Comprehensive Care Program Research Articles

Plesiomonas shigelloides infection in newborn: case report and literature review.

Plesiomonas shigelloides is a gram-negative bacillus causing foodborne infection due to contaminated seafood leading to gastroenteritis and dysentery. Instances of neonatal infection attributed to Plesiomonas shigelloides are exceedingly rare, and available literature is sparse, with only 15 reported cases to our knowledge. Central nervous system (CNS) involvement is reported, presenting severe meningoencephalitis in some cases. In this study, we report the case of a newborn with a clinical presentation of neonatal sepsis and central nervous system (CNS) involvement with meningoencephalitis caused by Plesiomonas shigelloides. Moreover, we review literature about this rare form of neonatal infection. During recovery, the baby underwent various laboratory tests and neurological diagnostic images (cerebral ultrasound, computer tomography and brain magnetic resonance), and received oxygen support, antibiotics, and anti-seizure treatment. Cerebral involvement in our patient was complicated by an extended abscess, cerebral arteritis, obstructive hydrocephalus, and a stroke which required multiple surgical interventions including drainage and a neurosurgical lobectomy. Gradual improvement in the general clinical condition of the child was observed, and he was discharged with a comprehensive follow-up program of clinical assessments, neurosurgical evaluations, neuroimaging monitoring, and physiotherapeutic care. We present a case of neonatal sepsis and neurological involvement caused by Plesiomonas shigelloides which resulted in a positive outcome despite severe neurological complications. This case contributes valuable additional data on the clinical course and radiological features of neonatal CNS involvement caused by this pathogen which is exceedingly rare and poorly described in the literature. This study also underscores the importance of targeted interventions and proposes specific recommendations for these unique cases.

Sickle cell disease in India: the journey and hope for the future.

India, the most populous nation in the world, also has a high frequency of the sickle hemoglobin (HbS) allele globally. The Arab Indian HbS haplotype in India is characterized by a relatively high percentage of fetal Hb, with widely varying frequencies of α-thalassemia. Hence, sickle cell disease (SCD) in India was perceived to be mild. Advances in the past decade in screening and SCD management have revealed that the severity of SCD in India is comparable to many other parts of the world. Clinical features in India include vaso-occlusive crisis, acute chest syndrome, avascular necrosis, renal involvement, stroke, etc, at a relatively young age. Once a fatal disease of childhood, the majority of patients born with SCD are expected to survive into adulthood, largely because of improvements in comprehensive care programs including newborn screening, penicillin prophylaxis, transcranial Doppler, and hydroxyurea therapy. Several centers are performing hematopoietic stem cell transplants successfully for SCD. To address the urgent need to control and manage SCD in India's population, the Government of India launched the National Sickle Cell Anaemia Elimination Mission, with significant funding for large-scale measures to screen, treat, counsel, educate, and develop technologies and novel therapies and gene therapies.

Patients with heart failure and reduced ejection fraction: A sub-analysis from the 3-year Coordinated Myocardial Infarction Care Program (KOS-MI) registry.

The Coordinated Care Program after Myocardial Infarction (KOS-MI) implemented in Poland has shown significant improvement in patient prognosis, ended in nationwide success, and got international attention. A similar program and methodology may be an attractive option for patients with heart failure (HF). This study aimed to analyze whether a similarly structured program would also be beneficial for HF patients after myocardial infarction. This is a multicenter retrospective study of 1972 patients hospitalized for MI. Almost half of patients (n = 963, 48.8%) participated in the KOS-MI program. In the total population, 467 patients presented with reduced ejection fraction HF (HFrEF ≤40%), and 237 (50.7%) participated in the program. Major adverse cardiovascular and cerebrovascular events were evaluated at a 3-year follow-up. Multivariate independent risk analysis was performed. We used propensity score matching for participants and non-participants in the KOS-MI program, resulting in 127 pairs. A 3-year follow-up (completed by 93% of patients), there was a 57% reduction in major adverse cardiovascular and cerebrovascular events (HR, 0.43; 95% CI, 0.31-0.6; P <0.001), 67% in mortality (HR, 0.33; 95% CI, 0.22-0.5; P <0.001), and 42% in hospital admissions for HF (HR, 0.58; 95% CI, 0.4-0.9; P <0.007) in the KOS-MI patients. There was no difference in the occurrence of MI (HR, 0.71; 95% CI, 0.37-1.34; P = 0.29), stroke (HR, 0.9; 95% CI, 0.18-4.45; P = 0.89), and repeated revascularization (HR, 0.6; 95% CI, 0.34-1.05; P = 0.07). Following propensity score matching 127, well-matched pairs between groups were created. Following adjustment, there was a statistically significant reduction in the risk of death (HR, 0.02; 95% CI, 0.29-0.89; P = 0.02) while other parameters were similar. The KOS-MI program significantly improved HFrEF patients' prognosis up to 3 years post-treatment, even after its cessation after one year. Thus, implementing a dedicated comprehensive care program for HF patients is warranted.

Do patients maintain improvement in physical capacity achieved after hybrid telerehabilitation implemented as part of managed care after acute myocardial infarction program at one-year follow-up?

Abstract Background Managed Care after Acute Myocardial Infarction (MC-AMI) is a one-year comprehensive care program dedicated to patients with acute coronary syndrome introduced in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid rehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of MC-AMI program. Purpose The purpose of this study was to evaluate whether the effect of improving physical capacity achieved after 5-week HTR was maintained during one-year follow-up. Methods The study enrolled 84 patients (90% males, aged 57.5 ± 10.2 years, LVEF 54,6 ± 6.8%) who underwent a 5-week HTR based on Nordic walking training and completed the entire one-year MC-AMI program. Unless there were contraindications, HTR began no later than 14 days after discharge from the hospital and consisted of an initial phase (1 week) conducted in an outpatient center and 4 weeks of telemonitored exercise training at home, five times weekly. Exercise capacity was assessed by comparing the exercise test results at baseline (before HTR), immediately after HTR and at the end of one-year MC-AMI program. Results HTR resulted in significant improvement in workload [METS] and workload duration in exercise test. This valuable effects were maintained after one-year follow-up. All results are presented in Table 1 and Figure 1. Conclusion The improvement in physical capacity achieved after 5-week of the hybrid telerehabilitation was maintained in patients who completed MC-AMI program in one-year follow-up.

Cardiovascular complications in COVID-19: acute management, long-term sequelae, and post-acute care strategies: a brief review

Background: The COVID-19 pandemic, driven by the SARS-CoV-2 virus, has significantly impacted individuals with pre-existing cardiovascular disease (CVD), elevating their risk of severe complications and mortality. Cardiovascular complications, such as myocarditis, acute coronary syndrome (ACS), arrhythmias, and venous thromboembolism (VTE), have been widely observed in COVID-19 patients, with mechanisms including viral myocardial injury, systemic inflammation, and a hypercoagulable state. These complications not only contribute to acute morbidity but also increase the risk of long-term cardiovascular sequelae, highlighting the need for optimized post-acute care in this population. Methods and Materials: A review was conducted based on a comprehensive search strategy using the PICO framework. Studies published from December 2019 onwards, focusing on COVID-19 patients with cardiovascular complications, were identified from databases including PubMed and Google Scholar. Objectives: This review aims to evaluate the cardiovascular complications of COVID-19, with particular attention to the acute and long-term management strategies. It seeks to assess whether comprehensive post-acute care programs tailored to cardiovascular health can reduce the incidence of long-term cardiovascular events and improve outcomes compared to standard care in COVID-19 survivors with pre-existing CVD. Discussion: The findings from this review underscore the significant cardiovascular burden faced by COVID-19 patients, particularly those with pre-existing conditions. Acute complications such as myocarditis, ACS, and VTE are common, with direct myocardial injury and systemic inflammation playing critical roles. Long-term sequelae, including persistent myocardial injury, heart failure, and arrhythmias, are increasingly being recognized, necessitating specialized post-acute care interventions. Evidence suggests that comprehensive cardiovascular rehabilitation programs incorporating lifestyle modification, pharmacotherapy optimisation, and regular monitoring may improve long-term outcomes. However, further research is required to establish the most effective management strategies, particularly for high-risk groups, such as patients with pre-existing CVD and pediatric populations.

Double burden of gestational diabetes and pregnancy-induced hypertension in Ethiopia: A systematic review and meta-analysis of observational studies.

The coexistence of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) amplifies the risk of maternal and perinatal mortality and complications, leading to more severe adverse pregnancy outcomes. This systematic review and meta-analysis aimed to assess the double burden of GDM and PIH (GDM/PIH) among pregnant women in Ethiopia. A comprehensive systematic search was conducted in the databases of PubMed, Cochrane Library, Science Direct, Embase, and Google Scholar, covering studies published up to May 14, 2023. The analysis was carried out using JBI SUMARI and STATA version 17. Subgroup analyses were computed to demonstrate heterogeneity. A sensitivity analysis was performed to examine the impact of a single study on the overall estimate. Publication bias was assessed through inspection of the funnel plot and statistically using Egger's regression test. Of 168 retrieved studies, 15 with a total of 6391 participants were deemed eligible. The pooled prevalence of GDM/PIH co-occurrence among pregnant women in Ethiopia was 3.76% (95% CI; 3.29-4.24). No publication bias was reported, and sensitivity analysis suggested that excluded studies did not significantly alter the pooled prevalence of GDM/PIH co-occurrence. A statistically significant association between GDM and PIH was observed, with pregnant women with GDM being three times more likely to develop PIH compared to those without GDM (OR = 3.44; 95% CI; 2.15-5.53). This systematic review and meta-analysis revealed a high dual burden of GDM and PIH among pregnant women in Ethiopia, with a significant association between the two morbidities. These findings emphasize the critical need for comprehensive antenatal care programs in Ethiopia to adequately address and monitor both GDM and PIH for improved maternal and perinatal health outcomes.

Societal costs and benefits of comprehensive dental care program

Societal costs and benefits of comprehensive dental care program

Exploring plantar pressure distribution in patients with newly diagnosed diabetes: Implications for foot ulcer prevention in an overweight Mexican population

IntroductionElevated plantar pressure (PP) constitutes a risk factor for developing foot ulcers. Once present, elevated PP increases morbidity and mortality in patients with diabetes. Given the high prevalence of overweight and obesity in the Mexican population, this study aimed to describe the magnitudes and the distribution of the PP observed in a sample of newly diagnosed patients with diabetes, adjusting for body mass index (BMI) groups (normal weight, overweight, grade I obesity, and grade II and III obesity). Materials and methodsA total of 250 volunteers attending a comprehensive care program for the management of type 2 diabetes received foot assessments that included vascular and neurological evaluation, the identification of musculoskeletal changes, and measurements of PP. ResultsDiabetic neuropathy and peripheral arterial disease were present in 21.6% and 11.2% of all participants. Musculoskeletal alterations were present in 70.8% of participants. A positive and significant correlation (p<0.001) was observed between BMI and the peak PP of all anatomical regions assessed. After adjusting for BMI, significant differences (p<0.001) were seen between groups. The metatarsal region, particularly under the third metatarsal head, denoted the highest magnitudes across all BMI. ConclusionsPeriodic PP assessment is recommended to identify the distribution of high-pressure points along the plantar surface. However, as a preventive measure, it is suggested to encourage patients with diabetes and overweight or obesity to wear appropriate footwear and pressure-relief insoles to relieve high-pressure areas – often seen in these populations – to help prevent foot complications.

What are the effects of comprehensive care programs for children and adolescents with medical complexity?

What are the effects of comprehensive care programs for children and adolescents with medical complexity?

Identification of implementation enhancement strategies for national comprehensive care standards using the CFIR-ERIC approach: a qualitative study

BackgroundComprehensive care is important for ensuring patients receive coordinated delivery of healthcare that aligns with their needs and preferences. While comprehensive care programs are recognised as beneficial, optimal implementation strategies in the real world remain unclear. This study utilises existing implementation theory to investigate barriers and enablers to implementing the Australian National Safety and Quality Health Service Standard 5 - Comprehensive Care Standard in acute care hospitals. The aim is to develop implementation enhancement strategies for work with comprehensive care standards in acute care.MethodsFree text data from 256 survey participants, who were care professionals working in acute care hospitals across Australia, were coded using the Consolidated Framework for Implementation Research (CFIR) using deductive content analysis. Codes were then converted to barrier and enabler statements and themes using inductive theme analysis approach. Subsequently, CFIR barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) using the CFIR-ERIC Matching Tool, facilitating the development of implementation enhancement strategies.ResultsTwelve (n = 12) CFIR barriers and 10 enablers were identified, with 14 barrier statements condensed into 12 themes and 11 enabler statements streamlined into 10 themes. Common themes of barriers include impact of COVID-19 pandemic; heavy workload; staff shortage, lack of skilled staff and high staff turnover; poorly integrated documentation system; staff lacking availability, capability, and motivation; lack of resources; lack of education and training; culture of nursing dependency; competing priorities; absence of tailored straties; insufficient planning and adjustment; and lack of multidisciplinary collaboration. Common themes of enablers include leadership from CCS committees and working groups; integrated documentation systems; established communication channels; access to education, training and information; available resources; culture of patient-centeredness; consumer representation on committees and working groups; engaging consumers in implementation and in care planning and delivery; implementing changes incrementally with a well-defined plan; and regularly collecting and discussing feedback. Following the mapping of CFIR enablers and barriers to the ERIC tool, 15 enhancement strategies were identified.ConclusionThis study identified barriers, enablers, and recommended strategies associated with implementing a national standard for comprehensive care in Australian acute care hospitals. Understanding and addressing these challenges and strategies is not only crucial for the Australian healthcare landscape but also holds significance for the broader international community that is striving to advance comprehensive care.

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.

The influence of the health status and functional capacity assessment of older people with heart failure on the participation in a cardiac rehabilitation program after myocardial infarction

Abstract Background Cardiac rehabilitation (CR) after myocardial infarction (MI), conducted by a multidisciplinary team, is considered to be the most effective secondary prevention strategy. CR might be particularly beneficial in older patients, who often suffer from heart failure (HF) and other comorbidities. Low enrolment in CR programs is observed in various age groups despite the proven effectiveness of CR in the reduction of subsequent ischemic episodes, hospitalization, and mortality risk. Purpose The study aimed to analyze the impact of the health status and functional capacity assessment of elderly patients with HF using the Vulnerable Elders Survey (VES-13) scale on the willingness to participate in the CR program as part of the national Comprehensive Care Program after Myocardial Infarction. Methods The analysis of the medical records of MI patients, who were hospitalized between 2017 and 2023 and met the inclusion criteria for CR was performed. People included in the study were ≥60 years of age and had previously been diagnosed with HF. The study included 350 people who underwent VES-13 assessment during hospitalization. The median age of the studied group was 74 (IQR 68-81), with the majority of males (59.1%). Results The willingness to participate in CR was declared by 26.3% of respondents. The median VES-13 score was 3 (IQR 2-7) points and was higher in patients who did not want to participate in CR [3 (IQR 2-7) vs 2 (IQR 1-3), p &amp;lt;0.0001]. In the group of patients who scored &amp;lt;3 points in the VES-13 scale, there was a significantly higher percentage of patients declaring their willingness to participate in CR compared to the group with ≥3 points (38.8% vs 18.5%, p=0.0001). Univariate analysis showed that all parameters assessed by the VES-13 scale had a significant impact on patients' willingness to participate in CR (Figure 1). Independent factors determining patients' declaration were age, difficulties in reaching or extending arms above the shoulder level, and limitations in shopping for personal items (like toilet items or medicines) (Figure 2). Conclusion The VES-13 scale can help to identify patients with HF after MI who require additional support and motivation in the decision process to participate in coordinated care and early CR. Limitations in the everyday functioning of elderly patients with HF determine the lack of willingness to participate in CR after MI. It is necessary to carry out intensive educational and motivational activities to improve the recruitment to the CR program.

Enhanced Comprehensive Care Programme: a retrospective study of patient empanelment by generalist-led multidisciplinary teams to reduce acute care utilisation.

Singapore faces an increasingly aged population with complex multimorbidity and psychosocial impairment. This change in demographic is challenging for existing healthcare systems. Breaks in care coordination and continuity result in poor health outcomes, increased acute care utilisation and higher healthcare costs. We proposed a patient empanelment approach adapted for the Singapore context based on the University of Chicago Comprehensive Care Physician model. This retrospective quasi-experimental, matched-controlled observational study sought to assess the effectiveness of the Enhanced Comprehensive Care Programme (ECCP) in reducing acute care utilisation at National University Hospital, Singapore. The primary outcomes were the number of hospitalisations and emergency department (ED) visits 6 months pre- and post-enrolment in ECCP. We used propensity score matching to balance prior healthcare utilisation between the intervention and control groups. Fifty-seven participants were recruited in the programme between October 2019 and April 2020. There was a reduction in the mean number of hospitalisations after intervention compared to before intervention (0.58 ± 1.03 vs. 1.90 ± 1.07, P < 0.001). There was also a reduction in the mean number of ED visits (0.77 ± 1.05 vs. 1.96 ± 1.14, P < 0.001). In the propensity-matched cohort, the mean number of hospitalisations was reduced in the intervention group (from 1.92 ± 1.07 to 0.58 ± 1.03, P < 0.001) compared to the control group (from 1.85 ± 0.99 to 1.06 ± 1.17, P = 0.04). This observational study shows the potential benefits of ECCP healthcare redesign to reduce acute care utilisation.

Assessment of oral health status and quality of life in hearing-impaired children from Syria

AimThis study aimed to evaluate the oral health status of children with hearing impairments and assess the relationship between various oral health factors and the Pediatric Oral Health-Related Quality of Life.Materials and methodsThis observational cohort study involved 90 hearing-impaired children aged 6–12 years. Diagnostic tools such as pure-tone audiometry were used to evaluate their hearing abilities. Dental health was assessed by calculating DMFT, dmft, Plaque and Gingival indices. The oral health-related quality of life was measured using the POHRQoL.ResultsThe severity of hearing impairment varied with 3% having severe hearing loss, 13% having profound hearing loss, and 83% having complete hearing loss. A high prevalence of dental cavities with 93% of children affected was found. DMFT score was similar between males and females (2.5 ± 0.3 vs. 2.3 ± 0.3 respectively). Males exhibited a higher mean dmft score (4.1 ± 0.5 vs. 3.3 ± 0.5), and a higher mean Plaque Index (1.9 ± 0.1 vs. 1.5 ± 0.1). On the other hand, females showed a higher mean Gingival Index (0.9 ± 0.1 vs. 1.1 ± 0.2). Results indicated a decreased OHRQoL with a mean POQL score of 6.4 ± 2.89. Spearman’s test revealed a significant positive correlation between POQL total score and DMFT scores (P = 0.000), dmft scores (P = 0.000), Plaque Index scores (P = 0.000), and Gingival Index scores (P = 0.038). There was a weak positive correlation between hearing impairment severity and POQL total score, it was not statistically significant.ConclusionsChildren who have hearing impairments exhibit poor oral health, and levels of dental caries, which can negatively impact their overall POHRQoL. Therefore, it is highly recommended to start specialized oral health education and comprehensive dental care programs to improve their OHRQoL.

TEACHER’S SELF-EDUCATION UNDER THE CONDITIONS OF MARTIAL LAW: FROM THE EXPERIENCE OF A HIGHER EDUCATION INSTITUTION

The article examines the problem of the teacher’s professional growth due to continuous self- education and personal development in the conditions of martial law. The aim of the article is to outline the pathways of self-educational activities for teachers and the approaches to enhancing the professional level of educators, implemented at Alfred Nobel University under martial law conditions. In the course of the research, methods of analogy, retrospective and semantic analysis, SWOT analysis, generalization, and specification of scientific principles and the regulatory framework related to teacher self-education were employed. A SWOT analysis of interpretations of the concept of “self-education” was conducted, and it was found that self-education is a necessary component of professional activity which is determined by social order and is a factor in the personal and professional growth of a specialist. Emphasis is placed on self-education of the teacher as the leading form of improvement of pedagogical skill and professional competence, which consists in assimilation, renewal, dissemination and deepening of knowledge, generalization of experience through purposeful, systematic self-education activities aimed at self-development and self-improvement of the individual, satisfaction of personal interests and objective needs of the educational institution. It was found that the conditions of the martial law in Ukraine and changes in educational orientations made corrections both in the content of teachers’ self-education and in the forms and types of their self-education activities. Some approaches to raising the professional level of a teacher, which were implemented at Alfred Nobel University under martial law conditions, namely acquiring competencies to preserve and restore mental health, providing psychological support to participants in the educational process, improving information competence, implementing effective ways to improve the quality of education in online learning, and mastering new learning/teaching methods, are considered. The content of the developed and implemented comprehensive program of care for human mental health, including a marathon of online meetings with domestic specialists and lecturers from European countries, aimed at mastering the competencies to ensure one’s own psychological health and improve the psycho-emotional state of higher education students in wartime conditions, is disclosed. The expediency of particular directions of development has been substantiated including teachers’ mastering various software, the ability to work on various educational platforms, and the use of interactive applications; cooperation and interaction with domestic and foreign higher education institutions in order to gain experience for the further implementation of the best European practices in the educational process; internships, participation in international projects, thanks to which teachers found and implemented effective ways to improve the quality of education in online learning, and mastered new methods of learning/ teaching. The feasibility of implementing special measures to support the self-educational activities of teachers under martial law conditions has been confirmed, with a focus on the targeted development of key professional competencies related to continuous professional self-development. The conclusions emphasise the need for purposeful self-education of the teacher, thanks to which a new invaluable experience of providing quality education in wartime conditions is formed.

A comprehensive supportive care program for fine-tuning cancer immunotherapy.

Supportive care has become a new pilar of modern oncology, and a great deal of research is being conducted in that area, especially on immune checkpoint inhibitors (ICIs), to help fine-tune immunotherapy. Four major areas of supportive care can enhance responsiveness to cancer immunotherapy whilst minimizing adverse effects: diet (indirectly, by modulating the microbiota or directly, by modulating the immune system), physical activity (by modulating the immune system), electronic patient-reported outcomes (ePRO) (by detecting and treating immune-related adverse events early on), and co-medication management (to possibly suppress those drugs that negatively affect the efficacy of ICIs). Therefore, patients treated with ICIs could receive a systematic multimodal supportive care program encompassing regular nutritional counseling, regular physical activity under the supervision of a physical activity professional, ePRO follow-up, and regular pharmaceutical counseling. This type of approach needs to be evaluated in well-conducted randomized clinical trials.

Experiences and preliminary effects of the Comprehensive chrOnic caRe outpatiEnt (CORE) clinic for patients with multimorbidity in the hospital setting.

Healthcare systems remain disease oriented despite growing sustainability concerns caused by inadequate management of patients with multimorbidity. Comprehensive care programmes (CCPs) can play an important role in streamlining care delivery, but large differences in setup and results hinder firm conclusions on their effectiveness. Many elements for successful implementation of CCPs are identified, but strategies to overcome barriers and embed programmes within health systems remain unknown. To address this knowledge gap through a detailed study of implementing a CCP in a Dutch hospital setting, including patient experiences, facilitators, barriers and ways to overcome those barriers. Additionally, this study aims to explore effects on patient satisfaction and healthcare use. A qualitative study design with 39 semistructured interviews and focus groups between July 2020 and February 2023 with 16 patients and 17 involved professionals. Additionally, effects on quantitative outcomes for patient satisfaction (PACIC-20) and healthcare use were explored. Professionals expressed a wide range of topics related to implementation and ways to overcome barriers at hospital and system level. Alterations in the design to accommodate varying care demands, focus on inclusions through referrals, and lack of long-term support and appropriate financing were key topics. Patients expressed varying experiences, stated a strong desire for comprehensive information, and emphasised the importance of trust in caregivers. Patient satisfaction showed no effects, while healthcare use showed slight decreases in trends, but patient numbers were limited. The introduction of a CCP is feasible, and exploratory analysis on effectiveness shows lower hospital care use without decreasing patient satisfaction. However, this is accompanied by several challenges that show current fragmented systems still do not support implementation of integrated care initiatives. Overcoming those comes with substantial costs and may require a strong bottom-up implementation within a motivated team and actions on all levels of healthcare systems.

Exploring the lived experiences of individuals with Parkinson’s disease and their relatives: insights into care provision experiences, disease management support, self-management strategies, and future needs in Germany (qualitative study)

BackgroundParkinson’s disease (PD) significantly impacts the health-related quality of life of affected individuals and their relatives. In order to support the affected individuals and their families in coping with PD, it is essential to offer comprehensive information about their experiences. A comprehensive understanding of their lived experiences with the disease, the healthcare system, applied self-management strategies and their needs is considered crucial for developing a PD support program. Therefore, we aimed to explore the lived experiences and support needs of individuals with PD and their relatives in Germany.MethodsThis non-interventional, qualitative study conducted an explorative status quo and needs assessment. It generated knowledge through semi-structured focus groups and interviews with individuals with PD at various disease stages and their relatives. The interviews were digitally recorded, transcribed verbatim, and analysed using content analysis.ResultsFifty-two individuals with PD and 29 relatives participated in eight focus groups and 13 paired and 13 individual interviews. Four themes with corresponding subthemes emerged: (1) experiences, revealing individuals’ experiences around their diagnosis and with disease-specific care provision; (2) management support offers, clarifying who provides support and the type of support offered; (3) self-management, including comprehensibility, meaningfulness and manageability; and (4) future needs, differentiating between deficits and needs. Most participants expressed a sense of abandonment when obtaining self-management strategies and mastering their lives with PD, often referred to as ‘life 2.0’. They identified the lack of structured and adequate provision of information, system orientation and social awareness.ConclusionsIn Germany, there is an urgent need for a comprehensive PD care program that addresses the needs of individuals with PD and their relatives from the start of their care trajectory. It could assist individuals in gaining a comprehensive understanding of the disease, obtaining self-management strategies, building a support network, and becoming experts in self-managing their disease. Moreover, it may positively influence their care trajectory and reduce burdens, such as overburdening, fear of progression, and health anxiety.Trial RegistrationGerman Clinical Studies Register (https://www.drks.de/DRKS00030090, No. DRKS00030090, Date of registration: 15.12.2022).

Influence of Music Therapy on the Improvement of Perceived Well-Being Indices in Women with Breast Cancer Undergoing Hormonal Treatment

ABSTRACT Background Although there are a growing number of studies investigating the benefits of music therapy interventions with patients diagnosed with cancer, few studies have taken an approach that specifically examines indices of perceived well-being in women with breast cancer. Overcoming these challenges can be an important step in the recovery process. Purpose The purpose of our study was to know the positive influence of responsive music therapy through gong sounds, emitted live, on different areas of well-being of women with breast cancer. Methods Four individual sessions of responsive music therapy with live gong sounds were conducted in which three women (M = 54; SD = 5.57) participated both in the music therapy program and in the completion of the Functional Assessment of Cancer Therapy – Breast (FACT-B) and a semi-structured interview with ad hoc designed questions about perception of qualitative aspects. Results The results showed that the music therapy sessions significantly improved, p = .043 < 0.05, various domains of perceived well-being in women with breast cancer. Discussion This article highlights several key benefits associated with music therapy and various indices of well-being in women with breast cancer, identifies the limitations of the study, and discusses the findings. It is considered necessary to replicate this practice in future studies that include a larger sample and age range over longer follow-up periods. Translation for Health Education Practice The text highlights the importance of considering music therapy as a complementary intervention in comprehensive cancer care programs, which may be relevant to health educators when considering intervention and support approaches for cancer patients. Health education interventions targeting the enhancement of cancer patients’ well-being should incorporate music therapy techniques.

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]