Comprehensive Medical Care Research Articles

The Role of the Nurse in the Optimal Care of Patients with Heart Failure

Heart failure (HF) is a clinical condition that requires comprehensive medical care, consisting of supervision by a cardiologist, primary care physician (PCP), nurse practitioner and nutritionist. A physiotherapist, pharmacologist play a no less important role, and psychological support for both the patient himself and his family can be equally helpful, which can positively influence the treatment process. A significant problem in the care of patients with HF are repeated hospitalizations, which can result from the progression of the disease itself, but also from suboptimal therapy, comorbidities or noncompliance. As each hospitalization worsens the patient's prognosis, but just as importantly, generates high costs, outpatient care options involving different groups of medical personnel are being sought to improve the prognosis and quality of life of HF patients, but also reduce the cost of care. Currently, 90% of the budget for HF care is consumed by hospitalizations. This article aims to show how the competencies and tasks of a nurse can be used in the care and education of a patient with HF. The role of the nurse in the outpatient care of patients with HF is emphasized by the guidelines of the European Society of Cardiology, resulting in the creation of the Education and Certification Program for Heart Failure Nurses in Poland under the auspices of the Polish Cardiac Society, the Heart Failure Association, the Supreme Chamber of Nurses and Midwives.

Enacting an "Empowerment Approach" After Sexual Assault: The Views and Beliefs of Forensic Nurse Examiners and Crisis Support Workers.

Sexual violence is a profoundly disempowering experience. It is essential that survivors are offered access to comprehensive medical care, psychological support, and follow-up in a way that offers them a high level of choice and control. There has been little research into how practitioners working in the context of immediate postassault understand empowerment and reflect this in their care delivery. This study sought to explore how crisis support workers and forensic nurse examiners conceive how they enact an "empowerment approach" in a sexual assault referral center (SARC) in the United Kingdom. A phenomenological approach was taken, and data were gathered through focus groups and interviews. Themes were identified under the headings of "indicators of empowerment," "empowerment as a process," and "the empowerment approach." As part of providing person-centered care that enacts an empowering approach within the SARC setting, professionals need the skills and resources to be able to respond flexibly to their clients. They have a role in addressing victim blaming of those subjected to sexual violence and in promoting the accessibility of SARC services.

Herbal Emulgel Containing Azadirachta indica (Neem) and Nigella Sativa L. (Black Cumin) Oils in Wound Management: Preclinical Investigations

Abstract Context: In wound management, traditional use of plants has received attention by the scientific community, as traditional medicines are a valuable source of affordable, comprehensive medical care. Azadirachta indica A. Juss (Neem) and Nigella sativa Linn (Black cumin) are well known versatile medicinal plants with wide spectrum of biological activity. Methods: This study was undertaken to evaluate the wound healing activity of neem oil (NO) and black cumin oil (BCO) in rats. The oils were standardized using standard procedures. Gas chromatography mass spectrometry analysis and high performance thin layer chromatography fingerprinting of oils were carried out to identify major phytoconstituents present in the oils. The oils were suitably incorporated in carbopol based emulgel formulation, evaluated for physicochemical parameters and stability. Results: The wound healing potential assessed by the measurement of wound contraction and histopathology studies in excision and burn wound models, demonstrated comparable efficacy with standard nano crystalline silver gel (0.002% w/w). This may be attributed to the presence of phytoconstituents such as nimbidin and thymoquinone present in selected oils. Polyunsaturated fatty acid profile of BCO may be responsible for stimulating the release of vascular endothelial growth factor, which plays a significant role in accelerating wound healing process. Conclusion: Topical carbopol 934 base emulgel containing natural oils such as BCO and NO have been successfully prepared for wound management. However, further studies to establish the mechanistic aspects of wound healing needs to be undertaken.

Role of Public and Private Universities’ Recruitment and Selection Strategies on Employees Retention in Kenya.

To survive in the rapidly changing and competitive global economy, universities in developed and developing countries, have recognized human resourcing, selection, retention and employee turnovers as among the major concerns facing managers which must be dealt with carefully if they are to keep pace with the stiff competition and realize their desire for improved institutional performance. The study’s purpose was to evaluate the role plaid by recruitment and selection frameworks on retention of employees in Public and Private Universities. By applying descriptive design and stratified random sampling criteria, the study used 384 respondents out of 50,670 staff members working in the seventy (70) approved Universities. Data which was analyzed by using linear regression models where SPSS Version 23 software was applied, made use of questionnaires as the main research tool to collect data. Based on analyzed data the study established that 58.5% of employee’s retention was realized as a result of suitable recruitment and selection frameworks put in place by managers of universities who participated in this study. Besides, the study established that employees’ Human Resource Planning framework which registered a P-value of .672 followed by a recruitment framework that had a P-value of .585 and a career development plan whose P-value stood at .584 were most significant factors which made employee retention in those institutions realizable. The researcher established that Recruitment and Selection strategies played a major role in universities employee retention and therefore recommends that, other human resourcing frameworks which includes a comprehensive medical care for all employees, better remunerations, and pension and leave allowances, among others, be given consideration by universities’ boards of management and councils so as to further improve employee retention. The study also recommends the need to have one well-structured selection policy which should be adhered to by all universities.

Optimized system of comprehensive medical care for the population with destructive diseases of large joints at the regional level

Optimized system of comprehensive medical care for the population with destructive diseases of large joints at the regional level

Analysis of Ear, Nose, Throat and Head & Neck Surgery Consultations and Diagnostic Accuracy in a Tertiary Care Hospital of Western Nepal

IntroductionENT cases are very common accounting for 25-40% of all hospital patient. Subspecialty consultations are a necessary part of comprehensive medical care that provide an opportunity for interactions between doctors and the exchange of knowledge and expertise that helps in quality patient management. MethodsA descriptive cross-sectional study was conducted among patients asked for consultation in the Department of ENT and Head & Neck Surgery, Manipal Teaching Hospital from March 2022 to November 2022. Diagnosis made by ENT surgeon after relevant investigations was recorded. Analysis of diagnostic accuracy by non-ENT surgeons was carried out. ResultsOut of 8019 cases seen in the department of ENT and Head & Neck Surgery from 15th March 2022 to 25th November 2022, 400 cases were asked for consultations. Consultations were more frequently asked from Internal medicine and subspeciality followed by Emergency and Pediatrics department. The most common complaint in consultation sheet was throat pain. The commonest ENT and Head & Neck Surgery diagnosis was Allergic Rhinitis, followed by Presbyacusis and Acute Tonsillitis. Two hundred and twenty cases were asked for consultations with diagnosis from the primary department, out of which 183 had correct diagnosis. Conclusions Different departments do have difficulties in identifying and addressing ENT and Head & Neck Surgery cases and there is benefit from ENT and Head & Neck Surgery consultations. Furthermore, ENT and Head & Neck Surgery consultations do have high educational value for other departments and plays a vital role in patient management.

STUDY OF THE PROBLEM OF CHILDREN’S EPILEPSY IN THE REPUBLIC OF SAKHA (YAKUTIA)

Epilepsy is one of the most common diseases of the nervous system in children. According to WHO, more than 50 million people worldwide suffer from epilepsy. It is estimated that the proportion of the general population with its active form (that is, with recurrent seizures and the need for treatment) currently ranges from 4 to 10 per 1,000 people. Globally, 2.4 million people are diagnosed with this disease every year. In Russia, epilepsy affects more than 1 million people. The analysis of statistical data on the prevalence and incidence of epilepsy in children in the Republic of Sakha (Yakutia) was carried out. In Yakutia, the first epidemiological study of epilepsy in the pediatric population was conducted in 1985 by E.A. Krivogornitsyna. As a result of the survey, data were obtained on 322 children who were registered at the dispensary with neurologists and psychiatrists in 32 districts of the republic and the city of Yakutsk. According to the study of the epidemiology of epilepsy in children in 2004 (Baisheva G.M., 2004), the prevalence of epilepsy was 5.2 per 1,000 children of the Republic of Sakha (Yakutia), and the primary incidence was 114 per 100,000 children. Prevalence of epilepsy in children under 14 years of age in 2020 was 5.4 per 1,000 population, the primary incidence was 50 per 100,000 population. On average, from 2010 to 2020, the primary incidence of epilepsy in children is 80 per 100,000 population. The prevalence of epilepsy in adolescents aged 15 – 17 years averaged 10.4 %. The average value of primary morbidity in this group of children was 140 per 100,000 population. The organization of comprehensive medical care will make it possible to form a strategy for the management of epilepsy patients at the municipal and republic levels.

Perspectives of women living with type 1 diabetes regarding preconception and antenatal care: A qualitative evidence synthesis.

Pregnant women with type 1 diabetes may have an increased risk of complications for both the baby and themselves. Educational programmes, preconception planning, strict glycemic control and comprehensive medical care are some of the antenatal interventions that have been proposed to improve the outcomes of pregnant women with type 1 diabetes. While some evidence-based recommendations about antenatal care are included in clinical practice guidelines (CPGs), the views, and experiences of women with type 1 diabetes about these interventions are not well known. To understand and synthesize the perceptions of women with type 1 diabetes about the interventions before pregnancy. A qualitative evidence synthesis (QES) was carried out with a framework analysis guided by the Cochrane Qualitative and Implementation Methods Group approach. Three online databases (Medline, Embase and Web of Science) were searched. We included qualitative articles that were published from 2011 to 2021 and which were available in English or Spanish. Ten references met the inclusion criteria of the study and were included. Three main themes were identified: (a) acceptability of antenatal care, (b) feasibility and implementation consideration and (c) equity and accessibility difficulties. Continuity of care, coordination between health professionals and services, and a more holistic approach are the key aspects women say need to be considered for more acceptable, feasible and equitable preconception and antenatal care. This QES was carried out as part of the CPGs on diabetes mellitus type 1, carried out as part of the Spanish Network of Health Technology Assessment Agencies. In this CPG, the representatives of the patient associations are Francisco Javier Darias Yanes, from the Association for Diabetes of Tenerife, who has participated in all the phases of the CPG; Aureliano Ruiz Salmón and Julián Antonio González Hernández (representatives of the Spanish Diabetes Federation (FEDE) who have participated as collaborator and external reviewer, respectively.

Families' perception of proposed nutrition screening on admission to pediatric hospitals: a qualitative analysis.

Nutrition screening is the first step in most acute care pediatric nutrition care pathways. However, there is a lack of understanding of patient and families' perception of nutrition screening in pediatric populations. The objective of this study was to explore the potential perceptions, feelings, and opinions of families if pediatric nutrition screening were to be completed during hospital admission. Nine members of the Family Advisory Council at the Alberta Children's Hospital participated in a focus group to discuss questions around nutrition screening practices, malnutrition, and the pediatric nutrition screening tool. Transcripts were analyzed using MAXQDA and thematic analysis using the Braun and Clarke methodology. Two major themes emerged: screening may raise sensitive emotions and understanding the purpose of nutrition screening and the questions. Participants agreed discussions around growth and nutrition are vital to comprehensive medical care; however, the timing and approach of nutrition screening can lead to anxiety and feelings of judgement. A lack of understanding of the purpose of screening, next steps, and benefit to the individual patient could limit acceptance of nutrition screening. The findings of this study can inform training and education of healthcare professionals involved in nutrition screening.

Arterial hypertension and erectile dysfunction: an experience in the study of their comprehensive care

At present, the issues related to arterial hypertension and erectile dysfunction constitute one of the phenomena that have attracted most attention in the last five years, due to their prevalence. This complex comorbidity, due to its psychological, physiological and medical implications, requires comprehensive in-hospital and out-of-hospital care. The primary purpose of the research was to identify the main categories that should be considered in the design of a comprehensive care process for patients with arterial hypertension and erectile dysfunction. A mixed methodology was used, with qualitative predominance. The process was divided into two stages, the first for the implementation of a grounded theory design and the second for a descriptive exploratory cross-sectional study. The main results show the need to further explore the etiology of both disorders and the physio-psychological nature of comorbidity. In addition, categories were identified that point towards the importance of disease critique and treatment adherence, multi- and interdisciplinary care with designed linkage of multimodal treatments. The study revealed the need for specialized tools and comprehensive medical and psychological care to improve patients' quality of life.

HIV and an Ageing Population-What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions.

The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug-drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review.

Recent Advances in Skin-Interfaced Wearable Sweat Sensors: Opportunities for Equitable Personalized Medicine and Global Health Diagnostics.

Recent advances in skin-interfaced wearable sweat sensors enable the noninvasive, real-time monitoring of biochemical signals associated with health and wellness. These wearable platforms leverage microfluidic channels, biochemical sensors, and flexible electronics to enable the continuous analysis of sweat-based biomarkers such as electrolytes, metabolites, and hormones. As this field continues to mature, the potential of low-cost, continuous personalized health monitoring enabled by such wearable sensors holds significant promise for addressing some of the formidable obstacles to delivering comprehensive medical care in under-resourced settings. This Perspective highlights the transformative potential of wearable sweat sensing for providing equitable access to cutting-edge healthcare diagnostics, especially in remote or geographically isolated areas. It examines the current understanding of sweat composition as well as recent innovations in microfluidic device architectures and sensing strategies by showcasing emerging applications and opportunities for innovation. It concludes with a discussion on expanding the utility of wearable sweat sensors for clinically relevant health applications and opportunities for enabling equitable access to innovation to address existing health disparities.

Research on the impact of China 's aging trend on health inequality

This paper studies the impact of China's aging trend on health inequality. The study found that: the individual's economic status and demographic 5characteristics such as gender and marriage can cause systemic differences in the health status of different social groups. And with the deepening of aging, its health inequality will be more significant. However, in 2020, the Chinese government's comprehensive poverty alleviation measures and the popularization of comprehensive medical care are also effectively alleviating the health inequality of groups.

MilCanEpi: Increased Capability for Cancer Care Research in the Department of Defense.

The Military Health System (MHS) of the US Department of Defense (DoD) provides comprehensive medical care to over nine million beneficiaries, including active-duty members, reservists, activated National Guard, military retirees, and their family members. The MHS generates an extensive database containing administrative claims and medical encounter data, while the DoD also maintains a cancer registry that collects information about the occurrence of cancer among its beneficiaries who receive care at military treatment facilities. Collating data from the two sources diminishes the limitations of using registry or medical claims data alone for cancer research and extends their usage. To facilitate cancer research using the unique military health resources, a computer interface linking the two databases has been developed, called Military Cancer Epidemiology, or MilCanEpi. The intent of this article is to provide an overview of the MilCanEpi data system, describing its components, structure, potential uses, and limitations.

Prevalence of Complementary and Alternate Medicine Use among People with Diabetes in Kerala, India

Abstract Introduction: The use of complementary and alternative medicine (CAM) among individuals with diabetes has seen a significant surge. Estimates show that 80% of people in developing countries still prefer CAM for the treatment of health conditions. CAM encompasses various medical practices outside mainstream medicine and is increasingly employed for the reasons such as enhancing control over treatment, adopting a holistic health approach, and managing conditions alongside conventional medicine. CAM is widely embraced, due to cultural factors and perceived benefits, driving its popularity. Despite varying opinions on the impact of CAM on glycemic control, its substantial use prompts the need for a focused study. Objective: The present study explores the utilization of CAM in people with diabetes and examines potential associations with various factors that could influence CAM use. Methods: Between October 2022 and June 2023, a cross-sectional survey was conducted among 335 people with type 2 diabetes at our center using a validated structured questionnaire to explore their utilization of CAM. Results: Among the study participants, 40.7% used CAM to treat diabetes. Among them, 40.6% of subjects used CAM as complementary to modern medicine and 59.4% used CAM as an alternative to modern medicine. 65.2% of people used Ayurveda, followed by homeopathic medicines (16.3%), yoga (5.2%), naturopathy (3%), massage therapy (1.5%), and ladoo therapy (0.7%). Some of the participants had used multiple types of CAM for their diabetes treatment. 1.5% of participants used homeopathy and Ayurveda decoction. 0.7% of CAM users used Ayurveda + naturopathy, a combination of Ayurveda + Unani, and the combination of Ayurveda + protein supplements. Other therapies (traditional medicine) were found to be used by 1.5% of CAM users. Among the CAM users, 73.5% chose CAM for the treatment of diabetes, while for 14.4%, it was recommended by family and friends. It was found that 83.7% of subjects discontinued CAM use, while a minuscule share of 16.3% continued with CAM. Among those discontinued, 43.4% did not find CAM to be effective, whereas 44.3% had other reasons for discontinuing CAM. Conclusion: These findings highlight the need for increased awareness and education regarding CAM use and its potential hazards. Health-care providers should consider discussing CAM use with their patients and encourage them to report its use to ensure comprehensive and safe medical care. Proper CAM practice and management are important for people with diabetes.

ФАКТОРИ І УМОВИ ПІДВИЩЕННЯ КОНКУРЕНТОСПРОМОЖНОСТІ СОЦІАЛЬНО-МЕДИЧНИХ ПОСЛУГ У РЕГІОНІ

In the conditions of the reform of the health care system of Ukraine and the increase in the number of private medical institutions, the problem of the competitiveness of medical services has actualized. Formation of the market of social and medical services contributes to the emergence of new relationships in the health care sphere. Increasing the competitiveness of social and medical services is directly related to the formation and development of human capital, which is provided by comprehensive and high-quality medical care servicing. Social and medical services are an absolute priority for preserving the consumer’s health and life, unlike other social services (education, sports, etc.), which the consumer can refuse from. Research of the list of social and medical services in a particular region, their types and functional purpose, establishing advantages and evaluating services is an urgent problem that needs to be solved. The purpose of the study is to determine the types and kinds of social and medical services, their functional purpose and competitiveness, to establish the advantages and evaluation of social and medical services, as well as to determine the main factors affecting the development of the competitive environment. As the theoretical and methodological basis of writing the article the authors used the legislation of Ukraine, the works of Ukrainian and foreign scientists, methods of analysis and synthesis, survey and comparison. In the article, based on the analysis of social and medical services provided by medical institutions in the region, a list of such services is defined as well as classified by types, kinds, functional purpose and other characteristics. On the example of the Hlyboka ECONOMICS AND MANAGEMENT OF ENTERPR ISES ACCORD ING TO TYPES OF BUSINESS ACTIVITY Issue II (90), 2023 23 territorial community, the advantages of individual business entities providing social and medical services were determined. Also, the quality of services of the Communal Non-profit Enterprise "Centre for Primary Medical and Sanitary Care of Hlyboka Rural United Territorial Community" was assessed. The main factors affecting the competitive environment were identified and the problems of competition development in the market of social and medical services in the region were highlighted. Creation of conditions for the formation of a competitive environment, establishment and development of the competitiveness of social and medical services is an effective tool for qualitative changes in the health care sphere.

Validation and reliability of the Russian version of the Perinatal Anxiety Screening Scale

BACKGROUND: Anxiety and depressive disorders in women are among the most common in the perinatal period. Timely detection of anxiety symptoms specific to the perinatal period is important for providing the necessary comprehensive psychological and medical care to women. This study assesses the validity and reliability of the Russian version of the Perinatal Anxiety Screening Scale (PASS-R).METHODS: A step-by-step translation of the scale into Russian was carried out. The study involved 609 pregnant women who answered questions in the following scales: PASS, Beck Depression Inventory II, Zung Self-Rating Depression Scale, Spielberger State-Trait Anxiety Inventory and the Clinical Questionnaire for the Identification and Assessment of Neurotic Conditions. Content validity, factor analysis and internal consistency were assessed.RESULTS: The Kaiser-Meyer-Olkin criterion was found to be 0.93, Bartlett’s Test was found to be significant at P<0.0001 (χ2=8184.421) and Cronbach’s α coefficient for the scale was 0.930. PASS-R also significantly correlated with other measures of depression and anxiety (P<0.001). Analyses revealed that the optimal cut-off of the PASS-R score for detecting anxiety was 26. Principal component analysis and oblique (oblimin) rotation, repeated with Varimax rotation, suggested a six-factor structure addressing the following conditions: 1) acute anxiety and trauma; 2) social anxiety; 3) perfectionism and control; 4) excessive worry and specific fears; 5) adjustment (dissociation); and 6) generalized anxiety.CONCLUSIONS: The Russian version of PASS showed reasonably adequate validity and reliability and can be used to screen for anxiety disorder among women in the perinatal period.

Excess Mortality Among Patients in the Veterans Affairs Health System Compared With the Overall US Population During the First Year of the COVID-19 Pandemic

During the first year of the COVID-19 pandemic, there was a substantial increase in the rate of death in the United States. It is unclear whether those who had access to comprehensive medical care through the Department of Veterans Affairs (VA) health care system had different death rates compared with the overall US population. To quantify and compare the increase in death rates during the first year of the COVID-19 pandemic between individuals who received comprehensive medical care through the VA health care system and those in the general US population. This cohort study compared 10.9 million enrollees in the VA, including 6.8 million active users of VA health care (those with a visit in the last 2 years), with the general population of the US, with deaths occurring from January 1, 2014, to December 31, 2020. Statistical analysis was conducted from May 17, 2021, to March 15, 2023. Changes in rates of death from any cause during the COVID-19 pandemic in 2020 compared with previous years. Changes in all-cause death rates by quarter were stratified by age, sex, race and ethnicity, and region, based on individual-level data. Multilevel regression models were fit in a bayesian setting. Standardized rates were used for comparison between populations. There were 10.9 million enrollees in the VA health care system and 6.8 million active users. The demographic characteristics of the VA populations were predominantly male (>85% in the VA health care system vs 49% in the general US population), older (mean [SD], 61.0 [18.2] years in the VA health care system vs 39.0 [23.1] years in the US population), and had a larger proportion of patients who were White (73% in the VA health care system vs 61% in the US population) or Black (17% in the VA health care system vs 13% in the US population). Increases in death rates were apparent across all of the adult age groups (≥25 years) in both the VA populations and the general US population. Across all of 2020, the relative increase in death rates compared with expected values was similar for VA enrollees (risk ratio [RR], 1.20 [95% CI, 1.14-1.29]), VA active users (RR, 1.19 [95% CI, 1.14-1.26]), and the general US population (RR, 1.20 [95% CI, 1.17-1.22]). Because the prepandemic standardized mortality rates were higher in the VA populations prior to the pandemic, the absolute rates of excess mortality were higher in the VA populations. In this cohort study, a comparison of excess deaths between populations suggests that active users of the VA health system had similar relative increases in mortality compared with the general US population during the first 10 months of the COVID-19 pandemic.

Knowledge, Awareness, and Attitude toward Dental Implants among Patients Attending a Comprehensive Medical Care Center in Jordan

Knowledge, Awareness, and Attitude toward Dental Implants among Patients Attending a Comprehensive Medical Care Center in Jordan

A Phenomenological Analysis of Women's Life Experiences with Burn Trauma

Most of burn survivors often face numerous challenges and may require comprehensive medical care, rehabilitation, psychological counseling, and financial assistance. The purpose of this study was to explore how female burn survivors experience their changed lives after traumatic experiences. In particular, this study focused on how the injury impacted on the participants' life and how to deal with their challenges. Max van Manen's model of four fundamental lifeworld existentials was used as the analysis framework in order to look into actual post-burn experiences of ten female participants. Through individual in-depth interviews, verbatim transcription and content analysis, the overarching themes included 6 thematic headings and 12 sub-themes. It points out that healthcare professionals, community organizations, and government agencies can work together to establish support networks in order to help them cope with the physical and emotional trauma of their injuries, and promote their overall well-being.