Comprehensive Care Model Research Articles

The predictive power of coping strategies of pediatric oncology patients on their quality of life and their attitudes toward diseases.

Pediatric oncology patients face several physical and psychological challenges that can significantly impact their quality of life (QoL) and attitudes toward their illness. Coping strategies are pivotal in managing the emotional and physical burdens of disease. This study aimed to examine the impact of coping strategies of pediatric oncology patients on their QoL and attitudes towards their illness. The descriptive, correlational, and cross-sectional study was conducted with 112 pediatric oncology patients aged 10-18 years. The Sociodemographic Form, Pediatric Cancer Coping Scale (PCCS), Pediatric Quality of Life Inventory (PedsQL), and Child Attitude Towards Illness Scale (CATIS) were used for data collection. Significant correlations were identified between cognitive coping, defensive coping, and CATIS (p<.001). The PCCS and subdimensions significantly predicted CATIS (p<.001), accounting for 15.3% of the cognitive and defensive coping variation. However, there was no relationship between PCCS total and subdimension scores on PedsQL (p=.534). The PedsQL and subdimensions significantly predicted CATIS (p<.001) and accounted for 27.2% of the variation in physical health summary score, emotional functioning, psychosocial health summary score, and total PedsQL score. The study reveals that cognitive coping strategies positively predict attitudes toward illness, whereas defensive coping strategies have an inverse effect. The study proposes that comprehensive care models in pediatric oncology support effective coping mechanisms and enhance the QoL of those who receive them.

Implementing a multidisciplinary approach for older adults with multiple sclerosis: geriatric neurology in practice

BackgroundOlder adults with multiple sclerosis (MS) face unique challenges arising from age-related changes in MS pathophysiology and overlapping geriatric syndromes. There is a need for geriatrics-focused multidisciplinary care for the rapidly growing older MS population. Objectiveto design and implement a geriatric multidisciplinary clinic for older adults with MS. MethodsWe describe the development of a multidisciplinary approach to geriatric MS care within a single institution through the implementation of the Aging with MS Clinic. The clinic model was conceived through collaboration between neurology and geriatric medicine to provide comprehensive care for older adults with MS who are uniquely affected by overlapping symptoms of aging and MS (e.g., frailty, falls, functional decline, multiple comorbidities, polypharmacy, cognitive impairment, nutritional deficits, barriers to access healthcare). Multidisciplinary specialists were recruited to staff the clinic, and initial patient satisfaction outcomes were collected. ResultsThe team of multidisciplinary specialists staffing the clinic consists of a MS advanced practice practitioner, MS pharmacist, physical therapist, neuropsychologist, dietitian, and social worker. A clinic template was devised where 4 patients with MS over age 60 are seen by each specialist during each a half-day clinic session. Initial patient satisfaction surveys from 25 participants showed overwhelmingly positive feedback. A majority of participants (92%) agreed that the clinic was well-organized, while 89% felt they benefitted from attending. Additionally, 70% of participants reported that the clinic improved their overall quality of care. ConclusionThe Aging with MS clinic outlines a model for comprehensive geriatric assessment and care in older adults with MS by a team of multidisciplinary specialists. Initial feedback from patients who attended the clinic conveyed improved quality of care.

Preventing Complications in Children: Blood Transfusions in Pediatric HIV Management

Children living with HIV face unique challenges that significantly impact their health and development, with anemia being one of the most prevalent complications. Blood transfusions have emerged as a vital therapeutic intervention for managing anemia in pediatric HIV patients, providing immediate correction of hemoglobin levels and alleviating debilitating symptoms. This review explores the role of blood transfusions in preventing complications associated with HIV, emphasizing their importance in improving health outcomes and enhancing the quality of life for affected children. The mechanisms through which blood transfusions confer benefits include enhanced oxygen delivery to tissues, improved immune function, and support for growth and development. Clinical evidence highlights the effectiveness of transfusions in reducing hospitalization rates and promoting adherence to antiretroviral therapy (ART). Furthermore, integrating blood transfusions into comprehensive care models fosters a multidisciplinary approach that addresses the medical, nutritional, and psychosocial needs of pediatric patients, ensuring a holistic management strategy. Keywords: Pediatrics, HIV, blood transfusions, anemia, immune function, HIV management

Systematic Review on Mortality in the Elderly on Methadone Maintenance Treatment.

Opioid dependence is a serious public health concern, particularly for older individuals who have a high prevalence of comorbid conditions. To effectively manage opioid use disorder (OUD), methadone maintenance treatment (MMT) is crucial; however, the MMT poses certain challenges for the aging population. The purpose of this review is to evaluate the impact of MMT on health outcomes, identify predictive factors for mortality, and assess mortality rates among older individuals receiving MMT. A systematic search was performed across databases, including PubMed, Scopus, Web of Science, and Google Scholar, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies included were published between January 2000 and December 2023, focused on elderly patients (60 years of age and older) receiving MMTand provided information on death rates. A total of 15 studies were examined. The main causes of death for older MMT patients were overdose, respiratory issues, and cardiovascular diseases. The annual mortality rates for these patients ranged from 2% to 10%. Treatment outcomes and mortality were significantly impacted by comorbid conditions. Greater treatment adherence and longer care periods were observed in older individuals, which correlated with better health outcomes and lower mortality. This review makes clear how elderly MMT patients with addiction and chronic health issues require integrated care models. Treatment effectiveness may be further increased by gender-specific interventions. For this aging population, policy reforms and enhanced healthcare support are essential. To enhance clinical results and lower mortality rates among older individuals enrolled in MMT programs, comprehensive age-appropriate care models are crucial. Long-term health outcomes should be investigated further and evidence-based treatments for older individuals with OUD should be developed.

P040 STRENGTHENING PRIMARY HEALTH SYSTEMS FOR HYPERTENSION: THE CASE OF HEARTS IMPLEMENTATION IN GUATEMALA

Hypertension is considered the leading cause of death and disability worldwide due to the multiple complications it entails. Hypertension contributes to 40% of the total cardiovascular diseases worldwide. In Guatemala, the burden of hypertension is increasing, with a prevalence of 32.2%. Hypertension alone is responsible for 12% of deaths in the country. The World Health Organization's (WHO) HEARTS is global to local initiative that consists in a technical package represents a public health approach to hypertension control, with a strong foundation in the effective and sustainable delivery of care for chronic diseases in primary care centers and their communities. Since 2017, Resolve to Save Lives, WHO, and other partners have supported the implementation of the HEARTS hypertension control program in public health care centers in LMICs (Low- and Middle-Income Countries). The goal was to establish a model for hypertension control suitable for broader expansion. By December 2022, 12.2 million hypertensive patients had been treated in the program across 33 participating LMICs. A pilot study integrating the diabetes module (HEARTS-D) into the implementation of the hypertension care model has been conducted in two health areas (Sololá and Chiquimula) since 2023. Starting in 2024, the execution of a project funded by the World Diabetes Foundation (WDF) will be carried out to expand these strategies by implementing a national comprehensive care model for diabetes and hypertension in the country. In 2021, a pilot study focused on the implementation of the model was conducted, resulting in a fourfold increase in the treatment rate of patients and a 14% increase in the proportion achieving blood pressure control. These results support the feasibility of implementing the HEARTS model for blood pressure control in the healthcare system of LMICs. The integration of the model in Guatemala since November 2022 enhances previous efforts and solidifies the country's commitment to integrating timely responses in the management of these conditions and the implementation of standardized treatment.

Unveiling the Longitudinal Journey: 3-Year Follow-up of Women with MINOCA and INOCA in a Specialized Heart Centre

BackgroundMyocardial infarction with no obstructive coronary arteries (MINOCA), and ischemia with no obstructive coronary arteries (INOCA), are female-predominant conditions; clinical trials are lacking to guide medical management for the common underlying vasomotor etiologies. Data on long-term outcomes of (M)INOCA patients following attendance at a women’s heart centre (WHC) are lacking. MethodsWomen diagnosed with MINOCA (n = 51) or INOCA (n = 112) were prospectively followed for 3 years at the Leslie Diamond WHC (LDWHC) in Vancouver. Baseline characteristics, diagnoses, chest-pain type, major adverse cardiac events, hospital encounters, medications, and Seattle Angina Questionnaire (SAQ) responses were compared between the baseline and 3-year timepoints. The χ2 test was used to compare categorical variables; the Student t test was used for continuous variables. ResultsMINOCA patients had significantly more nonexertional chest pain and more diagnoses of vasospasm than did INOCA patients, who had more exertional chest pain and more diagnoses of coronary microvascular dysfunction. Following the baseline timepoint, both groups had significant reductions in cardiovascular emergency room visits, with INOCA patients also experiencing fewer cardiovascular hospitalizations. At 3 years, the most commonly prescribed medications were calcium-channel blockers, long-acting nitrates, and beta-blockers, with MINOCA patients having more acetylsalicylic acid use, and INOCA patients having more short-acting nitrate and ranolazine prescriptions. Both groups observed significant improvements in SAQ scores, with greater improvements observed in INOCA patients. Patients with depression or who were prescribed ranolazine at 3 years had worse SAQ scores at baseline. ConclusionsThe 3-year outcomes of (M)INOCA patients indicate that the LDWHC's comprehensive care model effectively improves diagnostic clarity, reduces the number of hospital encounters, optimizes medication management, and improves self-reported patient well-being.

Enhancing Periodontal Treatment Through the Integration of Deep Learning-Based Detection with Bayesian Network Models.

This study incorporated deep learning for periodontal disease detection into a Bayesian network (BN) clinical decision support model for comprehensive periodontal care. BN structure and probabilities were based on clinical data and Faster R-CNN-detected radiographic images. Receiver operating characteristic curve analysis confirmed the model's high accuracy in treatment plan recommendations.

The Role of Certified Community Behavioral Health Centers in Improving Access to Peer-Supported Services.

Peer support workers (PSW) improve outcomes for people with behavioral health needs, but integrating PSWs into routine behavioral healthcare has been challenging. Certified Community Health Centers (CCBHC), a new comprehensive care model, provides new opportunities to increase access to PSWs. The present study examines whether PSW utilization changed following one organization's transition to a CCBHC. Administrative data from a large behavioral health organization was used to examine changes in peer delivered services before and after CCBHC implementation. Chi-square analyses examined changes in the number of visits delivered by peers. Logistic regression examined differences in the likelihood of accessing PSW services during pre and post timepoints. Following CCHC implementation, the overall number of PSW visits delivered within substance use and transition age youth programs increased. In contrast, the number of PSW visits in community-based intensive case management program decreased. Clients with opioid use disorders were more likely to have accessed PSW services following CCBHC implementation. Results reflect that CCBHC designation generally increased the number of PSW visits within this organization; however, changes in peer service utilization were primarily concentrated among individuals with opioid use disorders and within substance use and transitional aged youth programs. This study provides novel insight into how PSWers are being integrated into the CCBHC model.

Understanding the Importance of Daily Imaging in the Treatment of Non-Melanoma Skin Cancer with Image-Guided Superficial Radiation Therapy

Image-guided superficial radiation therapy (IGSRT) combines superficial radiation therapy (SRT) with full dermal visualization (FDV) via high-resolution dermal ultrasound (HRDUS) for the treatment of non-melanoma skin cancer (NMSC). The gold standard for IGSRT delivery includes a comprehensive cancer care model with support for dermatologists from a multidisciplinary team. When delivered in this model, IGSRT can achieve cure rates of 99% for treatment of NMSC. This paper focuses on the benefits of HRDUS used in conjunction with SRT for NMSC. Medical records from 7 dermatology clinics of 883 patients with 1507 cases of NMSC treated with IGSRT between 2017 and 2018 were retrospectively reviewed. In total, 92% of the NMSC lesions showed daily depth fluctuations, 60.32% of lesions did not require changes during therapy, and nearly 40% of lesions required at least one compensatory change during therapy. In total, 83% of NMSC lesions were labeled as high risk based on the 2024 NCCN guidelines. Increasing and decreasing tumor depth measurements during IGSRT inform dermatologists when adaptive changes in energy (kV), TDF, and dose will result in more efficacy and less toxicity, respectively.

Introduction of novel complex integrated care models supported by digital health interventions in European primary settings: a scoping review

IntroductionThere remains the need to develop comprehensive organisational care models supported by digital health interventions (DHIs) to manage chronic conditions in primary healthcare. Objectivethis review aimed to identify and map methods, interventions and outcomes investigated regarding the introduction of novel complex integrated care models supported by DHIs in the European primary care setting, as well as the level of integration achieved. Methodsa scoping review to identify literature from 2013 to 2023 in the European context was conducted across PubMed, Scopus and Web of Science. DHIs description, care models and outcomes were reported using the PRISMA- ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. ResultsA total of 53 studies was included. The models introduced, along with a DHI, at least one innovation in their structure or in the modality of care delivery: either a new figure (44%), interprofessional collaboration (37%), new functions like person-centred care (59%) or population stratification (11%). As regarding the DHIs, 56% implemented monitoring/management platforms and apps for chronic conditions. The most frequent combination of care model-DHI was the introduction of an app/platform, supported by phone calls/texts and electronic health records, paired with the introduction of a new healthcare professional/person centred care/ multidisciplinary team. All the studies reaching statistically significant outcomes introduced, along with one or more DHIs, either a new figure or a multidisciplinary team as part of the organizational change to support the technology. Conclusionsnovel complex integrated care models are focusing on introducing multidisciplinary perspectives and personalization of care, in line with the complex needs of chronic patients. The predominant development of monitoring/management platforms for patients is a further confirmation of this trend. Future research efforts should focus on the investigation of the effectiveness of current complex integrated care models integrating DHIs.

Crossroads of Care: A Black Social Worker’s Insights into the Lives of Black Men from Adolescence to Adulthood

ABSTRACT This autoethnographic study, “Crossroads of Care: A Black Social Worker’s Insights into the Lives of Black Men from Adolescence to Adulthood,” explores the intersections of race, education, and mental health throughout the life course of Black men. Drawing on varied professional and personal experiences – from providing telehealth services for college students to being a resource within a predominantly Black high school – the research illuminates systemic barriers and profound effects of marginalization and isolation. Emphasizing evidence-based social work interventions and culturally relevant care, the study underscores the importance of narrative therapy and self-disclosure in addressing Black men’s multifaceted needs. The findings contribute to discussions on racial equity in mental health and education, offering actionable recommendations for practitioners, policymakers, and educators to strengthen support systems. Advocating for a comprehensive care model, this research endeavors to empower Black men across various life milestones, enhancing well-being by addressing the complexities of race, education, and mental health.

A case study on the implementation of quality and comprehensive indicators set in routine diabetes care

IntroductionType 2 diabetes is a major public health issue in Mexico due to its high prevalence and its projection for the coming years for this disease. Findings on multidisciplinary care related to chronic diseases have proven effective, based on measurement of patient-centered outcomes, The Center of Comprehensive Care for Patients with Diabetes (CAIPaDi) is a multidisciplinary program focused on reducing diabetes complications. This case study aims to illustrate the results of implementing health outcomes measurements and demonstrate the beneficial effects of establishing a comprehensive model of care through a patient-centered approach.MethodsA descriptive analysis of the comprehensive care indicators of patients with type 2 diabetes treated in the CAIPaDi program between 2013 and 2023 was conducted. The results were structured according to the standard set of outcomes for diabetes proposed by the International Consortium for Health Outcomes Measurements (ICHOM).ResultsThe baseline and prospective registration of consultations was completed for five years, complying with 25 of the 26 indicators of the ICHOM set. In diabetes control, 56.5% of patients had A1c ≤ 7%, 87.9% had BP ≤ 130/80 mmHg, 60.9% had LDL-cholesterol < 100 mg/dl, and obesity rates decreased from 42.19% to 30.6% during annual consultations. Fewer years of diagnosis before the first visit is key to overall improvement in program adherence (P = 0.02).In acute events, a hyperglycemic crisis occurred in only two cases and severe hypoglycemia episodes in 8 patients. For chronic complications, no lower limb amputations occurred. Cardiovascular outcomes occurred in < 1%. Periodontal disease was analyzed, and periodontitis decreased from 82.9% to 78.7%. Mortality reports were low, with COVID-19 being the main cause of death. Patient-reported outcomes demonstrated reductions in anxiety, depression, and diabetes distress during follow-up.ConclusionRegistering quality-of-care indicators is feasible in a comprehensive care program. It allows improving the medical, mental health, and lifestyle outcomes of patients with type 2 diabetes and provides relevant data for planning health programs. A quick diagnosis before program adherence is crucial for overall improvement in patients.

Chemotherapy and Metabolic Syndrome: A Comprehensive Review of Molecular Pathways and Clinical Outcomes.

Cancer therapies, notably chemotherapy, have significantly improved survival rates and quality of life for many patients. However, chemotherapy's cytotoxic effects also impact normal cells, leading to adverse effects, including metabolic disturbances. This paper explores the link between chemotherapy and metabolic syndrome, a cluster of metabolic abnormalities that increase the risk of cardiovascular diseases and type 2 diabetes. Understanding the predictors, such as specific chemotherapy regimens, patient characteristics, comorbid conditions, lifestyle factors, and genetic variations, is crucial for formulating personalized care plans and preventive strategies. Research indicates that older age, female gender, pre-existing diabetes, and baseline obesity are significant predictors of metabolic syndrome in cancer patients. Chemotherapy-induced molecular changes, including insulin resistance, dyslipidemia, chronic inflammation, oxidative stress, and tissue fibrosis, contribute to the development of this syndrome. Effective management strategies require a multidisciplinary approach, incorporating lifestyle interventions, pharmacological treatments, and regular monitoring. This paper underscores the importance of personalized medicine in mitigating the risks associated with metabolic syndrome and improving long-term health outcomes for cancer survivors. Future research directions include longitudinal studies to track metabolic health over time, mechanistic studies to uncover the molecular pathways involved, and the development of integrative therapies. By adopting comprehensive care models, healthcare providers can enhance the overall quality of life for cancer survivors, addressing both cancer and metabolic health challenges.

Examining the Longitudinal Effects of Insomnia on Depression and Medication Adherence in People Living with HIV

ABSTRACT Objective The management of HIV has shifted from a focus solely on the disease to a broader perspective encompassing co-occurring medical conditions and quality of life. Mental health concerns such as depression and sleep disturbances, particularly insomnia, are often overlooked in HIV care. The aim of the study was to investigate the longitudinal impact of insomnia on depression and medication adherence among (PLWH). Methods This study, conducted in an urban HIV clinic, involved active patients and assessed depression, insomnia, and medication adherence at baseline, 3-month, and 6-month intervals. Hierarchical linear models were employed to analyze the fixed and random effects of time, within-person and between-person insomnia on depression, as well as the effects of time, within-person and between-person depression on ART adherence. Results Within-person effects revealed that each one unit increase in the Insomnia Severity Index (ISI) was associated with a b = 0.267-point rise in Patient Health Questionnaire-9 (PHQ-9) scores (p < .001). Between-person effects revealed that each one-point increase in an individual’s average ISI score was associated with a 0.476-point elevation in their PHQ-9 scores (p < .001). The between-person effects of depression on medication adherence indicated significance, with each point increase in an individual’s average PHQ-9 score being linked to a 0.36% decrease in adherence (p = .012). Conclusion The study underscores the potential impact of insomnia on mental health and treatment adherence in people living with HIV (PLWH). This study emphasizes the necessity of comprehensive care models considering the interplay between sleep quality, mental health, and medication adherence for PLWH.

Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders

Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study. To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older. A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews. Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level. The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80). In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.

Rationale, Design and Baseline Characteristics of a Randomized Controlled Trial of a Cardiovascular Quality Improvement Strategy in India: The C-QIP Trial

BackgroundQuality of chronic care for cardiovascular disease (CVD) remains suboptimal worldwide. The Collaborative Quality ImProvement (C-QIP) trial aims to develop and test the feasibility and clinical effect of a multicomponent strategy among patients with prevalent CVD in India. MethodsThe C-QIP is a clinic-based, open randomized trial of a multicomponent intervention versus usual care that was locally developed and adapted for use in Indian settings through rigorous formative research guided by Consolidated Framework for Implementation Research (CFIR). The C-QIP intervention consisted of 5 components: 1) electronic health records and decision support system for clinicians, 2) trained non-physician health workers (NPHW), 3) text-message based lifestyle reminders, 4) patient education materials, 5) quarterly audit and feedback reports. Patients with CVD (ischemic heart disease, ischemic stroke, or heart failure) attending outpatient CVD clinics were recruited from September 2022 to September 2023 and were randomized to the intervention or usual care arm for at least 12 months follow-up. The co-primary outcomes are implementation feasibility, fidelity (i.e., dose delivered and dose received), acceptability, adoption and appropriateness, measured at multiple levels: patient, provider and clinic site-level, The secondary outcomes include prescription of guideline directed medical therapy (GDMT) (provider-level), and adherence to prescribed therapy, change in mean blood pressure (BP) and LDL-cholesterol between the intervention and control groups (patient-level). In addition, a trial-based process and economic evaluations will be performed using standard guidelines. ResultsWe recruited 410 socio-demographically diverse patients with CVD from four hospitals in India. Mean (SD) age was 57.5 (11.7) years, and 73.0% were males. Self-reported history of hypertension (48.5%) and diabetes (41.5%) was common. At baseline, mean (SD) BP was 127.9 (18.2) /76.2 (11.6) mm Hg, mean (SD) LDLc: 80.3 (37.3) mg/dl and mean (SD) HbA1c: 6.8% (1.6%). At baseline, the GDMT varied from 62.4% for patients with ischemic heart disease, 48.6% for ischemic stroke and 36.1% for heart failure. ConclusionThis study will establish the feasibility of delivering contextually relevant, and evidence-based C-QIP strategy and assess whether it is acceptable to the target populations. The study results will inform a larger scale confirmatory trial of a comprehensive CVD care model in low-resource settings. Trial registrationClinical Trials Registry India: CTRI/2022/04/041847; Clinicaltrials.gov number: NCT05196659

Sickle cell anaemia control mission: Implementation of a comprehensive care model in Anuppur, Madhya Pradesh.

Background & objectives Sickle cell disease (SCD) is a common genetic disorder, predominantly found in the tribal population of India. The examples of models providing comprehensive care and management to individuals with SCD in public health facilities are sparse. The Sickle Cell Anaemia Control Mission is one such model implemented by Jan Swasthya Sahyog, a non-profit organization in collaboration with the National Health Mission in the Anuppur district of Madhya Pradesh. This article aimed to identify the key learnings from this programme that can guide the public health system strengthening with respect to SCD. Methods The Sickle Cell Anemia Control Mission Programme included door to door screening for anaemia, SCD and blood group. SCD cases were included in the programme and other individuals with Anemia were referred for further care. Care for individuals with SCD included counselling, provision of hydroxyurea, regular follow up of clinical parameters and management of complications. Care for individuals with SCD was provided through monthly patient support group (PSG) meetings and regular outpatient /in-patient care at public health facilities. Quantitative data on programme design, screening and patient management collected during programme implementation were used for analysis. Results A total of 39421 persons were screened in 18 months (August 2018-March 2020). Of these 81.9 per cent persons were anaemic, 16.9 per cent had sickle cell trait and 779 (1.98%) had SCD. Eighty-six already diagnosed individuals joined the programme for care. People from all caste categories were diagnosed with SCD. Out of 865 individuals with SCD, 157 underwent regular 9-11 months follow up and showed improvement in clinical symptoms and drug compliance. Interpretation & conclusions Central India has a significant burden of anaemia and SCD. This study found that SCD is present in non-tribals as well. PSGs are an efficient way to deliver non-emergency care for chronic diseases such as SCD.

Study on the Clinical Effectiveness of Comprehensive Anesthesia Nursing in Clinical Anesthesia Practice

Objective: to investigate the application mode and effect of a comprehensive anesthesia nursing program in clinical anesthesia patient care intervention. Methods: 40 cases of surgical treatment patients admitted to our hospital during the period from December 2022 to December 2023 were selected as research subjects, and were divided into 20 cases of the reference group and 20 cases of the experimental group according to the principle of random allocation. For the patients in the reference group, the conventional nursing mode was implemented, and for the patients in the experimental group, the comprehensive anesthesia nursing mode was implemented. The anesthesia time and operation time of the two groups were compared. Results: the anesthesia time of patients in the experimental group was (9.5±4.0) min, which was shorter than the anesthesia time of patients in the reference group (14.3±4.3) min; the operation time of patients in the experimental group was (195.5±13.6) min, which was shorter than the operation time of patients in the reference group (234.7±12.1) min, and the difference between the two groups was significant, with a difference of P＜0.05. Conclusion: When implementing clinical anesthesia in patients undergoing surgery, it is necessary to formulate a comprehensive anesthesia care model. Conclusion: when implementing clinical anesthesia, it is necessary to develop a comprehensive anesthesia nursing program to enhance the nursing effect and improve the postoperative recovery of patients.

Multidisciplinary, multicomponent interventions to reduce frailty among older persons in residents of residential care facilities: a scoping review

BackgroundFrailty reduction and reversal have been addressed successfully among older populations within community settings. However, these findings may not be applicable to residential care settings, largely due to the complex and multidimensional nature of the condition. Relatively, few attempts at frailty prevention exist in residential settings. This review aims to identify and describe best practice models of care for addressing frailty among older populations in residential care settings. This research also sets out to explore the impact of multidisciplinary health service delivery models on health outcomes such as mortality, hospitalisations, quality of life, falls and frailty.MethodsA scoping review of the literature was conducted to address the project objectives. Reference lists of included studies, bibliographic databases and the grey literature were systematically searched for literature reporting multidisciplinary, multidimensional models of care for frailty.ResultsThe scoping review found no interventions that met the inclusion criteria. Of the 704 articles screened, 664 were excluded as not relevant. Forty articles were fully assessed, and while no eligible studies were found, relevant data were extracted from 10 near-eligible studies that reported single disciplines or single dimensions rather than a model of care. The physical, nutritional, medicinal, social and cognitive aspects of the near eligible studies have been discussed as playing a key role in frailty reduction or prevention care models.ConclusionThis review has identified a paucity of interventions for addressing and reducing frailty in residential care settings. High-quality studies investigating novel models of care for addressing frailty in residential care facilities are required to address this knowledge gap. Similarly, there is a need to develop and validate appropriate screening and assessment tools for frailty in residential care populations. Health service providers and policy-makers should also increase their awareness of frailty as a dynamic and reversible condition. While age is a non-modifiable predictor of frailty, addressing modifiable factors through comprehensive care models may help manage and prevent the physical, social and financial impacts of frailty in the ageing population.

Effect of a comprehensive cancer care pathway and a navigation cancer program on breast cancer care in a middle-income country.

e13536 Background: Breast cancer (BC) is the most common cancer in women globally and in Colombia, with around 16.000 new cases estimated in 2022. Mortality associated with BC has decreased for 2 main reasons: screening that leads to early diagnosis and improved treatment of BC. However, BC related mortality remains stable in Colombia, with a 5-year overall survival of 74%, lower than other countries on the continent. This difference could be explained, among other things, by delays, barriers, and fragmentation of cancer care. Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC) is an institution designed for comprehensive cancer care, with specialized patient care through cancer clinics dedicated to a single disease (breast cancer, lung cancer, etc.). Every cancer clinic is associated with a cancer navigation program and has clinical care pathways with metrics that seek to monitor and reduce the time to diagnosis and treatment, among others. This study aims to describe the results of the comprehensive breast cancer care program and cancer navigation support in time to breast cancer diagnosis and treatment access. Methods: This descriptive study was carried out by retrospective reviewing of the navigation database from the breast cancer unit of the CTIC, sociodemographic information, clinical characteristics, and time to diagnosis (from first appointment to pathology report) and treatment were collected and described. A comparison between patients with comprehensive and fragmented care was done. Results: Since August 2022, 600 patients with confirmed breast cancer have been evaluated by the BC clinic, 401 (66.8%) patients were admitted through the cancer navigation program, 436 (72.6%) cases presented with a previously established diagnosis of breast cancer, and 164 (27.3%) were the novo cases. Of the novo cases, 37 (23.3%) cases received comprehensive care from diagnosis, with a time to diagnosis of 14 days, and time to treatment of 30.5 days, patients who did not receive comprehensive care presented a time to treatment of 68.1 days. Conclusions: A comprehensive cancer care and support from a navigation program significantly reduce the time to treatment in breast cancer patients. A comprehensive care model in Colombia has the opportunity to generate a better opportunity for access to diagnosis (14 days) and treatment (30.5 days) compared to the time to treatment data reported in the high-cost account (CAC) (27 and 52 days respectively). [Table: see text]