Comprehensive Health Care System Research Articles

Health systems strengthening to optimise scale-up in global mental health in low- and middle-income countries: lessons from the frontlines. A re-appraisal.

Against the backdrop of mounting calls for the global scaling-up of mental health services - including quality care and prevention services - there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries, and using exemplars from the front-lines in South Africa, we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. Although this approach will promote systems more enabling of scaling-up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.

Health systems strengthening to optimise scale-up in global mental health in low- and middle-income countries: lessons from the frontlines.

Against the backdrop of mounting calls for the global scaling-up of mental health services - including quality care and prevention services - there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries (LMICs), and using exemplars from the front-lines in South Africa; we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. While this approach will promote systems more enabling of scaling up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.

‘Ayushman Bharat is a Boon for the Country’: For the Motion

Ayushman Bharat approved by the Indian government in March 2018, is an ambitious reform to the Indian health system to provide Comprehensive Primary Health Care (CPHC) and to achieve Universal Health Coverage. The Ayushman Bharat with two components intends to provide a continuum of care services across the three-level of care, expanded service delivery through population enumeration and empanelment of Families at HWC and also expanded the range of preventive, promotive, curative, diagnostic, rehabilitative and palliative care services. There is sufficient evidence available that strengthening of primary healthcare is the most appropriate approach to achieve UHC. Investment on comprehensive primary healthcare system is a practical and affordable solution for India. The concept of Mid-Level Health Provider (MLHP) is newly introduced to improve Sub center and PHC resource utilization. Health and wellness centers with referral services provide preventive, promotive, curative, rehabilitative and palliative aspects with the inclusion of non-communicable disease and other important component will make the programme to deliver Comprehensive health care. With the availability of extensive potentially trainable human resources at comparatively low cost, the Health services of the programme are provided with the Human resource incentives. Ayushman Bharat National Health Protection Scheme will be implanted in conjunctions with the existing state insurance scheme, will provide a cashless benefit for identified secondary/ tertiary treatments, in public/ empaneled private facilities all over India without any cap on family size and age, beneficiaries being identified on the basis of Socio-Economic Caste Survey (SECC) 2011. The Utilization of manpower under Ayushman Bharat is proved by successful engagement and potential usage of nearly 1 million ASHA under the National Health Mission (NHM). The programme provides an innovative initiative of building a highly impactful health model with low cost with the utilization of skilledworkforce. This review describes why Ayushman Bharat is a boon for the country.

A modified-Delphi study of a framework to support the potential implementation of pharmacist prescribing.

There is an extensive evidence base of the effectiveness and safety of pharmacist prescribing around the globe. There is therefore potential to develop a framework to support the implementation in Qatar to achieve the National Vision 2030 of establishing a comprehensive world-class healthcare system by better utilisation of its healthcare workforce. To determine the levels of agreement amongst key stakeholders regarding a framework for the potential development and implementation of pharmacist prescribing in Qatar. A quantitative, consensus-based modified Delphi study involving stakeholders in Qatar with key strategic positions of health policy influence (directors of medicine/nursing/pharmacy, lead administrators, health-related academics, patient safety leads, professional regulators) was conducted. Delphi statements were developed from extensive literature reviews, semi-structured interviews, pharmacist prescribing frameworks implemented in other countries, and based on the Consolidated Framework for Implementation Research. The scope of the statements included definitions and scope of prescribing, education and training, and governance, were validated with eight specialists from UK and Qatar, and presented as an online Delphi. Consensus was set at 70% or higher agreement and less than 15% disagreement for each statement. Thirty-three experts agreed to participate in the Delphi, with a response rate of 94% for Round 1 and 91% for Round 2, at which point the Delphi stopped. Consensus was achieved for 38 out of 47 statements indicating that a collaborative prescribing model was preferred, and that experience and additional training were required along with robust governance. Consensus was not reached in relation to independent prescribing, prescribing controlled drugs, and ordering certain diagnostic/monitoring investigations (e.g. ECG, X-ray). High levels of agreement were attained for statements, which can constitute a framework for the development and implementation of pharmacist prescribing in Qatar. Further work is required to translate this framework into healthcare policy and practice.

What are the Experiences and Needs of Primary Care Nurses in Caring for Patients With Type 2 Diabetes in a Rural Village in South Africa? An Exploratory Study

Since 1994, the emphasis in the provision of health services in South Africa has shifted from hospital-based care to a community-based comprehensive primary health care system, especially important in the management of chronic diseases. However, primary health care professional nurses are not well trained to manage chronic conditions like type 2 diabetes. Therefore, this study aimed to explore the experiences and needs of primary care nurses as a basis for the development of a training programme for professional nurses who care for T2D patients. A qualitative descriptive approach was employed, using individual interviews with primary health care nurses caring for T2D patients in the Ga-Dikgale village clinics. Ethical considerations were observed throughout the study and quality supportive measures were employed. Three main themes emerged from the study findings which address the current practices and knowledge of professional nurses related to care provided to diabetes patients, the challenges experienced by professional nurses during the provision of care to diabetes patients on treatment and their training experiences, gaps and needs. A need for continuing education for professional nurses related to the care of patients with diabetes was identified. The results of this study will be used to develop a training programme to improve the knowledge and skills of professional nurses and to improve the quality of care of patients with type 2 diabetes.

Predicting Chronic Disease by Monitoring Patients Updating Sensor Information with Big Health Application System

Nowadays the advances in the computer technology have validated great development on healthcare technologies in numerous fields. However these new technologies have made also healthcare data not only much bigger but also much more difficult to handle and process. Currently the peoples are leading to death because of the proper distribution of medical resources over the world. Cloud and big data not only are important techniques but also are gradually becoming the trends in healthcare innovation. However these problems can be greatly solved by building a healthcare system with the help of these new technologies. But the greatest challenge of building a comprehensive healthcare system is in the handling of the heterogeneous healthcare data captured from multiple sources. In-order to provide a more convenient service and environment of healthcare, this paper proposes a big health application system based on the health internet of things and big data. The world is confronting issues, for example, uneven conveyance of restorative assets, the developing endless maladies, and the expanding restorative costs. Mixing the most recent data innovation into the human services framework will enormously alleviate the issues. So building huge well being application framework by adequately coordinating medicinal well being assets utilizing keen terminals, well being Internet of Things (IoT), enormous information and distributed computing is the significant method to unravel the above issues. Also in this work proposes a new convolutional neural network based multi-modal disease risk prediction (CNN-MDRP) algorithm using structured and unstructured data from hospital.

Abstract 99: Panniculectomy in Preparation for Renal Transplant Candidates: A 10-Year Experience

PURPOSE: Candidates for renal transplant are frequently denied access to transplant surgery due to obesity and poor functional status. Many patients are required to lose significant weight in order to maintain candidacy. Successful weight loss commonly produces a panniculus encompassing the lower abdominal surgical site used for transplant surgery. These patients are declined for renal transplantation secondary to predictable wound healing complications. To decrease post-transplant wound and graft complications, we implemented a Transplant/Plastic Surgery Program where patients underwent panniculectomy in an effort to regain candidacy on the renal transplant waiting list. We previously published our results of 21 patients in 2015, here we present our updated 10-year experience. METHODS: We performed a retrospective review of all patients deemed high-risk for post-kidney transplant wound complications who underwent panniculectomy in preparation for renal transplantation at our institution from 2008 to 2018. All patients had a minimum of 3 months follow-up. Patient characteristics (age, BMI, medical comorbidities, maximum BMI and weight lost prior to panniculectomy) and surgical outcomes (specimen weight, operation length, time to drain removal, wound complications, time to treat complication) were analyzed after panniculectomy as well as after transplantation. RESULTS: We performed 60 panniculectomies in renal transplant candidates. Wound complications occurred in 29 patients (48%). Minor wound complications (wound separation, cellulitis, skin necrosis) occurred in 21 patients (35%), major wound complications (hematoma, seroma, abscess, unplanned return to the operating room) occurred in 10 patients (17%). 30 patients have since undergone renal transplantation. No patients have had post-transplant wound healing complication. CONCLUSION: Panniculectomy in preparation for renal transplantation can be performed in patients with end-stage renal disease with a high but manageable complication rate, converting previously ineligible patients into eligible candidates for kidney transplantation. These wound complications are more easily managed prior to institution of immunosuppression required for renal transplant. While performing panniculectomies in these high-risk patients clearly shifts the burden of complications from Transplant Surgery to Plastic Surgery, it improves patient access to a life-extending procedure, further supporting Plastic Surgery’s vital role in our comprehensive healthcare system.

Pradhan Mantri Jan Arogya Yojana: A Paper Tiger

The current budgetary allocation of ₹20 billion under the Pradhan Mantri Jan Arogya Yojana (PMJAY) is grossly inadequate. Our paper estimates that in the current fiscal year, the scheme will require an allocation of at least ₹420.73 billion to be able to give any meaningful coverage to 0.1 billion targetted families. This paper argues that such an expensive tertiary sector- led medical care coverage model is not the correct approach to ensure Universal Health Care (UHC) in India. A majority of illnesses are treatable at the primary level and an unbalanced promotion of the tertiary sector while neglecting primary healthcare will cause a delay in treatments, resulting in more complex and expensive medical interventions. What India urgently needs is to develop a comprehensive primary healthcare system.

Recovering from Cystectomy: Patient Perspectives.

Background:Bladder cancer patients who undergo cystectomy and urinary diversion face functional and quality-of-life challenges. Little is known about these patients’ experiences during decision-making, surgery, and recovery, or how they vary by treatment setting.Objective:To learn about patients’ experiences with treatment choice, surgical care, and recovery across health settings. Understanding patient experiences is essential to closing care gaps and developing patient-reported measures.Methods:We conducted focus groups with cystectomy patients and family caregivers at a large comprehensive health care system (N = 32 patients) and an NCI-designated comprehensive cancer center (N = 25 patients and 5 caregivers). Using standard qualitative methods, we identified themes that are not well-represented in existing research.Results:Across both systems, patients described variable experiences in decision-making about their cystectomy and urinary diversion. Some felt overwhelmed by information; others felt poorly informed. Many found self-care equipment challenging; many felt they knew little about what to expect regarding chemotherapy, recovery, and transitioning home. At times, health care personnel could not help manage patients’ ostomies or catheterization equipment. Our study also contributes a grounded theoretical framework for describing meaningful domains of patient experience with cystectomy and urinary diversion. We identified a common trajectory that includes decision-making, surgery and post-operative recovery, mastery of self-care, and reintegration.Conclusions:Patients with radical cystectomy and urinary diversion report a wide variety of experiences not captured by quantitative measures. These findings demonstrate that many cystectomy patients could benefit from additional post-operative support. We offer a framework to measure patient-centered domains in future research.

Comprehensive Health Care System without Traditional Medicine: A Distorted Approach

Comprehensive Health Care System without Traditional Medicine: A Distorted Approach

Assessment of Health Status of the Elderly and Pre-elderly at a Malaysia Elderly Care Centre

They were once called the baby boomers, born between 1946 to 1964, but now aged above 50 years old, they contribute to the increasing number of elderly population in Malaysia. Age classification for elderly people varies between countries but commonly pre-elderly people is defined as those aged between 50 to 64 years old while those aged more than 64 years old fall in elderly category. In Malaysia, it is projected that the elderly population will make up for 10% of the total population or 3.4 million by year 2020. Without effective and comprehensive healthcare system, the healthy lifestyle of this elderly population can be affected thus prohibiting them to return to their premorbid function. In this study, the health status of pre-elderly and elderly community residing at an Elderly Care Center in Selangor, Malaysia is assessed. In overall, 12 male occupants (4 elderly and 8 pre-elderly people) aged 50 years and above were interviewed to obtain data on their sociodemographic characteristics, medical history, hand functionality and hand strength measurements. The overall sample mean (standard deviation) age are 63 (8) years. The mean (standard deviation) for BMI is 20.26 (2.73) kg/m2 that falls in the normal category despite the visible nutritional deficiencies sign and symptoms on their physical body and facial. The mean (standard deviation) of handgrip measurements is 12.47 (6.69) kg, which is quite low but reasonable due to ageing factor.

The influence of quality of primary care on productive interactions among community-living frail older persons and their general practitioners and practice nurses

Introduction: The Chronic Care Model CCM identifies important elements of primary healthcare systems that promote high-quality care, foster productive patient-professional interactions and improve patient outcomes. We lack evidence regarding the influence of quality of care on productivity of patient-professional interactions in a population of community-dwelling frail older adults. Exactly these productive interactions are at the heart of patient-centered care and considered essential in improving patient outcomes. The aim of our study was to investigate whether community-living frail older persons’ perspectives on quality of primary care delivery according to elements of the CCM are associated with perceived productivity of interactions with general practitioners GPs and practice nurses. Methods: A longitudinal study was conducted in the Netherlands between 2014 and 2017. The study included 4 GP practices providing usual primary care and 11 GP practices that implemented the proactive, integrated care approach ‘Finding and Follow-up of Frail older persons’ FFF. Interrelated components of the FFF approach e.g. multidisciplinary consultations, proactive case finding are presumed to promote high-quality care delivery and foster productive patient-professional interactions. Our study included 464 independently living frail older adults ≥ 75 years. Perceptions of quality of primary care Patient Assessment of Chronic Illness Care Short version; PACIC-S and productive interactions with the GP and practice nurse relational coproduction instrument were assessed at baseline and 12 months after. Data were analyzed using chi-square tests, t-tests, and multilevel methods. Results: Perceived quality of primary care, productive interaction with the GP and productive interaction with the practice nurse improved over time in both the intervention group and control group. Productive interactions with the GP and practice nurse were significantly influenced by the perceived productive interaction at baseline, the perceived quality of primary care at baseline, and the change in perceived quality of primary care over time. We found no significant differences between the intervention group and control group. Discussion and conclusion: Our study showed that perceived productive patient-professional interactions are associated with the perceived quality of primary care delivery in a sample of frail independently living older persons. Based on the relatively robust and comprehensive primary healthcare system in the Netherlands, the contrast between the FFF approach and care as usual may be too small to detect substantial differences between the groups. Lessons learned: Our study stresses the need to invest in high-quality primary care and interactions among frail older persons and their healthcare professionals. Especially in the care for older persons with often long-term complex healthcare needs and multimorbidity, productive patient-professional interactions seem to be important. Limitations: We limited the selection of professionals to GPs and practice nurses. These professionals are most frequently contacted in general practice in the Netherlands. Moreover, we did not examine whether improvements in quality of care and productive patient-professional interactions resulted in improved patient outcomes, like well-being. Suggestions for future research: Research to examine productive interactions with other professionals, like elderly care physicians, is necessary. Furthermore, the influence of improvements in quality of care and productive patient-professional interactions on patient outcomes should be investigated.

Essential elements of caregiver support in gynecologic oncology.

160 Background: Caregivers are instrumental to the health and well-being of gynecologic cancer patients and can be deeply affected by the demands of caregiving. Our aims were to increase awareness of the unmet needs of family caregivers of women with gynecologic cancers and provide recommendations for essential elements of support needed by caregivers to ensure that family caregivers are recognized and supported as key members of the patients’ care teams. Methods: Over the course of a year, a 16-person steering committee and 40 stakeholders, including caregivers, patients, and clinicians, participated in a modified Delphi approach to assemble, review and prioritize a set of essential elements for caregiver support. The process culminated in a multi-disciplinary research roundtable. Stakeholders prioritized caregiver needs and discussed, brainstormed and prioritized essential support services necessary to meet those needs, using three rounds of consensus-building activities. Basic descriptive statistics were performed to feed means and rankings back to stakeholders prior to each round. Results: Stakeholders prioritized the top three needs of caregivers as: 1) to obtain information about their loved one’s cancer (M = 4.18, SD = 4.33), 2) how to provide support and comfort to their loved one (M = 3.18, SD = 3.92) and 3) how to maintain their own emotional health and well-being (M = 2.94, SD = 3.90). Fifteen Essential Elements of Support to address the needs of caregivers of women with gynecologic cancers were identified. These ranged from supports that are immediately actionable (e.g., information for the caregiver on managing the patient’s symptoms, skilled-care training, a point-person to help navigate the system) to more aspirational supports (e.g., integrative services focused on the health and well-being of the caregiver). Conclusions: Caregivers are an integral part of cancer care, though their needs are inconsistently addressed by the care team. In order to provide comprehensive quality care, clinicians and healthcare systems should strive to provide caregivers with the Essential Elements of Support identified in this study and continue to build a healthcare system incorporating caregivers’ needs.

Upcoming epidemic of asbestos-related malignant pleural mesothelioma in Taiwan: A prediction of incidence in the next 30 years.

Globally, asbestos-related diseases (ARDs) keep rising over the coming decades. The epidemic of ARDs will be a burden on public health. We aimed to predict the malignant pleural mesothelioma (MPM) incidence in the next 30 years for Taiwan based on historical asbestos consumption. We collected annual data on local asbestos consumption during 1939-2015 and sex-specific incidence of pleural cancer as a proxy for MPM during 1979-2013. We applied Poisson log-linear models to predict future MPM numbers under the assumption that latency periods between asbestos exposure and MPM incidence were between 25 and 45 years. Asbestos consumption reached a peak in the 1980s, with a total of 668 thousand metric tons during 1939-2015. The observed number of MPM incidence increased by 9- and 6-fold in males and females during 1979-2013, with a cumulative number of 907. Given a latency period of 31 years, MPM incidences were expected to peak around 2012-2016 for males and 2016-2020 for females. In 2017-2046, the predicted total number of new MPM might reach 659 cases (95% confidence interval=579-749); and the male to female ratios ranged from 1.8 to 2.8. The MPM epidemic in Taiwan will likely peak in 2012-2020 as a result of local asbestos consumption. Approximately 659 new MPM cases in the next 30 years warrant an urgent need to implement a total asbestos ban and put more resources on a comprehensive surveillance, diagnosis, and follow-up health care system for ARDs.

Gender equality is crucial to the fight for better HIV treatment access and outcomes in the MENA region

Gender equality is crucial to the fight for better <scp>HIV</scp> treatment access and outcomes in the <scp>MENA</scp> region

Health and human development in Kenya

PurposeThis paper aims to critically analyze the empirical literature on health and human development in high-, middle- and low-income countries to develop a sustainable model for investing in human health. The model is critical in building a comprehensive health-care system that fosters the stakeholders’ financial stability, economic growth and high-quality education for the local community.Design/methodology/approachA comprehensive literature review was carried out on health, human development and sustainable health investment. After thoroughly examining theoretical frameworks underlying the strategies of successful human health systems, a summary of empirical articles is created. Summaries provided in this paper represent relevant health-care strategies for Kenya.FindingsBased on the empirical review of literature, a Nexus Health Care model focusing on human development, social and cultural development, economic development and environmental development in high-, middle- and low-income countries is proposed. The goal of this model is to enhance sustainable development where wealth creation is accompanied with environmental uplifting and protection of social and material well-being.Research limitations/implicationsThis paper is limited to a comprehensive literature review presenting empirical evidence of human development and sustainability.Originality/valueKenya like other developing nations aspires to contribute significantly in improving health through development of health products but the approaches used have been limiting. In most cases, the use of Western theories, lack of empowering the community and dependence on donor support have hindered the country from achieving comprehensive health and human development. This papers seeks to develop a model for health-care investment and provide strategies, operations and structure of successful health systems and human development for a developing country, such as Kenya.

Technological Health Intervention in Population Aging to Assist People to Work Smarter not Harder: Qualitative Study.

BackgroundTechnology-based health care has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work.ObjectiveThe objective of this study was to investigate how and why electronic health (eHealth) has been applied in Taiwan and to suggest implications that may inspire other countries facing similar challenges.MethodsA qualitative methodology was adopted to obtain insightful inputs from deeper probing. Taiwan was selected as a typical case study, given its aging population, advanced technology, and comprehensive health care system. This study investigated 38 stakeholders in the health care ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion.ResultsFirst, respondents indicated that the use of technology can enable seamless patient care and clinical benefits such as flexibility in time management. Second, the results suggested that a leader’s vision, authority, and management skills might influence success in health care innovation. Finally, the results implied that both internal and external organizational governance are highly relevant for implementing technology-based innovation in health care.ConclusionsThis study provided Taiwanese perspectives on how to intelligently use technology to benefit health care and debated the perception that technology prevents human interaction between clinicians and patients.

An Interdisciplinary Approach to a Well-Rounded Campus Healthcare Delivery System

An injury care clinic (ICC) as part of a comprehensive campus-wide healthcare system is a cost-effective way to optimize the flow of patient care utilizing a collaborative model of healthcare in a time of physician shortage. Services include: basic first aid, injury evaluation, acute injury care, basic rehabilitation, preventative techniques including taping and stretching, and professional referrals. The ICC provides care to previously underserved campus community members, focusing on: club sport and intramural athletes, recreation center users, and the general student body, in addition to faculty and staff, going beyond the varsity athlete. The ICC functions through the efforts of athletic trainers, physicians, fitness specialists, administrators, faculty, and students across disciplines. After 3 years, the clinic has serviced more than 2,500 unique patients exceeding 4,800 patient encounters, demonstrating outcomes that access to affordable healthcare options with a licensed healthcare provider are warranted and needed.

Medical Ethics and Health Care System

Background and Aim : Daily development of the human knowledge, promotion of biomedical technologies and improvement of physicians' ability in diagnosis and treatment of different types of diseases have always accompanied plenty of discussions and challengeable subjects, especially from the view point of ethical issues. Obtaining deep and accurate recognition of these subjects, the attention of the physicians and the scholars of different fields, especially of the has been drawn to as a new solution in the comprehensive Healthcare System. Materials and Methods : Available, published and related articles were located with an Ovid MEDLINE search for Ethics, Medical, and Ethics. The Internet was searched for medical and ethics, science and and and ethics using the Google search engine (www.google.com). Ethical Considerations : The principles of research have been observed in studies and citing the primary texts and sources. Findings : Despite the great changes in technologies, there are still some concerns about the physicians' abilities in decision makings that may directly or indirectly affect the health or life of the people. Therefore these concerns have leaded to the appearance of new movements all calling for the patients' rights and the rights of society to participate in decision-makings. On the other hand we should notice about some other cases that play effective roles in policy makings of the comprehensive healthcare system. For instance, the required resources will vary following the changes in technology; the population especially of the elderly is increasing; moreover the time needed for the new work forces to be entered into the labor market has typically increased. Consequently, a higher number of people are waiting to benefit from the recourses and lower number of them is involved in producing the recourses. Conclusion : Thus, to work on the important topics like the requirements of human societies, ethical considerations of biotechnology and researches, Allocation of limited and immense resources, important ethical criteria of decision makings, representation of fundamental solutions and trainings is considered as one of the most basic necessities of comprehensive healthcare system among others. Citation: Zali AR. Medical Ethics and Health Care System. Bioeth Health Law J . 2017; 1(1):19-25.

Improving milk for human consumption through genetic engineering technologies

Improved living conditions, food security and particularly access to comprehensive health care systems resulted in a continuous increase of the human life expectancy. However, living longer does not immediately mean quality of life can be maintained into old age which is commonly compromised by disease and the full benefit of a longer life can only be realized when the later stages of live can be enjoyed in good health. This has generated strong demand for new innovative foods that are not only save and nutritious but also have health enhancing properties. Genetic modification technology provides a direct approach of enhancing existing attributes that are beneficial for human health, minimizing any undesirable characteristics or enabling the introduction of novel, health promoting traits. Focused on milk as an important human food source, we will review the humble beginnings of testing transgenic approaches with mouse models, transfer of these simple overexpression strategies into livestock species, application of programmable nucleases for the targeted modifications of milk characteristics and discuss future opportunities that are becoming feasible with today’s sophisticated technical capabilities.