Patient Care System Research Articles

The increasing use of minimally invasive surgery in acute general surgical conditions: A decade of results from a national data set

BackgroundTo assess the rate of uptake of acute laparoscopic surgery for common general surgical conditions using national-level data. MethodsThe use of laparoscopic surgery in the acute management of appendicitis, cholecystitis, adhesive small bowel obstruction, and inguinal hernias was assessed between 2013 and 2022 at a national level in New Zealand. ResultsLaparoscopic appendicectomy increased from 83% to 95% (P = .0002). Laparoscopic cholecystectomy increased from 94% to 96% (P = .001). Laparoscopic adhesiolysis increased from 42% to 60% (P = .001). Laparoscopic inguinal hernia repair increased from 3% to 18% (P = .004). The rate of laparoscopic conversion demonstrated a decrease for appendicectomy (1.9% to 0.24%), cholecystectomy (0.77% to 0.39%), and adhesiolysis (9% to 2.4%) across this time. The laparoscopic cohorts were all associated with a shorter and less expensive length of stay compared to the open cohort. Māori and Pacific Island patients had largely equitable or superior rates of laparoscopic use compared to the rest of the population. No changes in laparoscopic use were detected during the COVID-19 pandemic. Rates of laparoscopic cholecystectomy and appendicectomy are similar throughout the regions. The largest difference in rates detected was for adhesiolysis, which was more common in the northern region. ConclusionThere has been a statistically significant rise in the use of acute laparoscopic surgery for acute general surgical procedures. This rise is likely clinically and economically significant, particularly in appendicectomy and adhesiolysis, with rises of 12% and 17% across the 10 years, with the known associated patient and health care system benefits.

New Insights Into Systemic Drivers of Inflammation and Their Contributions to the Pathophysiology of Acne.

Acne Vulgaris (AV) is a prominent skin disease commonly affecting teenagers. It often persists into adulthood and is associated with adverse physical and psychosocial impacts. The pathophysiology of AV is conventionally correlated with 4 factors within and around the pilosebaceous unit: increased sebum production, follicular hyperkeratinization, Cutibacterium acnes proliferation, and localized immune responses. As such, conventional therapeutic approaches for AV have primarily focused on these factors. In addition to this primarily localized pathophysiology, there is a progressively emerging body of evidence indicating that underlying systemic factors contributing to a generalized immuno-inflammatory response can contribute to or exacerbate AV. In this article, we introduce and provide the supporting data, for 6 patient-centric systems that may be implicated in the development of AV: psycho-emotional stress, diet and metabolism, dysbiosis of the gut and skin microbiome, hormonal fluctuations, oxidative stress, and immune response. Identifying these pathways and their contributions in a patient-centric approach may provide expanded therapeutic opportunities for treating patients with AV. J Drugs Dermatol. 2024;23(2):90-96.   doi:10.36849/JDD.8137.

Problems in organizing neurosurgical care for patients with Parkinson's disease in the Russian Federation

Currently, there are some problems in the Russian Federation complicating development of neurosurgical care for patients with Parkinson's disease (PD). In 2022, neurologists - movement disorders specialists were surveyed to analyze situation with PD pharmacological treatment and referral of patients for surgical treatment in Russian constituent entities. Data on neurosurgical treatment of PD were obtained by collecting information on the surgical activity of medical institutions in the Russian Federation. Most hospitals involved in PD treatment took part in this study. The state of neurosurgical care for patients with PD is analyzed and possible ways to improve the quality of treatment are discussed. Over the past 20 years, a system of neurosurgical care for patients with PD has been formed in 14 centers in the Russian Federation (2022). Obstacles to its further development can be divided into 3 categories: problems of patient selection and routing, complexity of organization and financing surgeries, and imperfect postoperative patient management. Ways to overcome these obstacles imply expanding the network of centers for extrapyramidal diseases, development of domestic neurostimulation systems, improving the distribution of quotas taking into account the capabilities of hospitals, specialized training of neurologists for extrapyramidal centers and neurosurgeons for deep brain stimulation centers, adequate financing and systematization of postoperative management of patients with PD.

Current Pediatric Endoscopy Training Situation in the Asia-Pacific Region: A Collaborative Survey by the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition Endoscopy Scientific Subcommittee.

To date, there is no region-specific guideline for pediatric endoscopy training. This study aimed to illustrate the current status of pediatric endoscopy training in Asia-Pacific region and identify opportunities for improvement. A cross-sectional survey, using a standardized electronic questionnaire, was conducted among medical schools in the Asia-Pacific region in January 2024. A total of 57 medical centers in 12 countries offering formal Pediatric Gastroenterology training programs participated in this regional survey. More than 75% of the centers had an average case load of <10 cases per week for both diagnostic and therapeutic endoscopies. Only 36% of the study programs employed competency-based outcomes for program development, whereas nearly half (48%) used volume-based curricula. Foreign body retrieval, polypectomy, percutaneous endoscopic gastrostomy, and esophageal variceal hemostasis, that is, sclerotherapy or band ligation (endoscopic variceal sclerotherapy and endoscopic variceal ligation), comprised the top four priorities that the trainees should acquire in the autonomous stage (unconscious) of competence. Regarding the learning environment, only 31.5% provided formal hands-on workshops/simulation training. The direct observation of procedural skills was the most commonly used assessment method. The application of a quality assurance (QA) system in both educational and patient care (Pediatric Endoscopy Quality Improvement Network) aspects was present in only 28% and 17% of the centers, respectively. Compared with Western academic societies, the limited availability of cases remains a major concern. To close this gap, simulation and adult endoscopy training are essential. The implementation of reliable and valid assessment tools and QA systems can lead to significant development in future programs.

The learning experiences of senior residents in laparoscopic gynecological surgeries: A quality study

Abstract Background: Laparoscopic operations have increased in acceptance over the years owing to their established advantages over conventional open procedures, ranging from superior diagnostic to therapeutic outcomes. Significant advances in surgical training, equipment development, imaging, and surgical procedures have made laparoscopic surgery safe and feasible in a variety of medical specialties. Materials and Methods: We aimed to qualitatively evaluate the learning experiences of senior residents in laparoscopic gynecological surgeries. The study is a qualitative descriptive study conducted in a tertiary care institution. It included senior residents undergoing training in laparoscopic gynecological surgery. Their learning experiences were qualitatively evaluated at the end of their 3-year residency. Six residents responded to questionnaires. Results: The experience of learning a new system from its beginning motivated residents to push themselves against all difficulties, work as a team, and pumped them with confidence when their mentors held back in encouragement and support. There is a requirement for an upgraded infrastructure to sustain consistent and skilled training that would aid in encouraging training experience at hospitals across the country. Patient management, strenuous surgeries, and complications affect residents’ physical and psychological well-being, making them vulnerable. The system must also collaborate with residents and doctors at work to create a positive environment not only for patients but also for their residents. Conclusion: Improving the residents’ learning experiences through effective uniform training and a healthier working environment will result in better patient care outcomes and system performance.

Leading from the bottom: The clinical leaders roles in an HIV primary care facility in Eldoret, Kenya.

Clinical leaders in health systems play critical roles in making decisions that impact patient care and health system performance. Current literature has focused on the importance of clinical leaders' roles in healthcare settings and has not addressed the leadership aspect that clinical leaders engage in day-to-day decision-making in HIV facilities while providing HIV patient care. Therefore, identifying the leadership roles that wclinical leaders perform at HIV primary facilities is of critical importance. The study explored the views of healthcare providers working in AMPATH-MTRH HIV facility on what they perceived as the roles of clinical leaders at the HIV primary care facility. We conducted a qualitative exploratory study between December 2019 to May 2020, involving in-depth interviews with (n = 22) healthcare providers working in AMPATH-MTRH HIV facility, who were purposively and conveniently sampled to participate in in-depth interviews to explore perceptions regarding the leadership roles of clinical leaders. The collected data were analyzed thematically and Nvivo vs.12 software was used for data management. The following themes were identified from the analysis regarding perceived clinical leaders' roles in an HIV primary care facility: 1) Strategic roles: providing direction and guidance, ensuring goals and objectives of the department are achieved within the set timelines, planning, and budgeting for adequate resources to support patient HIV care 2) Interconnecting health systems levels and supervisory oversight roles: a link between management, staff, and patients, solving problems, organizing and attending departmental meetings, facilitate staff training, accountable, collaborating with other departments and leaders, defines and assigns responsibilities, ensure quality patient service, coordination, and management of daily activities 3) Research roles: data collation, analysis, generation, review and reporting to the management. Clinical leaders in the HIV care system perform leadership roles that are characterized by strategic, middle-level, supervisorial and research which reflects the model of the leadership and management style of the HIV care system. The understanding of these roles contributes valuable insights to HIV leaders and managers to recognize the important contribution of clinical leaders and consider reviewing Standard Operating Procedures to include these leadership roles and strengthen their capacity to maximize clinicians' contribution to improve HIV care and enhance responsive health systems.

Стратегии новых моделей медицинских организаций в системе первичной медико-санитарной помощи.

At present, primary health care is improved by the new models of organisation’s work. All elements of the transformational change process are based on a patient-centered system of medical care that is sustainable in the long term. The urgent problem for outpatient clinics to become improve effectively using a patient-centered approach. The aim of this study was to describe the strategies on patient-centred outcomes used in primary care in Russian regions. Materials and methods. A systematic literature review was conducted in Google Scholar and Elibrary databases using keywords. According to the inclusion criteria, the studies described the experience of implementing new strategies in the Russian primary health care system between 2017 and 2023, resulted in a total of 2874 articles being found. After reviewing the abstracts of the retrieved articles, 211 were retained for further analysis. Another 175 articles were excluded after reading the full text. Results. In this article, we describe a set of priorities strategies related with a new models in primary health care: expanded role of nurses in primary health care, improvement of Ambulatory complementary technologies, use of new organizational structures of medical care, using remote technologies. Findings. The strategies of new organizational models in primary health care are based on the successful experience of reforms. Factors affecting the expansion of strategies to other health care organizations include: teamwork of medical and non-medical professionals, low level of interprofessional collaboration to ensure effective implementation and delivery of patient-centered care, lack of incentives to improve the Ambulatory complementary technologies, patient routing problem for primary health care services, systematization of experience of telemedicine technologies in outpatient practice.

Reducing the hospitalization epidemic of chronic heart failure by disease management programs.

Chronic heart failure is the most common cause of hospitalization in Europe and rates are steadily increasing due to aging of the population. Hospitalization identifies a fundamental change in the natural history of heart failure (HF) increasing the risk of re-hospitalization and mortality. Heart failure management programs improve the quality of care for HF patients and reduce hospitalization burden. The goals of the heart failure management programs include optimization of drug therapy, patient education, early recognition of signs of decompensation, and management of comorbidities. Randomized clinical trials evidenced that system of care for heart failure patients improved adherence to treatment and reduced unplanned re-admissions to hospital. Multidisciplinary programs and home-visiting have shown improved efficacy with reductions in HF and all-cause hospitalizations and mortality. Community HF clinics should take care of the management of stable patients in strict contact with primary care, while hospital out-patients clinics should care of patients with severe disease or persistent clinical instability, candidates to advanced treatment options. In any case a holistic, patient-centered approach is suggested, to optimize care considering the needs of the individual patient. Telemonitoring is a new opportunity for HF patients, because it allows the continuity of care at home. All heart failure patients should require follow-up in a specific management program, but most of date come from clinical trials that included high-risk patients. While clinical trials have a specified duration (from months to some years), lifelong follow-up is recommended with differentiated approaches according to the patient's need.

REGULATION OF E-COMMERCE OF MEDICINES IN UKRAINE: LEGAL AND ACCOUNTING ASPECTS

The availability of medicines, their quality, efficacy and safety in Ukraine are recognized as the COVID-19 pandemic and Russian armed aggression, the provision of medicines to the population and increasing their availability in Ukraine are becoming integral components of the state healthcare policy aimed at creating a patient-centered system, as implemented in developed European countries. E-commerce of medicines has become one of the new activities of pharmacies. As Ukraine has a large medical market and rapid digital development, e-pharmacies are becoming increasingly accessible and popular among customers. Electronic commerce in medicines (e-pharmacy) is a pharmacy that fulfills a consumer's order placed via the Internet. Despite the obvious convenience, strict regulation of activities and sufficient legislative basis, the procedural stages of selling medicines remotely remain unregulated. The main advantages of e-commerce of medicinal products in Ukraine include convenience and accessibility, a wide range of products, nationwide delivery, and expert advice. At the same time, the organizational and legal regulation of electronic trade in medicinal products in Ukraine does not regulate all the specifics of such trade, which could potentially threaten public health and safety. Further regulation is required for the delivery of prescription medicines; quality assurance of medicines; protection of the end user from violation of the rules for the sale and delivery of medicines, as well as from counterfeit and fake medicines; regulation of the issue of bringing a person to legal liability for violation of the rules for the sale and delivery of medicines; regulation of the issue of peculiarities of the use of payment transaction registers during the delivery of medicines.

“They just looked at me like I was human”: The experiences of parenting women and providers with substance use disorder treatment

BackgroundThe current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program. Design and methodsThe study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC). ResultsWe conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal). ConclusionThis research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.

Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study.

Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems.

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) Survey: Perspectives of Physicians in Gulf Cooperation Council Countries on Sickle Cell Disease

Introduction: Sickle cell disease (SCD) is a genetic disorder that adversely impacts patients' physical and emotional well-being, yet research on the impact of SCD on quality of life is limited. The prevalence of SCD across Gulf Cooperation Council (GCC) countries ranges 0.24-5.8% (Abu-Shaheen et al. Expert Rev Hematol 2022). The Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) survey aimed to broaden understanding of the global burden of SCD. This analysis reports the experiences of physicians in GCC countries treating patients with SCD who participated in the SHAPE survey within the context of insights obtained globally. Methods: Physicians from Brazil, Canada, France, Germany, the UK, the US, and 2 countries in the GCC (Saudi Arabia and the United Arab Emirates [UAE]) completed a 12-minute online survey comprising close-ended questions about their experiences of treating patients with SCD. Physicians practicing for 3-35 years and currently caring for ≥10 patients with SCD were eligible. Results:Of 219 physicians globally who responded, 30 (13.7%; Saudi Arabia and the UAE, n=15 each) were from GCC countries. Physicians in GCC countries on average were caring for 16 patients with SCD and had 16 years of experience treating patients with SCD. The most common symptoms of SCD reported to physicians in GCC countries were bone aches (95%) in patients aged ≤11 years, fatigue/tiredness and bone aches (92% each) in patients aged 12-17 years, and bone aches (100%) in patients aged ≥18 years. Bone aches and yellow eyes/skin/nails were symptoms reported by a significantly higher proportion of patients in all age groups to physicians in GCC countries than all surveyed physicians (Figure 1). Most physicians agreed early treatment of SCD can help with managing/preventing severe symptoms (80% in GCC countries vs 87% globally) and that treating hemolytic anemia can improve most aspects of SCD including, reducing end-organ damage (87% vs 84%). A significantly greater proportion of physicians in GCC countries, compared with all surveyed physicians, reported they were confident in their knowledge of the consequences of hemolytic anemia (93% vs 50%), and they were significantly more likely to attribute the development of SCD complications such as chronic anemia, kidney damage, and blood clots to hemolytic anemia (Figure 2). A significantly greater proportion of physicians in GCC countries, compared with all surveyed physicians, agreed end-organ damage is unavoidable (87% vs 59%), and they were reluctant to discuss the potential future challenges/complications of SCD with a patient or their family (57% vs 37%). Most physicians agreed they were optimistic about future treatments for SCD (73% in GCC countries vs 81% globally). A significantly greater proportion of physicians in GCC countries reported considering the cost/benefit ratio to the patient and/or health care system before recommending a treatment compared with all surveyed physicians (87% vs 64%). Physicians in GCC countries, compared with all surveyed physicians, reported a significantly smaller proportion of patients were treated with hydroxyurea (24% vs 43%) and opioids (10% vs 29%). The top concerns physicians in GCC countries had were their patients not understanding the long-term effects/progression of SCD (47%), only seeking treatment/care when experiencing crises (47%), and lack of community support for patients (40%). Physicians reported wanting more support to educate their patients about the long-term effects of SCD (93% in GCC countries vs 83% globally). Conclusions: Physicians in GCC countries identified the symptom(s) most frequently reported by patients aged ≤11 years and ≥18 years as bone aches, and by patients aged 12-17 years as bone aches and fatigue/tiredness. Most physicians in GCC countries agreed end-organ damage is unavoidable, but over half were reluctant to discuss the potential future complications of SCD with patients and their families. Findings from the SHAPE survey underline the need for treatments that target specific SCD symptoms and delay end-organ damage, as well as the need of physicians in GCC countries for greater support when treating patients with SCD.

Quality Control in Primary Healthcare in Saudi Arabia: A Systematic Review

Introduction: The quality of primary healthcare is crucial for ensuring efficient and effective patient care, particularly in rapidly evolving healthcare systems like that of Saudi Arabia. With ongoing reforms aimed at improving healthcare delivery, there is a pressing need to assess the state of quality control within primary healthcare settings. This systematic review aimed to evaluate the effectiveness of various quality control interventions implemented in primary healthcare centers in Saudi Arabia, focusing on their impact on patient care and system efficiency. Methods: The review strictly included interventional studies and clinical trials published in the last years up to 2022, employing a comprehensive search across multiple databases including PubMed, Scopus, Web of Science, and the Cochrane Library. Inclusion criteria were set to consider only studies that directly addressed quality control measures within primary healthcare settings in Saudi Arabia, with clear intervention and outcome measures. The analysis synthesized data on the types of interventions, sample sizes, and effectiveness, including risk ratios and percentage improvements with their confidence intervals. Results: Seven studies were included, revealing a range of interventions from EHR implementations to provider training programs and patient feedback systems. Key findings include a 55% reduction in medication errors following EHR system implementation, a 35% increase in compliance with national quality standards post-provider training, a 20% increase in patient satisfaction with the introduction of patient feedback systems, and a 30% improvement in patient outcomes from clinical guideline updates for chronic disease management. Conclusions: The review demonstrates that targeted interventions can significantly enhance quality control in primary healthcare settings in Saudi Arabia, with notable improvements in medication accuracy, compliance with quality standards, patient satisfaction, and clinical outcomes. These findings highlight the potential of comprehensive, integrated quality control measures to advance patient care and healthcare system efficiency.

Real-world experience with Deutetrabenazine management in patients with Huntington's disease using video-based telemedicine.

Huntington's disease (HD) is a rare progressive neurological disorder, and telemedicine has the potential to improve the quality of care for patients with HD. Deutetrabenazine (DTBZ) can reduce chorea symptoms in HD; however, there is limited experience with this medication in Asian countries. Retrospective and prospective studies were employed to explore the feasibility and reliability of a video-based telemedicine system for HD patient care. Reliability was demonstrated through consistency between selected-item scores (SIS) and total motor scores (TMS) and the agreement of scores obtained from hospital and home videos. Finally, a single-centre real-world DTBZ management study was conducted based on the telemedicine system to explore the efficacy of DTBZ in patients with HD. There were 77 patients included in the retrospective study, and a strong correlation was found between SIS and TMS (r = 0.911, P < 0.0001), indicating good representativeness. There were 32 patients enrolled in the prospective study. The reliability was further confirmed, indicated by correlations between SIS and TMS (r = 0.964, P < 0.0001) and consistency of SIS derived from the in-person and virtual visits (r = 0.969, P < 0.0001). There were 17 patients included in the DTBZ study with a mean 1.41 (95% confidence interval, 0.37-2.46) improvement in chorea score and reported treatment success. A video-based telemedicine system is a feasible and reliable option for HD patient care. It may also be used for drug management as a supplementary tool for clinical visits.

Navigating Challenges: The Profound Impact of Nursing Shortage on Patient Care and Healthcare Systems

In the wake of a global healthcare crisis, the shortage of nursing professionals has emerged as a pivotal challenge, profoundly affecting patient care and the efficiency of healthcare systems. This article, offers an in-depth analysis of this complex issue. It traces the historical evolution of the nursing shortage, examining its origins and the factors that have contributed to its current state. The paper presents comprehensive data to illustrate the extent of the shortage worldwide, highlighting trends in nursing education and workforce demographics. A significant focus is placed on the impact of this shortage on patient care, including a discussion on patient safety, care quality, and outcomes. The strain on healthcare systems is also scrutinized, with an analysis of the financial and operational implications for healthcare providers. The article explores the varying effects and responses to the nursing shortage across different countries, offering a global perspective. Innovative solutions and strategies are reviewed, showcasing successful interventions and the potential role of technology in addressing the crisis. The article concludes with a future outlook, offering predictions for the nursing workforce and potential shifts in healthcare delivery models. This comprehensive exploration aims to provide insights and foster discussions among healthcare professionals, policymakers, and stakeholders to address and mitigate the impact of the nursing shortage

Prior Daratumumab Exposure and It's Correlation to Parameters Related to Apheresis Prior to Hematopoietic Stem Cell Transplantation in Multiple Myeloma

A number of recent studies have brought to light the potential detrimental effect the biologic monoclonal antibody daratumumab, directed towards CD38, may have on the collection of stem cell collection for hematopoietic stem cell transplantation (HSCT). In our evaluation of this claim, we retrospectively reviewed multiple myeloma patients who underwent autologous HSCT at a major tertiary transplant center between 2017 and 2022. A total of 240 patients were identified which included 62 patients who received daratumumab prior to stem cell collection and 178 patients who had no prior daratumumab exposure. Basic demographic data was collected as well as radiation, chemotherapy, and smoking history. No significant differences were identified between the groups based on demographics, smoking, or radiation exposure. Parameters related to peripheral stem cell collection were identified and recorded. We found that in patients exposed to daratumumab prior to apheresis, the mean number of days of apheresis required to reach the target collection goal was statistically increased compared to control (1.42 days ± 0.07 vs 1.26 ± 0.03; p&amp;lt;0.05). Furthermore, medications used to increase peripheral stem cell collection yield were also increased. It was demonstrated that the mean number of doses of plerixafor and G-CSF analogs were increased in the daratumumab group vs the control (1.08 ± 0.12 vs 0.6 ± 0.05; p&amp;lt;0.001 and 5.98 ± 0.31 vs 5.17 ± 0.06; p &amp;lt;0.001 respectively). Total number of stem cells collected both as an absolute number and controlled for the number of days of apheresis were lower in the daratumumab group compared to the control (5.31x10^6 ± 0.31 vs 6.68x10^6 ± 0.20; p&amp;lt;0.05 and 4.16x10^6 ± 0.32 vs 5.84x10^6 ± 0.21; p &amp;lt; 0.001 respectively). These results suggest that pre-apheresis exposure to daratumumab has a detrimental effect on peripheral stem cell collection. These results have a significant implications for both long term patient care and healthcare system resource utilization. The clinical outcome implications of daratumumab are currently not well known and further study is needed to determine if alterations in stem cell collection protocols would result in improved stem cell collection yields for patients with pre-collection daratumumab exposure. All data is expressed as mean ± SEM

Patient, family, community, and health care system predictors of continuous glucose monitor use.

Patient, family, community, and health care system predictors of continuous glucose monitor use.

Participants' Engagement With and Results From a Web-Based Integrative Population Mental Wellness Program (CHAMindWell) During the COVID-19 Pandemic: Program Evaluation Study.

The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system's patient population. This program evaluation was conducted to explore participants' engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation. We examined participants' symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up. The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants' odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time. CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects.

Interprofessional collaboration to support patient-centered care: literature review

Patient-centered care is the hope of every patient who needs health care to handle their problems immediately, physically, psychologically, socially and culturally. Interprofessional collaboration of active health workers will create comprehensive services to manage and make the right decisions in patient care. This literature review aimed to explore how interprofessional collaboration can create a comprehensive professional service system to support patient-focused care. Nine articles were included in this literature review. Interprofessional collaboration begins by communicating and coordinating with members of the health care provider team, which has been proven to reduce errors and increase satisfaction in providing health services, providing a sense of comfort in interacting. Implementing interprofessional collaboration in a health care system allows all aspects of health care providers to provide complete services to realize a comprehensive and comprehensive health care system for patients. Coordination in services that prioritizes interprofessional collaboration is the creation of synergies in services, clinical decision-making of care and accuracy in handling all patient problems so that services that focus on patient needs are the main goals achieved. Interprofessional collaboration is proven to make patients feel satisfied with the perceived service system, namely holistic and comprehensive services focusing on patients and families

Communication Preferences During Pregnancy Care Among Patients With Primary Spanish Language: A Scoping Review

BackgroundQualified language service providers (QLSPs)—professional interpreters or multilingual clinicians certified to provide care in another language—are critical to ensuring meaningful language access for patients. Designing patient-centered systems for language access could improve quality of pregnancy care. ObjectiveWe synthesized and identified gaps in knowledge about communication preferences during pregnancy care among patients with Spanish primary language. MethodsWe performed a scoping review of original research studies published between 2000 and 2022 that assessed communication preferences in Spanish-speaking populations during pregnancy care. Studies underwent title, abstract, and full-text review by three investigators. Data were extracted for synthesis and thematic analysis. ResultsWe retrieved 1,539 studies. After title/abstract screening, 36 studies underwent full-text review, and 13 of them met inclusion criteria. Two additional studies were included after reference tracing. This yielded a total of 15 studies comprising qualitative (n = 7), quantitative (n = 4), and mixed-methods (n = 4) studies. Three communication preference themes were identified: language access through QLSPs (n = 7); interpersonal dynamics and perceptions of quality of care (n = 9); and information provision and shared decision-making (n = 8). Although seven studies reported a strong patient preference to receive prenatal care from Spanish-speaking clinicians, none of the included studies assessed clinician Spanish language proficiency or QLSP categorization. ConclusionsFew studies have assessed communication preferences during pregnancy care among patients with primary Spanish language. Future studies to improve communication during pregnancy care for patients with primary Spanish language require intentional analysis of their communication preferences, including precision regarding language proficiency among clinicians.