Comprehensive Care Plan Research Articles

Case Study

When older patients enter the healthcare system, determining the origin of injuries requires differentiating accidental from nonaccidental, or neglect-related causes. The involvement of a forensic nurse is invaluable, as the foundational education and expertise help in the assessment and documentation of the person's capacities and competence. Distinguishing between effective care planning and considering the risk of further harm occurs throughout the entire process, where the preservation of the older person's integrity, autonomy, and dignity includes delicately listening to statements made, and confirming the sources of injury. Adopting a trauma-informed person-centered care approach to care and recovery is the goal, creating an environment where older persons feel safe, supported, and understood. In a fast-paced healthcare setting, challenges in addressing lesser-known or less frequently discussed diseases reflect limited knowledge, complicating the care provided. Therefore, ongoing education and training expose the forensic nurse to the latest medical advancements, diminishing misdiagnoses or delayed treatments as outcomes. Critical and accurate communication, coupled with seamless collaboration among interprofessional and community members, serves as the cornerstone to establish a comprehensive and cohesive plan of care. Working together, all members of the interprofessional team ensure that the older person's presenting condition is thoroughly assessed, treated, and supported in the services by the community of providers.

Patient-centered health care planning in acute inpatient mental health settings: a best practice implementation project.

The current project aimed to improve the quality of health care by promoting evidence-based practice (EBP) regarding mental health care planning (MHCP) for adult inpatients. The implementation of the best evidence in the process of developing and documenting nursing care plans is currently an important legal requirement that contributes to increasing the quality of care. This implementation project was based on the JBI evidence implementation approach and included a baseline audit of seven criteria, implementation of strategies, and a follow-up audit. The project was conducted in an acute psychiatric setting at a university hospital in Bucharest, Romania. The sample included 17 nurses and 30 ward patients. The baseline audit revealed low compliance (33%-37%) for criterion 3 (a comprehensive care plan) and criterion 4 (patient involvement); moderate compliance (55%) for criterion 1 (care plan for all patients); and increased compliance (97%-100%) for criterion 2 (assessment of patient's needs), criterion 5 (education of patients/caregivers), criterion 6 (providing a copy at discharge), and criterion 7 (education of professionals). As a result of implementing the most appropriate strategies, the maximum improvement (100%) was observed across all five audit criteria that were found to be deficient in the baseline audit. The development and implementation of strategies adapted to specific care need to play a key role in the implementation of EBP. In this case, educating nurses, facilitating nurses' access to EBP for care planning, and improving procedures proved effective in achieving maximum compliance with all the audit criteria.

Abstract B013: Unsilenced strength: Survivorship perspectives from Black prostate cancer survivors

Abstract Introduction: The relentless surge of prostate cancer rates is rapidly alarming public health officials, leaving a trail of shattered hopes among Black men in the United States. This toll reduces mortality for this population, the urgent need for effective solutions becomes more apparent. Survivorship care plans (SCPs) emerge as a beacon of hope, holding the potential to transform the provision of care. Within this tool lies the encapsulation of vital cancer-related information, passed from the oncology team to the resilient survivor and their primary care physician. However, despite the unwavering support of national governing bodies, a disheartening reality persists for Black male survivors, who never access these life-saving plans. The study purpose was to identify receipt of SCPs and the preferred communication delivery of health information among Black prostate cancer survivors. Methods: Utilizing a grounded theory approach, our study delved into the experiences of a convenience sample of seven Black male prostate cancer survivors. In-person and telephone-based semi-structured interviews we sought to unravel unique narratives. The research inquiries used open-ended questions (1) knowledge, awareness, and understanding of SCPs; (2) interactions with medical professionals; and (3) preferred methods of communication of healthcare information. Employing a line-by-line descriptive force coding method, we extracted pertinent statements by open and axial coding to generate specific codes to encapsulate information collected from an underserved population. Results: Thorough analysis revealed several distinct themes pertaining to survivorship care plans and preferred communication styles. The relevant findings were a lack of SCPs knowledge, an absence of post-treatment care, the profound influence of faith and family support, and the value of group settings. Despite receiving education on treatment, survivors expressed a sense of being left adrift, as if their medical professional team had failed to provide them with a clear roadmap for their survivorship journey. In the absence of proper guidance, survivors resorted to considering pre-treatment risk assessments as a makeshift substitute for a comprehensive survivorship care plan. Conclusion: The impact of our study’s findings resonates deeply, revealing a startling reality: Black male survivors in our sample possessed a distressing lack of knowledge about the post-treatment phase of survivorship. Instead, they relied on the support of their spouses or fellow survivors with whom they connected during treatment sessions. The removal of government mandates aimed at promoting SCPs likely contributes toward a disheartening knowledge disparities among many Black men, leaving them without clear guidance regarding the crucial phase of aftercare. Armed with this data, we have the opportunity to drive change and enhance the development of culturally tailored, interactive care plans specifically designed to support Black male survivors after they conquer prostate cancer treatment. Citation Format: Dottington Fullwood, Charles Waldon, Carol Thomas, Mary Ellen Young, Shannon Pressey, Folakemi T. Odedina, Brandon Snipe, Isela Villasenor. Unsilenced strength: Survivorship perspectives from Black prostate cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B013.

Assessing the Professional Knowledge of Long Term Care Stations around the Blocks Personnel from the Perspective of Integrated Care for older People (ICOPE): An Example from Puli Christian Hospital

<p>C級巷弄長照站是長者照護的最前端場域，目前整合照護資源及服務素質不齊，影響長照2.0照護之實踐。本文以世衛組織高齡整合照護指南為基準，檢視埔基巷弄長照站現況與人才培育困境。埔基長照站宜再補強的知能包括：建立高齡整合照護的評估系統及追蹤報告，宜增加老人虐待、老人歧視，以及衛生教育技能課程，宜增強制定完整的照顧計畫，以及強化志工服務量。在行政上應加強：應建立長輩一站式整合服務模式、建立正式通報及轉診之服務系統，以及結合多元輔助產品，用於知能教學或服務品質。政府公共政策建議：宜加強照顧服務員之知能；以區域為基礎，盤點可提供之服務，以達公平性服務；提供跨專業整合及全面的照護計畫；鼓勵由下而上發展政策。</p> <p> </p><p>The Long Term Care (LTC) Stations around the Blocks is the primary prevention front for the elderly in the community. However, the resources and quality of multidisciplinary integrated care vary. According to the implementation framework of ICOPE, the current ability of the LTC station around the blocks to implement procedures outlined by ICOPE and impediments to staff training are examined in this study. Puli LTC Station staff should enhance their knowledge and skills in various areas, including systematic recruitment and case screening, implementing an ICOPE evaluation system with follow-up tracking, providing new training content on elder abuse and discrimination against the elderly, and improving health education for staff to create comprehensive care plans, expand volunteer recruitment, and increase volunteer training and service hours. Public policy recommendations aim to strengthen care abilities and promote regional equity, to provide integrate interdisciplinary care plans and advocate bottom-up policy development for adaptive service models.</p> <p> </p>

Assessing Aspects of Quality of Life Among Patients with Sickle Cell Disease in Saudi Arabia

Introduction: Sickle cell disease is a genetic disorder that can significantly alter the patient's quality of life. The disease trajectory can lead to acute and chronic complications, mainly resulting from repeated episodes of vascular occlusion. The patients can experience frequent infections and hospitalizations, chronic pain, fatigue, hand-foot syndrome, delayed growth. Therefore, assessing the quality of life among sickle cell patients in Saudi Arabia is pertinent to the devise of a comprehensive plan of patient care. The quality of life can be determined based on numerous markers, including physical health, psychological health, happiness, and physical activity. We aimed to assess the overall quality of life among Saudi sickle cell disease patients living in different regions of the Kingdom. This an ongoing study with open enrollment target of more than 600 patients. Methods: A questionnaire-based survey was conducted among the adult Saudi sickle cell disease population residing in different provinces, who were stable, Saudi nationals and over age of 18 years. The questionnaire assessed the quality of life, including fatigue, general happiness, physical activity, and psychological well-being using standardized questionnaire SF-36 and HADS validated Arabic version. Additional data about blood transfusion and visit to ER were collected The collected data were recorded for each respondent, and the results were statistically analyzed. Results: The included participants' (n=166) mean age 33.6 ± 9.2. years, with respondents belonging to eastern region Qatif (n=48; 28.9%), central region Riyadh (n=75; 45.1%), and southern region Jizan (n=43; 25.9), respectively. The study's cohort had varying educational backgrounds, with the highest number holding a bachelor's degree (n=77; 46.4%); followed by secondary education (n=50; 30.1); master's degree (n=8; 4.8); doctoral degree (n=5; 3.0) and other education (n=18; 10). In total, 17.5% of participants reported excellent reviews about health, and only 9% reported badly. However, the overall quality of life compared to the previous year was much lower, with 10.8% responses as worse. Strenuous activities constrained 40.9% of the participants, 14.5% were constrained by work of medium intensity, and 13.2% felt even a lot of constraint while carrying groceries. Almost 40% of respondents answered negatively when asked about feeling energetic compared to psychological health, where more than 50% of responses were positive. More than 52% of participants felt their ability to do activities at work and otherwise was diminished. More than 80% of participants felt pain over the past four weeks that affected their quality of life. The findings have been graphically summarized in Figure 1. The patients with blood transfusion assessed their health significantly poor than those without transfusion (p-value = 0.0022). Their health conflicted with their daily routine significantly (p-value=0.003), where they were significantly more tired (p-value=0.04), and felt less assured (p-value=0.02). Conclusion: The physical and psychological health-related quality of life is satisfactory among Saudi sickle cell disease patients.. Furthermore, the lack of energy and appropriate physical activity is a serious concern that can negatively impact sickle cell disease patients' overall quality of life. This is a planned cohort to measure quality of life in sickle cell disease in Saudi Arabia at a large scale with link to demographic representation .

Implementation of an Adult Sickle Cell Center Directly Correlates with Improved Patient Outcomes and Decreased Acute Care Utilization

Introduction: The lack of comprehensive care for adult patients with sickle cell disease (SCD) remains a major unmet need in the United States, leading to the noted increase acute care utilization, high morbidity and mortality as well as increased healthcare burden. By establishing a dedicated adult center, the delivery of SCD care will be moved from the acute to the outpatient setting where best practices of disease management and a trusting therapeutic relationship can be established. This will allow for timely detection of complications and address the psychosocial contributors to disease management. Here, we demonstrate how the establishment of a dedicated adult sickle cell results in direct and immediate improvement in acute care utilization and patient outcomes. With funding from our institution and health department, Inova Adult Sickle Cell Center (IASC) was established in March of 2022. After IASC opening, each provider's schedule allowed for frequent clinic visits to apply standard of care and address timely unmet needs, particularly those with highest disease burden and acute care use. Methods/ Results: With IASC opening, disease-modifying therapies, screening studies and individualized care plans (ICPs) were implemented for each patient. Equally important and perhaps a key factor for IASC funding was the degree of acute care utilization within our hospital system which comprises of five large hospitals including a 1000-bed tertiary care center as well as numerous standalone ED facilities. To standardize care across this large institution, we quickly developed ICPs for all IASC patients and provided education to ED and hospitalist colleagues. In line with other adult sickle cell centers, we eliminated use of parenteral diphenhydramine as well intermittent parenteral opioid bolus use. Instead, patient controlled anesthesia (PCA) pumps were utilized along with oral opioids. Upon admission, the care for each patient was closely coordinated between IASC and inpatient teams. We also identified several patients with frequent hospitalizations for comprehensive care plan meeting. The patients consisted of all sickle genotypes, males and females and predominately in the second and third decade of life. The care plan meeting consisted of IASC team, the patient and his or her identified caregiver(s). In this meeting, barriers to care including psychosocial support, food and housing insecurity and transportation needs were identified. Patient's sickle cell disease and comorbidities were reviewed and goals of care agreed upon. Patients were then seen weekly to continue ongoing discussions and management of underlying disease, psychosocial support and monitoring of acute care and opioid use. Within IASC's first year, interim analysis showed of the 1439 total hospital days saved from all service lines, 864 were predominately SCD. The total number of admission days across the system was continuously rising until opening of the IASC in March 2022 and within a year, we saw a reduction in total hospital days by 11% which equates to tremendous cost savings (Fig. 1). Moreover, for each of our identified highest acute care utilizing patients, we noted a dramatic reduction in hospitalization after clinic opening with aggressive disease management and frequent clinic visits (Fig. 2). With IASC opening, we were able to begin implementation of disease modifying therapies including enhanced hydroxyurea compliance as well as initiation of vaccinations and screening studies including nephropathy and iron overload. These changes were nearly a 100% increase from the year before given that patients were not receiving comprehensive care. Conclusion: Individuals with SCD without a ‘medical home’ face many barriers to care including access to regular clinic visits where ongoing education and gaps in care can be identified including physical, psychological, and social impact. It is important for sickle cell providers to account for all aspects of a patient's well-being when devising individual treatment strategies. Caring for a sickle cell patient is complex and time consuming and best done by sickle cell disease experts in a dedicated center. Using data from our center in our large healthcare system, we demonstrate that a dedicated adult sickle cell center allows for much improved overall patient outcomes and decreased healthcare burden by moving the delivery of care form the inpatient to outpatient setting.

Enhancing Caregiver Empowerment Through the Story Mosaic System: Human-Centered Design Approach for Visualizing Older Adult Life Stories.

Various older adult care settings have embraced the use of the life story approach to enhance the development of comprehensive care plans. However, organizing life stories and extracting useful information is labor-intensive, primarily due to the repetitive, fragmented, and redundant nature of life stories gathered from everyday communication scenarios. Existing life story systems, while available, do not adequately fulfill the requirements of users, especially in the application of care services. The objective of this study is to design, develop, and evaluate a digital system that provides caregivers with the necessary tools to view and manage the life stories of older adults, enabling expedited access to pertinent information effectively and visually. This study used a multidisciplinary, user-centered design approach across 4 phases: initial design requirements, prototyping, prototype refinement workshops, and usability testing. During the initial phase, we conducted field research in the Hefei Tianyu Senior Living Service Nursing Home, China, to discover how caregivers currently store and use life stories and their needs, challenges, and obstacles in organizing and retrieving information. Subsequently, we designed a low-fidelity prototype according to the users' requirements. A prototyping workshop involving 6 participants was held to collaboratively design and discuss the prototype's function and interaction. User feedback from the workshops was used to optimize the prototype, leading to the development of the system. We then designed 2 rounds of usability testing with 7 caregivers to evaluate the system's usability and effectiveness. We identified 3 categories of functionalities that are necessary to include in the design of our initial low-fidelity prototype of life story visualizations: life story input, life story organization, and timeline generation. Subsequently, through the workshops, we identified 3 categories for functional optimization: feedback on user interface and usability, optimization suggestions for existing features, and the request for additional functionalities. Next, we designed a medium-fidelity prototype based on human-centered design. The Story Mosaic system underwent usability testing in the Hefei Tianyu Senior Living Service Nursing Home. Overall, 7 users recorded and organized 1123 life stories of 16 older adults. The usability testing results indicated that the system was accessible and easy to use for caregivers. Based on the feedback from the usability testing, we finalized the high-fidelity prototype. We designed, developed, and evaluated the Story Mosaic system to support the visual management of older adults' life stories. This system empowers caregivers through digital technology and innovative design, pioneering personal narrative integration in caregiving. This system can expand to include informal caregivers and family members for continued adaptability and empathy.

Cost-effectiveness analysis of the Geriatric Fracture Center (GFC) concept: a prospective multicentre cohort study

IntroductionGeriatric Fracture Centers (GFCs) are dedicated treatment units where care is tailored towards elderly patients who have suffered fragility fractures. The primary objective of this economic analysis was to determine...

The Johns Hopkins Hope at Hopkins Clinic: Supporting the comprehensive needs of individuals with metastatic breast cancer.

452 Background: Individuals with metastatic breast cancer (MBC) may live with their disease for many years. We initiated the Johns Hopkins Hope at Hopkins Clinic, a multi-pronged quality improvement initiative that aims to optimize care for individuals with MBC. Methods: Individuals with MBC were offered participation in the Clinic, in addition to their usual care. Participants completed baseline patient reported outcome (PRO) surveys through REDCap. They were offered a menu of services, including cancer rehabilitation, supportive oncology, social work, nutrition, navigation, and access to optional services based on baseline PRO data and preferences. A medical oncologist assembled and delivered a comprehensive Care Plan synthesizing recommendations from all consultants with a focus on optimizing treatment, managing symptoms, and promoting wellness. Patients were asked to complete an evaluation survey 3 days after the clinic session, and follow-up PRO surveys at 3 and 6 months after the Care Plan was delivered. We report summary statistics of baseline demographics, tumor characteristics, and PRO scores at the pre-clinic visit. Results: From 11/2020 to 6/2022, 53 patients were referred, and 44 (83%) completed baseline surveys and participated in the Hope at Hopkins Clinic. Median age (N=44) was 58 (32-86); 32 (73%) were white, and 6 (14%) were Black; 24 (55%) had BMI>25. Tumors were mostly estrogen receptor-positive (85%) and HER2-negative (68%). Physical and mental health was not good for ≥14 days for 9/44 (20%) and 4/44 (9%), respectively. PROMIS measure scores were >1 standard deviation below average for 14/44 (32%) for Physical Health, 7/44 (16%) for Mental Health, and 10/44 (23%) for Physical Function. PHQ8 scores indicated depression for 10/44 (23%); GAD7 scores indicated anxiety for 3/44 (7%). 37 (84%) participants received an individualized Care Plan and educational materials based on identified symptoms, concerns, and interests. We will report the number and types recommendations by domain. Follow-up PRO data are available for 10 and 4 patients at 3- and 6-months, respectively. Conclusions: We have provided individualized assessment, education, and recommendations and created a comprehensive Care Plan to guide patients living with MBC. We have used the experience to implement a new multidisciplinary model, and to extend support services to patients living with MBC and their care teams.

Recommendations for Improving Systemic Lupus Erythematosus Care From Black Adults

Racial inequities in incidence, morbidity, and mortality are a defining feature of systemic lupus erythematosus (SLE). Health care systems are integral to addressing these inequities. However, qualitative evidence that highlights Black SLE care experiences is limited. To identify opportunities for improving SLE care based on the experiences and perspectives of Black adults with SLE. In this qualitative study, an interpretive description approach was used and data were analyzed using inductive thematic analysis. Semistructured interviews with Black adults in Michigan who were diagnosed with SLE were conducted. Interviews occurred from November 2, 2021, to July 19, 2022, and data analysis occurred from May 6, 2022, to April 12, 2023. Deidentified transcripts from the interviews were analyzed to develop themes that focused on opportunities to improve quality of care and symptom management. The participants included 30 Black adults with SLE (97% women; mean age, 41 years; range, 18-65 years). Four main themes were identified: (1) awareness of SLE signs and symptoms before diagnosis (participants emphasized delays in diagnosis and how knowledge concerning SLE could be limited in their families and communities); (2) patient-clinician interactions (participants faced discrimination in health care settings and talked about the value of coordinated and supportive health care teams); (3) medication adherence and health effects (participants experienced a range of adverse effects from medications that treat SLE and described how monitoring medication use and efficacy could inform tailored care approaches); and (4) comprehensive care plans after diagnosis (participants reported persistent pain and other symptoms despite treatment). In the context of disease management, participants emphasized the importance of behavioral change and the negative impact of social risk factors. The findings of this qualitative study suggest how limited information about SLE, experiences of racism, treatment regimens, and social risk factors may affect Black people with SLE. Future research should further engage and include Black communities within the context of treatment and intervention development to reduce racial inequities.

English validation of the Living with long term conditions scale

Abstract Background The English version of the living with long term conditions (LwLTCs) scale is a comprehensive person-centred measure that evaluates the complex process of living with long term conditions. Objectives To present the psychometric properties of the LwLTCs scale in an English-speaking population in people with different long term conditions. Methods An observational and cross-sectional study, with a convenience sample of 577 people living with osteoarthritis, diabetes mellitus type 2, chronic kidney disease, chronic obstructive pulmonary disease, chronic heart failure, and Parkinson's disease. Data collection was conducted between December 2021 and June 2022 across the United Kingdom via primary care surgeries and voluntary organisations. Psychometric properties including feasibility, internal consistency, confirmatory factor analysis, reproducibility, and content validity were tested. Results 44.7% were female, the age range was 37-97 years (98 ± 9.65), 71.1% were married and 76.4% were retired. Internal consistency was excellent for the total score (ordinal alpha =0.90) but confirmatory factor analysis showed that the fit of the 5-domain structure improved significantly if items 2, 5, 10, 16, 18 and 23 were removed and item 24 reallocated. Conclusions This is the first validation study of the LwLTCs scale in an English-speaking population living with different long term conditions. Having a reliable and valid healthcare and social care outcome measure is essential to identify comprehensive and complex needs of people living with long term conditions. A shorter version of the LwLTCs scale is recommended to facilitate the implementation of person-centred pathways and more comprehensive care plans and evaluation in the national healthcare system. Key messages • Innovative comprehensive scale to evaluate the daily living. • Reliable and valid health and social care outcome measure.

Taming Postoperative Delirium with Dexmedetomidine: A Review of the Therapeutic Agent's Neuroprotective Effects following Surgery.

Postoperative delirium (POD) represents a perioperative neurocognitive disorder that has dreaded ramifications on a patient's recovery from surgery. Dexmedetomidine displays multiple mechanisms of neuroprotection to assist in preventing POD as a part of a comprehensive anesthetic care plan. This review will cover dexmedetomidine's pharmacological overlap with the current etiological theories behind POD along with pre-clinical and clinical studies on POD prevention with dexmedetomidine. While the body of evidence surrounding the use of dexmedetomidine for POD prevention still requires further development, promising evidence exists for the use of dexmedetomidine in select dosing and circumstances to enhance recovery from surgery.

Effects of humanized nursing care on negative emotions and complications in patients undergoing hysteromyoma surgery.

Uterine fibroids, are prevalent benign tumors affecting women of reproductive age. However, surgical treatment is often necessary for symptomatic hysteromyoma cases. This study examines the impact of humanized nursing care on reducing negative emotions and postoperative complications in patients receiving hysteromyoma surgery. To investigate the impact of humanized nursing care on patients undergoing hysteromyoma surgery. Among patients who underwent hysteromyoma surgery at the Fudan University Affiliated Obstetrics and Gynecology Hospital, 200 were randomly assigned to either the control group (n = 100) or the humanized nursing care group (n = 100). The control group received traditional nursing care, while the humanized nursing care group received a comprehensive care plan encompassing psychological support, pain management, and tailored rehabilitation programs. In addition, anxiety and depression levels were assessed using the hospital anxiety and depression scale preoperatively and postoperatively. Postoperative complications were evaluated during follow-up assessments and compared between both groups. The humanized nursing care group demonstrated a significant decrease in anxiety and depression levels compared to the control group (P < 0.05). The rate of postoperative complications, including infection, bleeding, and deep venous thrombosis, was also markedly lower in the humanized nursing care group (P < 0.05). Humanized nursing care can effectively alleviate negative emotions and reduce the incidence of postoperative complications in patients undergoing hysteromyoma surgery. This approach should be considered a crucial component of perioperative care for these patients. Further research may be needed to explore additional benefits and long-term outcomes of implementing humanized nursing care in this population.

National survey on the availability of oncology palliative care services at tertiary general and cancer hospitals in China

BackgroundThis nationwide survey studied the level of palliative care (PC) access for Chinese patients with cancer among cancer care providers either in tertiary general hospitals or cancer hospitals in China.MethodsUsing a probability-proportionate-to-size method, we identified local tertiary general hospitals with oncology departments to match cancer hospitals at the same geographic area. A PC program leader or a designee at each hospital reported available PC services, including staffing, inpatient and outpatient services, education, and research, with most questions adapted from a previous national survey on PC. The primary outcome was availability of a PC service.ResultsMost responders reported that some type of PC service (possibly called “comprehensive cancer care,” “pain and symptom management,” or “supportive care”) was available at their institution (84.3% of tertiary general hospitals, 82.8% of cancer hospitals). However, cancer hospitals were significantly more likely than tertiary general hospitals to have a PC department or specialist (34.1% vs. 15.5%, p < 0.001). The most popular services were pain consultation (> 92%), symptom management (> 77%), comprehensive care plans (~ 60%), obtaining advanced directives and do-not-resuscitate orders (~ 45%), referrals to hospice (> 32%), and psychiatric assessment (> 25%). Cancer hospitals were also more likely than tertiary general hospitals to report having inpatient beds for PC (46.3% vs. 30.5%; p = 0.010), outpatient PC clinics (28.0% vs. 16.8%; p = 0.029), educational programs (18.2% vs. 9.0%, p = 0.014), and research programs (17.2% vs. 9.3%, p < 0.001).ConclusionsCancer hospitals are more likely to offer PC than are tertiary general hospitals in China. Our findings highlight opportunities to further increase the PC capacity in Chinese hospitals.

Logic modelling as hermeneutic praxis: Bringing knowledge systems into view during comprehensive primary health care planning for homelessness in Australia.

Logic modelling is used widely in health promotion planning for complex health and social problems. It is often undertaken collaboratively with stakeholders across sectors that hold and enact different institutional approaches. We use hermeneutic philosophy to explore how knowledge is 'lived' by - and unfolds differently for - cross-sectoral stakeholders during comprehensive primary healthcare service planning. An Organisational Action Research partnership was established with a non-government organisation designing comprehensive primary health care for individuals experiencing homelessness in Adelaide, Australia. Grey literature, stakeholder input, academic feedback, a targeted literature review and evidence synthesis were integrated in iterative cycles to inform and refine the logic model. Diverse knowledge systems are active when cross-sectoral stakeholders collaborate on logic models for comprehensive primary health care planning. Considering logic modelling as a hermeneutic praxis helps to foreground and explore these differences. In our case, divergent ideas emerged in how health/wellbeing and trust were conceptualised; language had different meanings across sectors; and the outcomes and data sought were nuanced for various collaborators. We explicate these methodological insights and also contribute our evidence-informed, collaboratively-derived model for design of a comprehensive primary health care service with populations experiencing homelessness. We outline the value of considering cross-sectoral logic modelling as hermeneutic praxis. Engaging with points of difference in cross-sectoral knowledge systems can strengthen logic modelling processes, partnerships and potential outcomes for complex and comprehensive primary health care services.

Nursing Intervention for the Timing of Catheterization in a Patient with Frequent Abnormal Autonomic Reflexes from Cervical Medullary Injury: A Case Report

Introduction: Cervical medullary injury is a severe type of spinal cord injury that can lead to neurogenic bladder and neurogenic rectum, which increases the risk of autonomic dysreflexia (AD) in patients. Autonomic dysreflexia is a common group of clinical syndromes characterized by autonomic dysfunction after spinal cord injury in the T6 or higher level. If left untreated, AD can lead to severe complications such as hypertensive crisis, paroxysms, intracranial hemorrhage, and even death. Nursing interventions are crucial in selecting the timing of catheterization for a patient with frequent AD during intermittent catheterization for cervical medullary injury, enhancing the overall quality of care for patients with cervical medullary injury. Case Presentation: This study focused on a tetraplegic patient with a cervical medullary injury who developed AD during intermittent catheterization. The factors influencing AD during intermittent catheterization were explored through a literature review, urodynamics, and a bladder scanner. The nursing interventions implemented included active control of AD, personalized assessment of the risk of abnormal autonomic dysreflexia, prevention, early identification, acute episode management, precise bladder management, and implementation of a personalized care plan. After 31 days of treatment, the number of AD episodes was significantly reduced, leakage was decreased, and urine volume was controlled in the normal range with good results. The key points of care included timely control of urine output, selection of the best catheterization timing, and other health education methods. The nursing interventions played an active and effective role in maintaining normal bladder function, and the patient resumed regular intermittent catheterization. Conclusions: Nursing interventions are vital in managing patients with cervical medullary injuries who require intermittent catheterization. A comprehensive nursing care plan that includes personalized assessment and management of AD can significantly improve outcomes for these patients and prevent the occurrence of AD, ultimately leading to a better quality of life.

An information-motivation-behavioral skills model-based intervention for patients with epilepsy

PurposeSelf-management is crucial for patients with epilepsy (PWE) as it can effectively control the condition, improve treatment outcomes, and reduce the risk of seizures. The objective of this study was to evaluate the effectiveness of health education based on the Information-Motivation-Behavioral Skills (IMB) model in improving self-management, quality of life, and medication adherence among PWE. MethodThis study was conducted in a district in Shanghai, China, from September 2022 to March 2023. A total of 90 PWE were randomly assigned to an intervention group or a control group. Patients in the intervention group received health education based on the IMB model, whereas those in the control group received routine medical treatment only. The effectiveness of the intervention was evaluated by measuring self-management ability, quality of life, and medication adherence at three months and six months after the intervention. ResultsThe study included a total of 90 PWE; among them, 55 patients (61.11%) were male, divided into two groups: 45 participants in the control group and 45 participants in the intervention group. After 3 and 6 months of intervention, the self-management scores of the intervention group were significantly higher than those of the control group (t = 14.274, 12.448; P < 0.05). After 6 months of the intervention, the quality-of-life scores of the intervention group were significantly higher than those of the control group (t = 2.025, P < 0.05), and the medication adherence in the intervention group was significantly higher than that in the control group (X2 = 9.003, P < 0.05). ConclusionHealth education based on the IMB model is a promising approach to improving self-management, quality of life, and medication adherence among PWE. It provides personalized, patient-centered interventions that consider patients' knowledge, motivation, and behavior skills, and could be a useful tool for healthcare providers in developing comprehensive care plans for individuals with epilepsy.

Recommendations for the holistic care of patients with hereditary ATTR amyloidosis: an international Delphi consensus of patient advocates and multidisciplinary healthcare professionals

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Alnylam Pharmaceuticals Background Hereditary transthyretin-mediated amyloidosis (ATTRv) is a rare, progressive, and potentially life-limiting multisystem disease, with cardiac manifestations, managed in a specialist settings by a multidisciplinary team (MDT) and supported by allied healthcare professionals (HCPs). Purpose This online international Delphi survey aimed to evolve clinical-patient-led practical guidance for the delivery of patient-centred holistic care based on the needs and priorities of affected patients and their families. Methods A 14-member joint patient−HCP Primary Panel was convened including patient advocacy groups (PAGs) and key clinical specialties (neurology, cardiology, physiotherapy, psychology, nutrition and nursing). All members of the Primary Panel had a role in identifying the challenges and opportunities which could be addressed by the recommendations (Figure) and in the writing and reviewing of the recommendations, using published evidence/guidelines to support each recommendation. Guidance evolved on the care provision needed to support seven core goals: early diagnosis and treatment; disease monitoring and organisation of care; maintenance of physical rehabilitation and mental health; family-centred care and caregiver support; patient−doctor dialogue; access to social support; and social networking. Results Between June−October 2022, 100 HCPs and 22 PAG representatives from 27 countries took part in anonymised online Delphi voting to establish the level of agreement (≥75% group agreement) and feasibility in practice for 50 recommendations. The clinical–patient community endorsed all but one of the primary panel’s recommendations. However, only 34% (17 of 50) of the recommendations were identified by most HCPs as a core part of routine care at their institutions, with the remainder of the recommendations identified as either part of usual care (by &amp;lt;50% HCPs respondents) or as largely achievable (by a further 30%-45% of HCPs) with current resources. The highest level of agreement amongst PAG representatives was for the regular referral and assessment of patients by a nutritionist, patient education and information for families; the role of specialist centres in providing information on national patient associations; the option for interim review (telemedicine) between scheduled tertiary centre visits for patients with worsening of symptoms; the need for treatment decisions informed by discussion with the MDT and patients; and training of HCPs to increase disease awareness and early diagnosis/intervention. Conclusions This research highlights the challenges associated with the holistic care of patients, particularly in rare diseases, recognising the roles of PAGs and allied HCPs, including those in the cardiovascular specialty, in supporting patients and their families as part of a comprehensive care plan. Figure: Opportunities and challenges for the delivery of care for patients with ATTRv amyloidosis and their caregivers

The intersection of pharmacology and dentistry: A comprehensive overview of pharmacotherapeutics

Pharmacotherapy is an essential component of dental practice to manage pain, prevent infections, and maintain oral health. Analgesics such as non steroidal anti-inflammatory drugs (NSAIDs) and opioids are commonly used to manage pain during and after dental procedures. Antibiotics are prescribed to treat and prevent infections, but their use should be limited to reduce the risk of antibiotic resistance. Local anesthetics provide safe and effective pain relief during dental procedures. Fluorides are used to prevent tooth decay and strengthen tooth enamel. Dental healthcare providers should evaluate each patient's individual needs and medical history to determine the most appropriate pharmacotherapy. Patient education on the proper use of medications and potential side effects is also important. By incorporating pharmacotherapy as part of a comprehensive dental care plan, patients can experience a more comfortable and successful dental experience.

Identifying and Mapping Canadian Dietetic Students' Interaction(s) with Simulation-Based Education: A Scoping Review.

This scoping review mapped literature available on Canadian dietetics, nutrition, and foods students' and graduates' interaction(s) with simulation-based education (SBE) during undergraduate and/or practicum. One certified Librarian led the preliminary search (Summer, 2021), while three Joanna Briggs Institute-trained reviewers conducted the comprehensive search via MEDLINE (OVID), CINAHL (EBSCO), Academic Search Premier (EBSCO), Embase (Elsevier), Scopus (Elsevier), and Google (February 2022). A data extraction tool designed specifically for the study objectives and research inclusion criteria was used. We recorded 354 results and included 7. Seven types of SBE were recorded: (i) comprehensive care plan (n = 2); (ii) nutritional diagnosis/assessment (n = 2); (iii) body composition assessment (n = 1); (iv) introducing patient to dysphagia care (n = 1); (v) nutrition counselling session (n = 1); (vi) nutrition-focused physical examination (n = 1); and (vii) professional communications via social media (n = 1). Results indicate that Canadian dietitian-led SBE includes the use of simulated patients, nutritional diagnosis/assessment, and the creation of comprehensive care plans, among others. Students have been assessed for performance of trained tasks through exams, self-awareness surveys, and interviews, and SBE activities have been evaluated for effectiveness through questionnaires and interviews with users/students. Canadian literature is limited, and more can be learned by exploring the global context within and outside the profession.