perceived stress (ß=−0.24, P=0.048), whereas emotion-focused disengagement was positively associated with stress (ß=0.46, P&lt;0.001). The final model explained 28.1% of the variance in perceived stress.Conclusion: The way individuals regulate their emotional experience is a relevant factor in stress associated with haemodialysis. These findings highlight the need to integrate psychosocial support and emotional regulation strategies into care programmes for patients with chronic kidney disease.

Medication-assisted treatment (MAT) is associated with low maternal weight gain, and low maternal weight gain is associated with infant mortality. Many MAT patients also are smokers. This study investigates buprenorphine administration during pregnancy as a possible independent risk factor for low maternal weight gain. To our knowledge, this is the first study that compares pregnant buprenorphine patients with both smoking and nonsmoking pregnant control groups. Our institution offers a combined MAT and prenatal care program for pregnant patients with opioid use disorder. With institutional review board approval, we retrospectively studied four groups of pregnant patients: very-low-dose (University) MAT, 83 patients; standard dose (community) MAT, 77 patients; smokers not taking MAT, 75 patients; and nonsmokers also not taking MAT, 167 patients. Informed consent was waived by the institutional review board, and standard methods were employed to maintain confidentiality. Exclusion criteria were body mass index greater than 30 at onset of care or inability to document body mass index, preterm delivery, incomplete data, intrauterine fetal demise or fetal anomaly, late prenatal care, polysubstance use, and maternal medical comorbidities. An analysis of variance of 402 patients showed that women using buprenorphine gained less weight than women not using buprenorphine (P = 0.021). Although the very-low-dose group gained more weight (average 24.92 lb) compared with the standard-dose group (average 21.34 lb), the difference was not significant. The difference between the very-low-dose buprenorphine group and the nonsmoking, nonbuprenorphine group, as well as between the standard-dose buprenorphine group and the nonsmoking, non-buprenorphine group also were statistically significant. Buprenorphine MAT may be an independent risk factor for decreased maternal weight gain. Given this association of maternal MAT with low birth weight, further research could explore potential advantages of nutritional supplementation for pregnant patients undergoing MAT at risk for the delivery of low-birth-weight infants.

Longitudinal care program for families and patients with surgical malformations in a NIDCAP Training Center

The purpose of our study was to investigate the relationship between patient handling techniques and the incidence of patient-inflicted injury to veterinary staff. Furthermore, we aimed to characterize hospitals' postinjury care protocols. This cross-sectional study was conducted on convenience sample data of small animal general practices in the US and Canada, collected via an online survey. The survey was distributed between October and November 2023. Practices located outside of the US and Canada and those not identified as primary care or general small animal practices were excluded. There were 113 survey responses that met the inclusion criteria. Injury rates were lower in practices where 100% of veterinary staff were certified in some type of stress-reducing care method or program. Practices with < 100% of employees certified were 3.5 times (95% CI, 1.2 to 10.4) more likely to have injuries once a month or more compared to practices with 100% certification. It is possible that training in stress-reducing animal care could make veterinary workplaces safer. Given the burnout and staff retention issues veterinary medicine is facing, as well as the cost of workers' compensation insurance, this study's findings could provide valuable information for veterinary employers. Stress-reducing patient care programs that allow all members of the veterinary staff or the practice as a whole to become certified can lead to a reduction in occupational injury associated with animal handling.

The implementation of community service programs during the COVID-19 pandemic has posed significant challenges, especially for students participating in the University Community Engagement Program or Kuliah Kerja Nyata (KKN). Social restrictions and health protocols limited students' ability to engage in conventional fieldwork activities. This article aimed to describe the design and impact of the KKN Propepsa (Program Peduli dan Pendampingan Pasien Isolasi Mandiri Covid-19) initiated by the Faculty of Medicine, Universitas Muhammadiyah Surabaya (UMS) as a responsive model during the pandemic. The study used a descriptive-participatory method involving activity documentation, observation, and reflection. Data were collected from activity logs, reports, and direct involvement of students and mentors. The program involved multiple forms of engagement, including daily teleconsultation and monitoring of self-isolated COVID-19 patients, dissemination of educational content via social media, religious motivation and psychological support, organizing public webinars, and distribution of basic necessities through social fundraising. The program was conducted in July–August 2020, reaching dozens of patients and families across Surabaya. The results indicated that the KKN Propepsa significantly benefited the target community, particularly by reducing anxiety among patients in isolation and enhancing public awareness regarding COVID-19 symptoms and home management. Students also developed practical competencies, empathy, and digital communication skills while supporting public health services overwhelmed by case surges. In conclusion, KKN Propepsa demonstrates that medical student-led community service can adapt effectively under crisis conditions, providing not only educational impact but also meaningful social contributions. The model can serve as a reference for similar programs during health emergencies.

Despite the increasing recognition of palliative care in the management of heart failure (HF), many patients continue to experience unmet care needs due to the delayed integration of supportive services. Identifying these needs is crucial for enhancing patient-centered care and informing healthcare policies. This qualitative study aimed to explore the palliative care needs of patients with HF. This qualitative study employed a directed content analysis approach. Semi-structured in-depth interviews were conducted with 22 adult patients with heart failure in Ahvaz, Iran. Data collection continued until saturation, ensuring no new themes emerged. To ensure the trustworthiness of the findings, Lincoln and Guba's criteria were used. A total of 22 adult patients with heart failure participated in the study, with a mean age of 58.45±18.07 years. Data analysis revealed eight main categories of needs, including 'care structures and processes', 'physical aspects', 'psychological aspects', 'social aspects', 'cultural aspects', 'end-of-life care', 'ethical and legal aspects' and 'spiritual and existential aspects' with 30 subcategories. This study highlights the urgent need for early and thorough palliative care in heart failure management. By meeting patients' diverse needs with team-based, patient-focused methods, we can enhance quality of life, manage symptoms better and reduce healthcare challenges. These results are important for clinical practices and policies, supporting the creation of specialised palliative care programmes for heart failure patients.

Impact of an integrated transitional care programme for older patients with multimorbidity and repeated emergency department visits.

ABSTRACTObjectiveTo develop and assess the efficacy of a rehabilitation–cognition integrated care (RCIC) program for elderly patients with lower limb fractures and mild‐to‐moderate cognitive impairment.MethodsA total of 128 eligible patients during January 2023 to December 2024 were randomly allocated to conventional (n = 64) or integrated care group (n = 64). Both groups received 12 weeks of intervention. Outcomes, including Fugl‐Meyer Assessment (FMA), Berg Balance Scale (BBS), Montreal Cognitive Assessment (MoCA), Functional Independence Measure (FIM), and Hospital Anxiety and Depression Scale (HADS) scores, were compared. Serum neurotrophic and neuroinflammatory markers were analyzed pre‐ and post‐intervention. Complications, fall recurrence rates, and nursing satisfaction were recorded.ResultsPost‐intervention, both groups showed improved FMA, BBS, and FIM scores, with significantly greater improvement in the integrated care group (p < 0.05). HADS‐Anxiety (HADS‐A) and HADS‐Depression (HADS‐D) scores decreased significantly more in the integrated care group (p < 0.05). The integrated care group demonstrated higher MoCA scores versus both its own baseline and the conventional care group post‐intervention (p < 0.05). Serum BDNF and GDNF levels increased significantly in the integrated care group compared to both time‐matched controls and its baseline (p < 0.05), while S100‐β and IL‐6 levels decreased significantly (p < 0.05). The integrated care group had lower overall complication rates (p < 0.05), comparable fall recurrence (p > 0.05), and higher nursing satisfaction (p < 0.05).ConclusionThe RCIC program significantly enhances motor function, balance, cognition, and psychological status while reducing complications and improving satisfaction in elderly fracture patients with cognitive impairment.

Chronic and complex wounds are serious public health problems worldwide. Given the time-consuming nature of chronic wound healing and the need for long-term follow-up, a virtual care approach can effectively manage these patients. Identifying the care needs of patients with chronic wounds is key to successfully managing their care remotely. This study aimed to identify the care needs of patients with chronic wounds for implementing a virtual care program to manage this group of patients remotely. This descriptive qualitative study was conducted using a conventional content analysis approach in wound care clinics of East Azerbaijan Province (northwestern Iran). Data were collected through six focus group discussions with wound therapists and six semi-structured individual interviews with patients with chronic wounds. Participants were recruited using purposive sampling. The data were analyzed by MAXQDA 10 software. After analyzing the data, the most important care needs of patients with chronic wounds for implementing a virtual care program were identified into three main categories, including the need for awareness-raising, needs related to health dimensions, and the need for specialized financial support (insurance). The findings of this study indicated that the successful implementation of a virtual care program for patients with chronic wounds requires addressing three core needs: enhancing patients' awareness regarding wound management, attending to their physical, emotional, and social health dimensions, and providing financial support through insurance coverage for wound care services. Addressing these needs can significantly improve the quality of care and therapeutic outcomes for patients in a virtual care setting.

IntroductionChronic and complex wounds are serious public health problems worldwide. Given the time-consuming nature of chronic wound healing and the need for long-term follow-up, a virtual care approach can effectively manage these patients. Identifying the care needs of patients with chronic wounds is key to successfully managing their care remotely. This study aimed to identify the care needs of patients with chronic wounds for implementing a virtual care program to manage this group of patients remotely.MethodsThis descriptive qualitative study was conducted using a conventional content analysis approach in wound care clinics of East Azerbaijan Province (northwestern Iran). Data were collected through six focus group discussions with wound therapists and six semi-structured individual interviews with patients with chronic wounds. Participants were recruited using purposive sampling. The data were analyzed by MAXQDA 10 software.ResultsAfter analyzing the data, the most important care needs of patients with chronic wounds for implementing a virtual care program were identified into three main categories, including the need for awareness-raising, needs related to health dimensions, and the need for specialized financial support (insurance).ConclusionThe findings of this study indicated that the successful implementation of a virtual care program for patients with chronic wounds requires addressing three core needs: enhancing patients’ awareness regarding wound management, attending to their physical, emotional, and social health dimensions, and providing financial support through insurance coverage for wound care services. Addressing these needs can significantly improve the quality of care and therapeutic outcomes for patients in a virtual care setting.

Background: Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast disease with poorly understood etiology. Current wound management lacks standardized protocols, highlighting the need for evidence synthesis to inform clinical decision-making.Objectives: To comprehensively search the relevant literature on wound treatment and nursing in patients with granulomatous lobular mastitis at home and abroad, to sort out and analyze the included literature, and to extract, sort out and integrate the items of wound-related interventions, so as to provide a framework and basis for the construction of breast wound care programs for patients with granulomatous lobular mastitis.Methods: We conducted a systematic review following the 6S evidence pyramid model (Jan 2023 version). Twelve databases were searched from inception to January 2025, including: BMJ Best Practice, Up to Date, The Journal of the American Medical Association (JAMA), Scottish Intercollegiate Guidelines Network (SIGN), CNKI, Wan fang, CBM. Inclusion criteria covered clinical studies and guidelines addressing GLM wound care. Two reviewers independently performed quality assessment using AMSTAR-2 (for reviews) and JBI tools (for primary studies), with evidence graded (Level 1-5) and recommendations categorized (Grade A/B).Results: From 1,333 screened records, 19 studies met inclusion criteria:3 systematic reviews,3 consensus guidelines,6 RCTs,6 quasi-experimental studies,1 cohort study. Key findings were synthesized into 38 evidence statements across four domains: Assessment (8 items): Recommended use of GMDAI for inflammatory activity monitoring, Wound care (20 items): Strong evidence (Grade A) for TCM patching in chronic phases. Education (5 items): Structured self-care programs reduced recurrence by 30%. Follow-up (5 items): Combined digital and clinic follow-ups improved compliance.Conclusion: This study summarized the evidence of wound care for GLM patients through evidence-based nursing methods, and provided evidence support for the clinical formulation of breast wound care programs for GLM patients. Healthcare professionals can apply evidence to the clinic based on the clinical context to improve breast wounds and quality of life.

Background/Objectives: Evidence on the optimal components and effectiveness of care programs for patients with multimorbidity is limited. This study aimed to evaluate the impact of a structured interdisciplinary program on the incidence of emergency visits, hospitalizations, and avoidable outpatient consultations following an admission or emergency visit. Methods: This retrospective observational study included 200 patients enrolled in the Multimorbidity Care Program at Hospital Universitario Infanta Cristina. Event rates were compared during the year before and after program inclusion. Multiple-event survival analysis was performed using the counting process method. Results: After program inclusion, patients showed a significant reduction in emergency visits (HR 0.74, 95% CI 0.60-0.92, p = 0.006), in conventional hospitalizations (HR 0.54, 95% CI 0.44-0.68, p = 0.001), and in avoidable outpatient visits (HR 0.66, 95% CI 0.51-0.86, p = 0.005). Conclusions: An interdisciplinary care model for patients over 65 with multimorbidity, integrating comprehensive multidimensional assessment, structured patient education, early management of decompensations in a day hospital, and systematic medication review, significantly reduces healthcare utilization. These findings support implementing integrated care programs for complex patients, though multicenter studies and cost-effectiveness analyses are needed to confirm generalizability and sustainability.