Concept Of Care Research Articles

Diagnosis and treatment of Parkinson´s disease (guideline of the German Society for Neurology)

IntroductionThe aim of this German national guideline is to optimize the clinical care of patients with Parkinson's disease (PD) in terms of diagnostics, drug and surgical treatment and care.Summary or definition of the topicThis guidance was prepared for the German Society of Neurology (DGN) in collaboration with the Austrian Society of Neurology (ÖGN) and the Swiss Neurological Society (SNG) for German-speaking countries. The guidelines for the diagnosis and treatment of PD have been revised by a national expert group and the guideline commission of the DGN at S2k level. The main objective of these guidelines is to optimize the clinical care of PD patients regarding diagnosis, including early detection, technical diagnostic examinations, and pharmacological as well as invasive treatment options.RecommendationsThe updated PD diagnosis and treatment guidelines are emphasizing optimized clinical care. Key revisions include preferring the name "Parkinson's disease" over previous terms and adopting International Parkinson and Movement Disorder Society (MDS) diagnostic criteria. Recommendations cover genetic and imaging diagnostics, initial pharmacotherapy considering efficacy and patient factors, and tailored pharmacological combinations for complications. Guidelines extend to managing cognitive, affective, psychotic, and autonomic symptoms, along with non-oral therapies like pump therapy and deep brain stimulation. Special situations like akinetic crisis, driving ability, and care concepts are addressed, ensuring comprehensive management for PD patients at various stages and conditions.ConclusionsThis guidance reflects the state of the art at the beginning of 2024.

Adapting Dementia Care Management to a Regional German Context: Assessment of Changes in Acceptability, Appropriateness, and Feasibility.

Dementia care management, an evidence-based care concept in Germany, optimizes care for people with dementia and their caregivers. Implemented by qualified professionals, it comprises intervention modules addressing treatment and care, medication management, and caregiver support. Positively evaluated in one federal state, it's recommended for nationwide integration into routine care. Since the infrastructure of the German healthcare system differs regionally, the concept underwent adaption for regional implementation in a participatory, iterative process. Five local healthcare experts as co-researchers tested and adjusted selected components of the concept in a pilot study. This trend analysis aims to assess the adapted concept for acceptance, appropriateness, and feasibility. A total of 89 intervention modules were tested over 18weeks, and the co-researcher's assessment was gathered through an accompanying online survey. The participatory process itself was rated positively overall, but technical problems had a negative impact on the implementation and evaluation of the care concept.

The Liver Frailty Index: a model for establishing organ-specific frailty metrics across all solid organ transplantation.

In this review, we discuss the development of the Liver Frailty Index (LFI) and how it may serve as a model for developing other organ-specific frailty indices. As the demand for solid organ transplants continues to increase, the transplantation community is enhancing its strategies for organ allocation to gain deeper insights into patient risk profiles and anticipated outcomes. Frailty has emerged as a critical concept in transplant care, offering valuable insights into adverse health outcomes. Standardizing frailty assessment across transplant programs could enhance prognostic accuracy and inform pretransplant interventions.The LFI comprises of three performance-based tests that each represents essential components of the multidimensional frailty construct. This composite metric provides insights beyond liver function and considers nonhepatic comorbid factors. Identifying common frailty principles among all transplant candidates and adopting the LFI methodology, which assesses fundamental frailty principles using liver-specific tools, could establish a foundational pool of shared core frailty principles. From this pool, organ-specific frailty indices could be derived, each equipped with the clinically relevant organ-specific tools to evaluate common core principles. Creating a standardized framework across all solid-organ transplants, with common principles and organ-specific measurements, would facilitate consistent frailty assessment, standardize the integration of the frailty construct into transplant decision-making, and enable center-level interventions to improve outcomes for patients with end-stage organ disease.

The concept of caring and its contemporary translation: the view of French doctoral candidates

Jean Watson developed, in the United States, a conceptual model of nursing based on caring. Aterm sometimes translated as "to care" without properly reflecting what the concept entails. This theory has been adopted in many countries. Some authors report that it brings satisfaction to students, nurses, and managers of health facilities. Based on Watson's work, Chantal Cara built the humanist model of nursing at Montreal University. The aim of the project is to improve the well-being of patients and caregivers. It is likely to retain existing nurses and attract the next generation to the institutions which implement it.

An Evolutionary Concept Analysis of Pediatric Hospice and Palliative Care.

This study aimed to clarify the concept of pediatric hospice and palliative care through conceptual analysis. It also sought to identify the differences between related concepts such as pediatric death care and pediatric spiritual care, in order to provide foundational data for the development of nursing theory and knowledge. A conceptual analysis of pediatric hospice and palliative care was conducted using Rodgers' evolutionary method. Out of 5,013 papers identified, 28 were selected for detailed reading and analysis. Pediatric hospice and palliative care encompasses physical, psychological, social, mental, spiritual, and family care for children with acute and chronic diseases with uncertain prognoses ahead of death, as well as their families. Effective pediatric hospice and palliative care will require multidisciplinary team nursing, effective communication, and supportive policies. The findings of this study suggest that providing pediatric hospice and palliative care will lead to improvements in pain relief for children and families, the efficiency of responses to death in children, and the quality of life for children and families. The significance of this study is that it clearly clarifies the concept by analyzing pediatric hospice and palliative care using an evolutionary method.

Low-value care: an evolutionary concept analysis

Abstract Background: Low-value care is a significant contributor to health care waste and a threat to the viability and sustainability of health care systems. Low-value care has attracted increasing international attention in the last decade, but its precise conception remains elusive. Objective: To clarify the concept of low-value care. Methods: A systematic search was conducted of the Medline, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases from their inception to July 22, 2023 for articles written in English. Rodgers’ evolutionary method guided the narrative analysis. The attributes of low-value care, as well as its antecedents, consequences, and related terms were extracted and synthesized. Results: A total of 53 articles were included in this concept analysis. Defining attributes included being of little to no benefit or potentially harmful, not being cost-effective, occurring along a continuum, being relative, ignoring or disregarding patient wishes in certain circumstances, and involving multiple types of care. Low-value care antecedents were classified into 4 categories: demand-side factors, supply-side factors, social factors, and health care system factors, while consequences of low-value care were categorized into patient harms and health care system-related consequences. Conclusions: This in-depth analysis of attributes, antecedents, and consequences of low-value care promotes a better understanding of low-value care among health care providers, thus contributing to the identification and deimplementation of low-value care in practice and eventually contributing to reducing waste in health care spending and improving patient outcomes.

Regional Anaesthesia in the Prehospital Setting

Pain is often the main symptom in trauma patients. Although peripheral nerve blocks (PNB) provide fast, safe, and adequate analgesia, they are currently only rarely used outside the perioperative setting. In Germany, intravenous analgesia with non-opioid analgesics (NOPA) and strong opioids is the main treatment concept for prehospital pain. However, the use of highly potent opioids can be associated with significant side effects, especially in emergency patients. Therefore, PNBs are used in many hospitals for the treatment of perioperative pain. As with perioperative use, the advantages of early PNB in the prehospital analgesic treatment of trauma patients are obvious, especially for elderly and multimorbid patients. Early prehospital PNB can also facilitate the reduction of dislocated fractures or dislocated joints as well as the technical rescue of trauma patients. Common geriatric fractures, such as proximal femur or humerus fractures, can be treated appropriately and adequately with PNB.In this article, we show which PNB procedures can be useful in prehospital patient care and which requirements should be met for their safe use. We also present a concept for assessing whether and to what extent the prehospital use of PNB is indicated and appropriate. The aim of this article is to draw attention to PNB as a possible part of prehospital care concepts for trauma patients and to discuss its prehospital use.

Is "Less be More" Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine.

Kapadia F, Bharadwaj S, Sharma R. Is "Less be More" Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine. Indian J Crit Care Med 2024;28(6):533-551.

<심청전>에 나타난 돌봄의 제 양상

The aim of this paper is to explore the several aspects of care in “Shimcheongjeon.” While the term “filial daughter Shimcheong” aptly represents the thematic consciousness of the work, confining it within the framework of a text about ‘filial piety’ restricts the possibilities for diverse interpretations. In the Confucian values of the Joseon Dynasty, filial piety was a value of great importance, not only in the realm of ethics but also in that of justice. Filial piety, commonly understood as a child's duty to serve their parents well, tends to imply a unilateral relationship. However, this paper posits that filial piety can be included within a broader concept of care, suggesting it involves reciprocal, interdependent actions, thus necessitating a focus on care in “Shimcheongjeon.” “Shimcheongjeon” features various characters in need of care, who engage in reciprocal relationships and perform acts of care. This study examines aspects of care, distinguishing between the realms of private ethics and public justice, and observes how care extends from the private to the public sphere. Key to examining care in each realm are the notions of relationality and contextuality. In the private realm, the focus is on how care is enacted within spousal and parent-child relationships. In the public realm of justice, the study explores how care extends from the familial unit to community and national levels. This process confirms that care is portrayed not only ethically but also justly. “Shimcheongjeon” advocates for the practice of care, illustrating that the performance of care leads to rewards or punishments. The scope of care is not limited to family members but expands through the community and national units, enhancing social cohesion and solidarity. This paper's attempt to interpret “Shimcheongjeon” as a narrative of care highlights how individual acts of care contribute to ethical values within the community and to social justice, reminding us that care holds significant social and political implications beyond the personal level.

Bibliometric and visual analysis of severe trauma literature in the past 20 years

AbstractSevere trauma is a critical aspect of medical practice, profoundly impacting patient care and outcomes. Over the past 20 years, advancements in trauma care concepts and the utilization of advanced technologies have led to substantial growth in severe trauma research, evidenced by a notable increase in research activity and subsequent publications. To understand the publication landscape in severe trauma, identify prevailing research trends, and highlight areas requiring further development for future insights, we conducted a bibliometric analysis. Our analysis indicates that there are 16,939 severe trauma‐related publications from the past 20 years, with a continuous increase in publication volume, particularly showing a rapid growth trend from 2018 to 2021. The United States leads in both volume and citation frequency. Moreover, we synthesized data on productive countries/regions and research institutions, showcasing extensive collaboration across diverse geographic locations and institutional affiliations. Substantial progress has been achieved in severe trauma research, particularly in clinical diagnosis, treatment, epidemiology, prevention, and pathogenesis. However, there is still a gap in adopting cutting‐edge interdisciplinary methodologies. This study provides a comprehensive overview of the current state of severe trauma research and suggests pathways for future advancement.

An Analysis of Reemployment Pathways for China's Young Elderly

With the increasing scale of population aging, China may face the situation of labor shortage. Exploiting the social potential of the elderly group, stimulating the social vitality of the elderly group, and letting younger elderly join the reemployment team play an important role in effectively making up for the lack of labor force and coping with the aging population. By exploring the feasibility of reemployment of the young elderly in China, it is found that the reemployment of the young elderly in China is facing a double dilemma at the personal and social levels. The growth of age, the decline of physical function, and other related factors make the young elderly unable to adapt to digitalization, few employment channels, and the impact of the traditional concept of intergenerational care on the reemployment of the young elderly, while the vulnerability of the elderly group itself brings challenges to their social participation. To effectively solve these dilemmas, this paper puts forward the optimization scheme from the three dimensions of the state, society, and the elderly themselves.

Investigating spiritual care perceptions and religious coping methods among the relatives of terminally ill patients during the COVID-19 pandemic: the case of Turkey.

The COVID-19 pandemic in Turkey and around the world has had a profound impact on the families of terminally ill patients. In this challenging period, investigating the spiritual care perceptions and religious coping methods of patients' relatives is an essential step towards understanding the experiences in this process with the additional challenges brought by the pandemic and developing appropriate support services. This study aims to determine the spiritual care perceptions and the use of religious coping methods among the relatives of terminally ill patients in Turkey during the COVID-19 pandemic. The sample of this descriptive and correlational study consisted of the relatives of terminally ill patients (n = 147) who were receiving treatment in the Anesthesiology and Reanimation Intensive Care Unit of a state hospital in Turkey. Spirituality and Spiritual Care Rating Scale and the Religious Coping Scale to them using face-to-face interviews. Mann-Whitney U test, Kruskal-Wallis test, and Spearman's correlation analysis were used to analyze the data. The mean age of the participants was 38.84 ± 11.19years. Also, 63.3% of them were employed. The participant's total score on the Spirituality and Spiritual Care Rating Scale was 57.16 ± 6.41, and it was determined that the participants' level of perception of spirituality and spiritual care concepts was close to good. When the Religious Coping Scale scores of the participants were examined, it was found that both Positive Religious Coping levels (23.11 ± 2.34) and Negative Religious Coping levels (9.48 ± 1.47) were close to high. There was no correlation between the scores of RCOPE and SSCRS (p > 0.05). As a result, it was determined that the level of perception of spirituality and spiritual care concepts of the relatives of terminally ill patients during the COVID-19 pandemic was close to sound, and their Positive Religious Coping levels were high. Epidemics are a reality of the world, and it is essential to learn lessons from this process and take precautions for the future. We offer a perspective to realize the coping power of religion and spirituality, which are integral parts of life. The needs of terminally ill patients' relatives, a sensitive group, become visible.

Social infrastructuring in public libraries: librarians' continuous care in everyday library practice

PurposeAs social infrastructures, public libraries are increasingly recognised as providing more than access to books and information; librarians’ work is importantly centred around practices of care. However, the ways in which they provide care is poorly researched, let alone conceptualised. This paper explores how this important part of librarians’ daily work is practiced through the lens of infrastructuring.Design/methodology/approachThe paper first theoretically discusses the concepts of social infrastructuring, care and tinkering. Then, it turns to ethnographic research conducted in the public library networks of three European cities: Vienna (Austria), Rotterdam (the Netherlands) and Malmö (Sweden). The paper comprises empirical materials from all three countries and unpacks 16 librarians’ daily working routines of care through participant observations.FindingsThe empirical analysis resulted in three modes of social infrastructuring in public libraries: (1) maintaining, (2) building connections and (3) drawing boundaries. Practices of care are prominent in each of these infrastructuring modes: librarians infrastructure the library with and via their care practices. Whilst care practices are difficult to quantify and verbalise, they are valuable for library patrons. By using the concept of tinkering, the article conceptualises librarians’ infrastructuring enactments as crucial community-building aspects of libraries.Originality/valueBy focusing on the enactment of social infrastructuring, the paper goes beyond a descriptive approach to understanding public libraries as important social infrastructures. Rather, the paper unpacks how libraries come into being as infrastructuring agencies by highlighting what librarians do and say. Our international study articulates the importance of care practices in public libraries across different national contexts.

The Crane bag: Braiding Irish mythology, indigenous knowledge and posthuman concepts in early childhood education and care

Initially, this article aimed to present findings from an empirical set of data, where postgraduates explored their pedagogical practice within early childhood education and care (ECEC). However, predictable modes of knowing were disrupted while braiding an artefact from Irish mythology known as the Crane bag, together with indigenous knowledge and posthuman concepts. In the generation of knowledge, the teachings of the Crane bag transformed the methodological approach to go beyond the fabricated split of matter and spirit. This transformation created the conditions for an onto-epistemological becoming with water. Hence, the intra-action of braiding together multiple theories became part of the empirical data. From the initial set of data, a photograph, capturing children rolling down a hill, was submitted by a research participant as an example of their approach to safety. In agreement with the research participant, I re-present the photograph in a different format, to tell the story of how an onto-epistemological becoming created an opening to decentre the image of the child. This opening changed the approach to the data analysis, which in turn allowed the more-than-human to come to the fore in the spirit of reciprocity.

Single German centre experience with patient journey and care-relevant needs in amyloidosis: The German AMY-NEEDS research and care program.

Amyloidosis is a rare multi-system disorder associated with frequently delayed diagnosis, enormous disease burden and psychosocial distress. Systematic assessment of needs was performed by a subtype-spanning questionnaire-based survey within the AMY-NEEDS research and care program. 118 patients with proven amyloidosis (62.7% ATTR, 22.0% AL, 15.3% other forms) were included in August 2020 until February 2021 (mean age 71.2 ±11.3 years; 30% women). The median diagnostic delay between onset of symptoms and diagnosis was 9.0 (range: 2.5; 33.0) months. Local health care providers (HCPs) play a central role on the way to diagnosis. Diagnosis itself typically requires a clinical but not necessarily a university setting. In the treatment phase, the focus moves to the amyloidosis centre as primary contact and coordinator, with general practitioners (GPs) acting predominantly as a contact point in crisis and link to additional services. About half of patients reported impaired quality of life and one third suffering from anxiety and depressed mood, respectively. The majority of patients talk about their concerns with close caregivers and local HCPs. Advance care planning is a relevant, yet insufficiently met need. The journey of patients with amyloidotic disease, their contact partners and needs at different stages were characterized in detail within the German health care system. An amyloidosis-specific care concept has to master the multitude of interfaces connecting the numerous treatment providers involved with the amyloidosis centre and GPs as key players. Telemedical approaches could be a promising and well-accepted option allowing optimal coordination and communication.

The necessity of an empirical study to determine if church congregations function as a family

Scripture’s reference to believers as the ‘family of God’ may indicate that believers should mutually care for one another like members of a caring family do, and not merely that members are part of a ‘spiritual’ family. From this perspective, the article investigated the extent of mutual care within congregations. The increasing need for pastoral care, within and outside church congregations, reveals the need for mutual care between members. The necessity for empirical studies within church congregations were revealed by the differences in the intensity of the answers by the participants. Without knowledge about the experiences of church members, leaders of church congregations may overlook potential needs of their members. A quantitative empirical study was done through an anonymous online survey with church members, pastoral counsellors, and pastors and ministers from various denominations who completed the survey, according to their experiences within their individual church congregation. The concepts of fellowship (koinōnia), service (diakonia), care, and family were used in the survey to determine the experiences of mutual care between members of the church congregation. The deficiency of mutual care between members of the congregation may motivate leaders to intentionally develop relationships through fellowship (koinōnia) to foster mutual care between members, and intentionally develop members to serve (diakonia) one another and their community.Contribution: This article contributes to an interdisciplinary discussion between pastoral theology, practical theology, and systematic theology from a Reformed perspective with a focus on the practical participation of members of the church congregation in pastoral care as the ‘family of God’.

Narrative Care and Engagement in Social and Health Care: Enhancing Identity with a Small Story Approach

<p>Narrative care, an approach developed from the larger concept of narrative gerontology, considers the importance of stories as a source of identity. A type of person-centered care, narrative care in care settings encourages care workers to elicit stories to gain a more wholistic understanding of the person. Drawing on personal experience in the field, I argue that although “big” story approaches (e.g., grand life narratives) have typically been used in social and healthcare settings, “small” story approaches (e.g., snippets or moments) are more practical for care workers. The expansion of the concept of narrative care to include “narrative engagement” will be explored, which if applied in meaningful ways can promote citizenship, shift power dynamics, generate empowerment, and create systemic change in social and health care settings. Finally, newly developed train-the-trainer narrative care training will be discussed, which is designed to meet the needs of diverse social/health care workers, with a focus on meaningful methods of adopting narrative care and engagement in practice.</p>

Concept Recognition and Characterization of Patients Undergoing Resection of Vestibular Schwannoma Using Natural Language Processing

Abstract Background Natural language processing (NLP), a subset of artificial intelligence (AI), aims to decipher unstructured human language. This study showcases NLP's application in surgical health care, focusing on vestibular schwannoma (VS). By employing an NLP platform, we identify prevalent text concepts in VS patients' electronic health care records (EHRs), creating concept panels covering symptomatology, comorbidities, and management. Through a case study, we illustrate NLP's potential in predicting postoperative cerebrospinal fluid (CSF) leaks. Methods An NLP model analyzed EHRs of surgically managed VS patients from 2008 to 2018 in a single center. The model underwent unsupervised (trained on one million documents from EHR) and supervised (300 documents annotated in duplicate) learning phases, extracting text concepts and generating concept panels related to symptoms, comorbidities, and management. Statistical analysis correlated concept occurrences with postoperative complications, notably CSF leaks. Results Analysis included 292 patients' records, yielding 6,901 unique concepts and 360,929 occurrences. Concept panels highlighted key associations with postoperative CSF leaks, including “antibiotics,” “sepsis,” and “intensive care unit admission.” The NLP model demonstrated high accuracy (precision 0.92, recall 0.96, macro F1 0.93). Conclusion Our NLP model effectively extracted concepts from VS patients' EHRs, facilitating personalized concept panels with diverse applications. NLP shows promise in surgical settings, aiding in early diagnosis, complication prediction, and patient care. Further validation of NLP's predictive capabilities is warranted.

ESPEN guideline on nutrition and hydration in dementia – Update 2024

Background & aimsDementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. MethodsThe previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. Results40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. ConclusionNutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.

Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis.

Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.