Continuity Of Care Research Articles

Utilisation and associated socio-demographic factors related to the maternal continuum of care in sub-Saharan Africa: A systematic review and meta-analysis.

Maternal continuum of care (MCC) is the utilisation of maternal health care services, including 4+ antenatal care (ANC) visits, skilled birth attendants (SBAs), and postnatal care (PNC). This systematic review and meta-analysis assessed the pooled proportion of MCC utilisation among women in sub-Saharan Africa (SSA) and its association with selected sociodemographic factors. We identified keywords and MeSH terms related to the condition (MCC), the context (SSA), and population (women with history of childbirth) to search for published or unpublished observational studies. We used the Joanna Briggs Institute tool to extract data and the Newcastle Ottawa Scale for quality assessment. Meta-analysis was used to compute pooled estimates (MCC utilisation and odds ratio (OR) associates) with 95% confidence intervals (CI) using Stata 17. Of 45 402 studies identified, we included 23 involving 320 353 women. The pooled estimate of MCC utilisation across SSA was 18.72% (95% CI = 14.51, 22.93), showing a significant increase (P < 0.05) from 2015 to 2022. Southern Africa had the highest MCC utilisation (38%; 95% CI = 36.59, 39.41), while East Africa had the lowest (17.5%; 95% CI = 12.22, 22.75). Maternal continuum of care utilisation was associated with maternal age 25-34 years (pooled odds ratio (POR) = 1.27), urban residence (POR = 2.69), richer/richest wealth status (POR = 1.68), as well as higher level of education and employment (POR = 1.32). MCC utilisation in SSA remains low, with significant variation across the sub-regions and sociodemographic strata. Context-specific interventions targeting identified factors are essential to enhance MCC utilisation in SSA. PROSPERO: CRD42021272708.

Unlocking Success: Community Engagement for Enhanced HIV Care Outcomes.

Background: Though social determinants are the primary drivers of health, few studies of people living with HIV (PLWH) focus on non-clinical correlates of insecure and/or fragmented connections with the care system. Our team has used linked clinical and multisector non-clinical data to study how residential mobility and connection to social services influence the HIV care continuum. We engage a diverse group of invested patients and community members to guide and inform this research. Our objective is to generate stakeholder-informed, research-based interventions that are relevant to the community, and to share our engagement approach and findings so that other researchers can do the same. Methods: Our research team partnered with the Indiana Clinical and Translational Sciences Institute's Research Jam, to develop and implement a human-centered design research plan to engage with individuals with lived experience relevant to our research. We recruited a panel composed of PLWH as well as clinicians and individuals from agencies that provide medical and non-medical services to PLWH in Marion County, Indiana. We used a variety of human-centered design tools and activities to engage individuals during six sessions, with results informing our engagement and research activities. Results: Since the inception of the project, 48 individuals have joined the stakeholder panel. Thirty-five are actively engaged and have participated in one or more of the six sessions conducted to date. The panel helped guide and prioritize analyses, aided in identification of data missing from our ecosystem, helped interpret results, provided feedback on future interventions, and co-presented with us at a local health equity conference. Conclusions: We utilized community engagement to expand the scope of our research and found that the process provided value to both stakeholders and research team members. Human-centered design enhanced this partnership by keeping it person-centered, developing empathy and trust, increasing stakeholder retention, and empowering stakeholders to collaborate meaningfully with the research team. The use of these methods is essential to conducting relevant, impactful, and sustainable research. We anticipate that these methods will be important for academic and public health researchers wishing to engage with and integrate the ideas of community stakeholders.

Utilizing the CFIR framework for mapping the facilitators and barriers of implementing teachers led school mental health programs - a scoping review.

Ample evidence has been generated regarding the effectiveness of school-based mental health interventions as part of the continuum of care for children and capacity building of teachers to deal with the emotional and behavioral challenges of students. The increasing trend of utilization of teachers as the natural support system of children and the huge financial impact of public health interventions highlights the need to review all available evidence regarding multilevel factors that facilitate or pose a challenge to the provision of School Mental Health Programs (SMHP) using teachers as providers. The current review aims to map extracted evidence under the Consolidated Framework for Implementation Research (CFIR) domains to support future implementation research on school-based mental health services. The scoping review included experimental, qualitative studies, and systematic reviews involving teacher-led mental health programs conducted in the school setting to improve the socio-emotional well-being of children and adolescents irrespective of time and geographical limitations. All (published and unpublished) evidence in English from Pubmed, Cochrane database of systematic reviews and clinical trials, Scopus, and Science Direct was searched using keywords and Boolean combinations and extracted using study designs, place of study, year of publication, sample size, and target population. A qualitative analysis of implementation facilitators and barriers cited by the studies was carried out and mapped on CFIR. This review identified barriers and facilitators of implementation across school-based mental health Programs in 29 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation, and the characteristics of individuals involved in implementation. These included the availability of structural characteristics, positive school culture, organizational readiness, committed leadership, and beliefs of the providers. Findings highlight the need for early assessment of contextual factors acting as barriers and facilitators and careful execution following realistic planning and stakeholders' engagement to ensure the success of SMHP.

Resilient health care performance in the real world: fixing problems that never happened

BackgroundStaff in health systems everywhere have exhibited flexibility and a capacity for improvisations during, and in response to, the COVID-19 pandemic. Looking to other examples of such resilient behaviours outside of those induced by the pandemic is instructive for those involved with researching or understanding change, or making health systems improvements.MethodsHere, we synthesise and then assess the value of eight case studies of in situ resilient performance from Canada, Sweden, Japan, Belgium, the United Kingdom, Norway, the United States and Brazil. The cases are divided into four categories: responsiveness to a crisis; adaptiveness over time; local adoption in accommodating to a top down, national policy change; and the consequential outcomes of an intervention.ResultsThe cases illuminate the resourcefulness of translational and social researchers in examining such behaviours and practices. More than that, they also foreground the ingenuity and adaptive capacity of staff on-the-ground who continually anticipate, respond and adapt to make systems work and provide continuous care in the face of many challenges, including resource deficiencies, policy misalignments, and new technologies, policies and procedures that need to be integrated into local workflows. Front line clinicians make care systems work, pre-empting issues and sorting out problems before they occur or as they arise.ConclusionsA key lesson amongst a range of findings is that, rather than focusing on shiny new tools of change (checklists, frameworks, policy mandates), it is much more insightful and satisfying to deeply apprehend care at the sharp end, where clinicians deliver care to patients, understanding how everyday work is executed. This, rather than the Health Ministry, the Boardroom, or the Management Consultant’s office, is where and how change is being enabled, and where street level actors solve problems, thwart issues in advance, and constantly avoid pitfalls.

A Latent Class Analysis of Nutrition Impact Symptoms in Cancer Survivors

Those with a cancer diagnosis report experiencing a wide range of nutrition impact symptoms, the prevalence of which varies by study, group, and cancer type. We aimed to identify groups of cancer survivors with specific patterns of nutrition impact symptoms. Two hundred and twenty-nine individuals attending oncology day ward and outpatient clinics completed a series of questionnaires and physical measurements. A latent class analysis was performed to identify subgroups based on 13 nutrition impact symptoms taken from the Patient Generated Subjective Global Assessment short form. The identified classes were subsequently compared using analysis of variance and chi-square tests, by sociodemographic, clinical and nutritional variables, and by the Global Health Status (GHS) and five functioning scales determined using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Three latent subtypes were identified: (1) Fatigue (n = 58, 28%); (2) Low Symptom Burden (n = 146, 64%), and (3) High Symptom Burden (n = 25, 11%). Those in the High Symptom Burden group were more likely to be female, were currently receiving some form of treatment, were diagnosed ≥two years, and had consumed less food than usual in the last month compared to those in the Low Symptom Burden group. Those in the Fatigue group were less likely to have reported their food intake to be unchanged and more likely to be diagnosed ≥two years than those in the Low Symptom Burden group. The EORTC-QLQ-C30 functioning and GHS scores were all significantly different between the three nutrition impact symptoms classes (p &lt; 0.001). This is the first study to examine heterogeneity of nutrition impact symptoms in Irish cancer survivors. The findings of this work will inform and allow for more individualised nutrition care. By tailoring interventions to these specific groups, we can enhance the precision of care, improve prognostic accuracy, and significantly elevate the quality of life of survivors. This work underscores the critical importance of symptom management in the continuum of cancer care, ensuring that every survivor receives comprehensive support tailored to their unique journey.

Readiness of the health system to provide non-communicable disease services in Nepal: a comparison between the 2015 and 2021 comprehensive health facility surveys

BackgroundIn Nepal, despite the escalating burden of non-communicable diseases (NCDs), there is a gap in the continuum of care for prevention, diagnosis, treatment, and care services for NCDs. The study aimed at assessing the changes in availability and readiness scores of health facilities between two consecutive health facility surveys.MethodsWe compared NCD readiness scores between 2015 and 2021, using data from two nationally representative cross-sectional Nepal Health Facility Surveys (NHFS). Both consecutive surveys used globally validated standard tools of Demographic and Health Surveys (DHS)’s service provision assessment. Both surveys were undertaken using World Health Organization’s (WHO) service availability and readiness assessment (SARA) tools. Data were collected using the Census and Survey Processing System on tablets, with validation performed through field check tables. Trained enumerators with a medical background collected data for the surveys, and we analyzed the information from a de-identified dataset downloaded from the DHS website upon request. Both the NHFS protocols were reviewed and approved by the Nepal Health Research Council and the institutional review board of ICF. We calculated the readiness scores based on WHO SARA indicators for diabetes, cardiovascular disease (CVD), and chronic respiratory disease (CRD) using a additive procedure. Multivariate linear regression analysis was undertaken to assess associated factors, with complex sampling design accounting for both surveys.ResultsThe overall availability of all three services has improved between 2015 and 2021 NHFS. Although the availability of diabetes-related services increased significantly between 2015 and 2021, this does not correspond to the increase in the readiness score. The readiness score increased by 10% points for CVDs related services and 9% points for CRDs. Compared to public hospitals, primary healthcare facilities experienced greater increase in readiness scores (11.5% versus 20.9%). Interestingly, those health facilities without quality assurance systems experienced a lower increase or even decrease in readiness scores than those with quality assurance systems. For the factors associated with readiness scores, health facilities charging additional or separate fees to the patients had a higher readiness score than those not charging any user fee for all three services. Compared to 2015, the readiness scores in 2021 improved for diabetes [β = 11.01 (95% CI 9.02 to 12.96)], CVD [β = 10.70 (95% CI 9.61 to 11.80)], and CRD [β = 8.41 (95% CI 7.20 to 9.62)].ConclusionThe improvement in NCD service availability does not correspond to the proportional increase in readiness scores, which is crucial for delivering quality care. Regular staff meetings and feedback systems are crucial for improving all services including NCD-related service readiness and should be prioritized by local and provincial governments.

Multiple relocation cases in disaster-related deaths after the Fukushima nuclear accident

IntroductionRelocation after a disaster often has negative health effects on vulnerable people, particularly older adults. However, little is known about the number of repeated evacuations and relocations after disasters among those experienced disaster-related deaths. This case series aimed to summarize the secondary problems and mortality risks in patients involved in relocation after disasters.MethodsWe analyzed and summarized the data on 520 disaster-related deaths in Minamisoma City, a municipality near the Fukushima Daiichi Nuclear Power Plant, focusing on the number of relocations. Herein, we describe the cases of three individuals over 80 years old, who died after eight or more relocations, which were certified as disaster-related deaths.ResultsWe discuss following three cases, which are (1) a female patient in her 90s who had a stroke and was completely disabled, (2) a female patient in her 80s whose cancer was detected later due to her failing to see her family doctor, and (3) a male patient in his 80s whose regular postoperative treatment was disrupted following cancer recurrence.DiscussionOur findings indicate that evacuation led to the worsening of chronic diseases and eventually to post-disaster death. Prolonged wide-area evacuation and repeated relocation likely interrupted the continuum of care and led to the failure of adequate care provision. To reduce the loss of human life, it is necessary to review the number of wide-area evacuations and relocations over the medium to long term after large-scale disasters, including nuclear disasters, which may occur in the future. Simultaneously, it is important to establish a medical system at the evacuation site so that disaster victims can continue to receive medical care even after evacuation or relocation.

IMPACT OF SEX AND GENDER IN STROKE IN SOUTH-AND-SOUTHEAST ASIA: A RAPID SCOPING REVIEW.

South Asia and Southeast Asia account for more than 40% of the global stroke burden, with differences in stroke risk factors, mortality, and outcomes compared to high-income countries. Socio-cultural norms compound the pre-existing biological risk differences, resulting in a disproportionate burden of stroke in women in this region. This review summarizes the sex and gender differences across the stroke care continuum in South Asia and Southeast Asia over the past 20 years. Despite a higher incidence of stroke in men than women in South-and-Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. Higher levels of pre-morbid disability and poor physical health at baseline may be contributory. There is a high prevalence of vascular risk factors such as hypertension, dyslipidemia, cardiac sources of embolism, as well as metabolic syndrome and insulin resistance, among the women in this region. Smoking is uncommon among women, however other forms of smokeless tobacco (SLT), such as tobacco leaf and betel nut chewing are more prevalent, especially in the rural areas in these countries. Women are more likely to have delayed presentations to the hospital due to untimely recognition of stroke symptoms, however, with regards to door-to-needle times or intravenous thrombolysis (IVT) rates, we found equivocal data. Wide gaps exist in stroke awareness and healthcare-seeking behaviors, with women more commonly opting for public hospitals and low-cost wards, more likely to discontinue treatment, and less likely to adhere to post-stroke rehabilitation. This review exposes the gender lacunae in stroke service provision across South Asia and Southeast Asia while acknowledging the many knowledge gaps in our understanding. Although the biological risk differences are non-modifiable, educational, policy, and economic measures to mitigate socio-cultural barriers are much needed in the region. Sound epidemiological data is needed from more countries to better understand these differences and bridge this gap. It is imperative to advocate and implement policies and programs for stroke care viable for women, cognizant of the gender and cost bias, as well as the interplay of social and cultural structures specific to the regions.

Organizational readiness to implement bundled interventions to increase HIV linkage and retention in care and treatment: results from the Black Women First (BWF) initiative

BackgroundEvidence-based and evidence-informed interventions designed to address gaps in the HIV care continuum have the potential to improve HIV care and treatment. However, inadequate organizational readiness can derail intervention uptake, prevent the integration of interventions, and contribute to suboptimal HIV treatment outcomes. This study sought to understand organizational readiness to implement bundled interventions for Black women with HIV and inform facilitators and barriers to implementation.MethodsWe conducted a mixed methods readiness assessment across 12 sites participating in the Black Women First (BWF) initiative to gauge preparedness to implement bundled interventions. Readiness was assessed using the organizational readiness for implementing change (ORIC) scale, and two open-ended questions examined facilitators and barriers. Associations between participant and organizational level factors were evaluated using linear models with clustering by site at baseline, 6- and 12-months. Pre-implementation interviews were conducted with staff virtually and transcripts were managed in NVivo. Directed content analysis was used to explore implementation barriers and facilitators.FindingsSites demonstrated high levels of organizational readiness at baseline; overall organizational readiness for implementing change (ORIC) (mean 56.4, median 59, interquartile range [IQR] 5) and subscales of the ORIC change efficacy (mean 32.4, median 35, IQR 4), change commitment (mean 24, median 25, IQR 1), which is consistent with willingness and capability to implement bundled interventions for Black women with HIV. Organizational readiness remained high at 6- and 12-month follow-up periods. Staff role was significantly associated with organizational readiness (p = 0.007), change efficacy (p = 0.006), and change commitment (p = 0.020) at 6 months. Qualitative analysis indicated strategic planning and assessment (e.g., team coordination and the development of workflows to support implementation); organizational change through network weaving across silos within the organization, and communications systems that engage external partners, as well as resources available for hiring and training, supported readiness. Collaborative leadership and organizational buy-in, staff motivation, and partnerships facilitated implementation processes.ConclusionsOrganizations in the BWF initiative have high levels of organizational readiness reflecting willingness and capability to implement bundled interventions for Black women with HIV. Future research should examine the relationship between readiness and clinical outcomes.

Navigating artificial intelligence in spine surgery: implementation and optimization across the care continuum

The field of spine surgery has long been characterized by innovations and technological advancements. The integration of artificial intelligence (AI) into spine surgery represents one of the latest technical developments in the field. The ability of AI to rapidly analyze datasets improves decision making, risk assessment, intraoperative precision, and postoperative management, all of which contribute to increasing personalized spine care and improving outcomes. However, the successful implementation of AI faces regulatory and privacy challenges that must be addressed before its full potential can be realized. Here, we provide a detailed analysis of the current applications and future prospects of AI in spine surgery, highlighting both the opportunities and challenges in this evolving field.

Engaging Diverse African American/Black and Latine Youth and Emerging Adults Living with HIV into Research: Description of Recruitment Strategies and Lessons Learned.

Improving engagement along the HIV care continuum and reducing racial/ethnic disparities are necessary to end the HIV epidemic. Research on African American/Black and Latine (AABL) younger people living with HIV (LWH) is essential to this goal. However, a number of key subgroups are challenging to locate and engage, and are therefore under-represented in research. Primary among these are persons with non-suppressed HIV viral load, severe socioeconomic disadvantage, transgender/gender expansive identities, and refugee/migrant/immigrant populations. Research in community settings is needed to complement studies conducted in medical institutions. The present study describes the efficiency of recruitment strategies used in the community to enroll AABL young and emerging adults LWH ages 19-28 years. Strategies were designed to be culturally responsive and structurally salient. They were: peer-to-peer, social media, classified advertisements (newspaper, craigslist), subway ads, dating apps (Jack'd, Positive Singles), and direct recruitment in community-based organizations. Data were analyzed using mainly descriptive statistics and interpreted using a consensus building approach. We screened 575 individuals in a first step, 409 were eligible (71%), of these 297 presented to the second screening step (73%), but 112 were lost. Almost all presenting at the second step were eligible (98%, 291/297) and 94% enrolled (274/291). Peer-to-peer, dating app (Jack'd), direct recruitment, and craigslist were the most efficient strategies. Recruitment on dating apps was superior to the peer-to-peer approach in yielding eligible participants (OR = 1.5; 95% CI: 0.98-2.3; p = 0.06). The sample enrolled was diverse with respect to HIV viral suppression, gender identify, sexual orientation, immigration status, and barriers to HIV care engagement. We discuss the advantages and disadvantages of each strategy. Recruitment is a vital aspect of research and warrants attention in the empirical literature.

Strategy for scheduled downtime of hospital information system utilizing third-party applications

BackgroundThe widespread adoption of Hospital Information Systems (HIS) has brought significant benefits in healthcare quality and workflow efficiency. However, downtimes for system maintenance are inevitable and pose a considerable challenge to continuous patient care. Existing strategies, including manual prescription methods, are no longer effective due to increasing reliance on digital systems.MethodThis study implemented two main strategies to mitigate the impact of scheduled downtimes. First, we created an “Emergency query program” that switches to a read-only backup server during downtimes, allowing clinicians to view essential patient data. Second, an “Emergency prescription system” was developed based on the Microsoft Power Platform and integrated into Microsoft Teams. This allows clinicians to perform digital prescriptions even during downtimes.ResultsDuring a planned 90-minute downtime, 282 users accessed the Emergency Prescription System, resulting in 22 prescriptions from various departments. Average times for prescription confirmation and completion were 8 min and 3 s, and 18 min and 40 s, respectively. A post-downtime evaluation revealed high user satisfaction.ConclusionEssential maintenance-induced HIS downtimes are inherently disruptive to patient care process. Our deployment of an emergency query program and a Microsoft Teams-integrated emergency prescription system demonstrated robust care continuity during HIS downtime.

Examining priorities and investments made through the Global Financing Facility for maternal and newborn health: a sub-analysis on quality

ABSTRACT Improving quality of care could avert most of the 4.5 million maternal and neonatal deaths and stillbirths that occur each year. The Global Financing Facility (GFF) aims to catalyse the national scale-up of maternal and newborn health (MNH) interventions through focused investments. Achieving impact and value for money requires high, equitable coverage and high quality of interventions. This study examines whether the rhetoric of increasing coverage together with quality has informed investment strategies in MNH through a secondary analysis of 25 GFF documents from 11 African countries. The analysis shows that the country GFF-related documents incorporate some MNH-related quality of care components; however, there is a lack of clarity in what is meant by quality and the absence of core MNH quality of care components as identified by the World Health Organization’s MNH quality framework, especially experience of care and newborn care. Many of the Investment Cases have a more diagonal focus on MNH service delivery considering the clinical dimensions of quality, while the investments described in the Project Appraisal Documents are primarily on horizontal structural aspects of the health system strengthening environment. The GFF is at the forefront of investing in MNH globally and provides an important opportunity to explicitly link health systems investments and quality interventions within the MNH continuum of care for optimal impact.

Healthcare use among cancer survivors during the COVID-19 pandemic: results from the SHARE COVID-19 Survey

PurposeTo estimate the association between a previous cancer diagnosis and healthcare use during the COVID-19 pandemic among Europeans and Israelis individuals.MethodsThis cross-sectional study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the SHARE COVID-19 Survey, which was conducted in the summer of 2020, in 27 countries. Cancer survivors (CS, n = 6409) were country-, sex-, age-, and education-matched (1:2) to non-cancer individuals (NC). Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression.ResultsOverall, CS were more likely to refer that they forwent medical appointments due to fear of COVID-19 (OR = 1.29, 95%CI 1.19–1.41) than NC, particularly those who lived with their partner and other relatives (OR = 1.79, 95%CI 1.39–2.30). Likewise, CS had their medical appointments postponed more often (OR = 1.54, 95%CI 1.44–1.64); this association was stronger among CS who lived with their partner and other relatives (OR = 1.96, 95%CI 1.63–2.36) who reported higher economic difficulties (OR = 1.73, 95%CI 1.50–2.00) and those with no multimorbidity (OR = 1.85, 95%CI 1.62–2.11). CS were also more likely to refer that they were unable to book an appointment (OR = 1.43, 95%CI 1.26–1.63), particularly those who reported that a person close to them died due to COVID-19 (OR = 2.72, 95%CI 1.47–5.01).ConclusionCS were more likely to forgo medical treatment, report healthcare postponements, and be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum.

Midwifery in Turkey within the Framework of The Areas of Competence and Proficiency: A Qualitative Study

Objective: The objective of this study is to evaluate the proficiency and competence of the midwifery profession in Turkiye through the eyes of midwives, academic midwives, student midwives, and women receiving care from midwives. Methods: This research is qualitative research conducted using the phenomenological research design. The interviews were conducted on an online platform. The sample group was selected through purposive sampling and was completed using the individual in-depth interview technique with 20 participants. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Data saturation was reached because of interviewing 20 participants. The transcripts of the interviews were systematically examined, and the study results were gathered around the areas of competence and proficiency determined. Within the framework of these main themes, competence in midwifery is included under the headings of "Public Health," "Pregnancy," "Birth," "Postpartum," "Newborn," and "Women and Counseling." Proficiency in midwifery is included under the headings of "General Qualification," "Before Pregnancy," "Pregnancy and Antenatal," "Childbirth and Care During Childbirth," and "Continuous Care for Woman and Newborn." An intense/strong relationship was detected between the main themes. Conclusion: As a result, it was revealed that the most emphasis was placed on the proficiency and competence of midwives related to childbirth. It can be stated that the study results will shed light on the health policies in different areas to be developed for the midwifery profession in Türkiye.

A Programme of Hepatitis C Surveillance With Active Linkage to Care (HEAL) for Inpatients in Two Tertiary Hospitals in Jiangsu, China.

Hepatitis C virus (HCV) infection is a major public health burden in China, affecting more than 10 million individuals. We aimed to evaluate the effectiveness of a hospital-based intervention programme for HCV Surveillance with linkage to care (HEAL) in a prospective cohort. The HEAL programme was carried out targeting inpatients from non-infectious departments of two tertiary hospitals in Jiangsu, China. It consisted of an educational campaign to raise awareness of physicians from non-IDs to promote HCV surveillance, a patient-navigator-centred clinical algorithm responsible for the efficient follow-up of patients with positive HCV antibody, including comprehensive testing, diagnosis and treatment. We characterised the rate of linkage to HCV diagnosis, care and treatment during the pre-intervention period (from 1 July 2016 and June 30, 2018) and after the intervention (from March 2019 to May 2021). During the pre-intervention period, 89,303 (45.3%) out of 196,780 non-ID inpatients were screened for anti-HCV, and 631 patients were tested positive. One hundred and fifty-six (24.7%) patients was followed up for HCV RNA confirmatory testing, and 58 (37.1%) of patients further were diagnosed with chronic HCV infection (CHC). Only 18 (31.3%) of the diagnosed patients with CHC were linked to hepatitis C clinics for treatment, 10 (55.6%) patients received antiviral regimen. Among them, two (11.1%) received DAA treatment, while eight (44.4%) adopted peginterferon/ribavirin regimen. During the intervention period, 232,275 patients were hospitalised in non-infectious department and 151,203 (65.1%) were screened for anti-HCV. Of these, 960 patients tested positive for HCV antibodies, resulting in a prevalence of anti-HCV positivity of 0.63%. Six hundred and seventy (69.8%) patients were enrolled, and 100% were followed up for HCV RNA confirmatory testing. Two hundred and ninety-one (43.4%) individuals with active HCV were identified. Two hundred and thirty-eight (81.8%) of HCV-infected individuals were linked to HCV care, and 157 (65.9%) were linked to treatment. Compared to the pre-intervention period, there was a 2.61-fold increase in the percentage of patients linked to care and a 5.94-fold increase in the proportion of patients who started DAAs therapy. This HEAL programme achieved enhanced HCV Surveillance with linkage to care, which has been demonstrated as an effective strategy in the hospital setting to improve the hepatitis C care continuum by identifying inpatients unaware of their HCV status and facilitating their access to HCV treatment.

Continuous Midwifery Care for Mrs. P at TPMB Karin Alesha, Subang Regency

This final project report discusses the continuous midwifery care for Mrs. P at TPMB Karin Alesha by using the case study method using continuity of care. Case taking through the SOAP approach. Observation of Mrs. P shows that COC is carried out three visits during various phases of pregnancy and childbirth, as well as appropriate examinations during the postpartum and neonate periods. Midwifery care also includes complementary therapies such as warm compresses for discomfort during pregnancy. In the delivery phase, the use of gym ball and pelvic rocking therapy to overcome pain and accelerate the smooth delivery process. In addition, postpartum care is also carried out by providing appropriate care, including the application of oxytocin massage to facilitate breast milk production. As well as providing care to neonates. Through this Final Project Report, it is hoped that health workers at TPMB Karin Alesha can maintain and improve services in providing midwifery care during pregnancy, childbirth, BBL, postpartum, and family planning, to minimize the mortality rate and/or pain rate in mothers and babies.

Empowering Wellness: A Comprehensive Narrative Review of Cancer Prehabilitation from Treatment Onset to Surveillance.

Cancer prehabilitation, defined as a process occurring between cancer diagnosis and the onset of acute treatment, is highlighted for its ability to enhance physical and mental health results while decreasing overall healthcare costs. This summary introduces the concept of cancer prehabilitation and emphasises the crucial role of oncology nurses in rehabilitation care. The cancer treatment plan of prehabilitation requires timely and efficient assessment across the care continuum, focusing on enhancing outcomes at every stage of cancer. The battle with cancer involves three different assessments with distinct goals: i) prehabilitation evaluation before treatment, ii) early post-treatment evaluations of rehabilitation and iii) final evaluations of health promotion. Analyses and treatments for significant side effects or complications associated with the treatment specifically for prehabilitation are recommended. The roles of coordination, counseling, preparing for discharge and teaching are outlined as integral components of a cancer nurse's responsibilities in the prevention of cancer. A literature search from March 2016 to June 2023 was conducted using the keywords 'neoplasms,' 'cancer,' 'prehabilitation,' 'continuum of care,' 'care continuum,' 'patient care continuity,' 'epidemiology,' 'therapeutics,' 'health,' 'prevention and control' and 'guidelines as topic.' The findings suggest that care coordinators or navigators for cancer should be educated to assess the physical and psychological status of patients once a cancer diagnosis is confirmed, particularly for those awaiting surgery at home. To enhance their competence in prehabilitation care, oncology nurses are encouraged to gain knowledge of certain tumours' outcomes and cancer-related treatments. Additionally, improving the ability to evaluate patients' functional status and emotional distress is crucial for oncology nurses involved in cancer prehabilitation.

Exploring lifestyle components and associated factors in newly injured individuals with spinal cord injury.

Cross-sectional analysis from the Inception Cohort of the Swiss Spinal Cord Injury Study (SwiSCI). To describe five lifestyle components in newly injured individuals with spinal cord injury (SCI), explore co-occurrence of these components, and identify associated personal and clinical factors. Initial rehabilitation stay following traumatic and non-traumatic SCI. Lifestyle components including overweight/obesity, low diet score, physical inactivity, smoking, and alcohol consumption were used independently and to calculate a composite lifestyle score. Analyses were conducted using descriptive statistics, co-occurrence analysis, and multivariate logistic regression. We included 251 individuals, of whom 77.7% were male, 73.7% suffered from traumatic SCI, and 59.8% had paraplegia. The median age was 51 years (IQR 36-64). Approximately twelve weeks after the injury, more than two-thirds of the study population met the criteria for overweight/obesity, and consumed insufficient amounts of fruits and vegetables, and excessive amounts of meat. Alcohol was consumed by 85.3% of individuals, and 26.8% were current smokers. Almost all study participants met the physical activity guidelines (90 min of moderate to strenuous activity physical activity per week). One-quarter of study participants experienced the co-occurrence of overweight/obesity, low diet score and alcohol consumption. Female sex, younger age and higher education were associated with healthier lifestyle components. Despite methodological limitations, this study underscores the complexities of healthy lifestyle adherence among individuals newly injured with SCI. It highlights the necessity of improving and implementing screening strategies throughout the continuum of SCI care as early as possible following the trauma.

A contemporary snapshot of familial hypercholesterolemia registries.

Familial hypercholesterolemia (FH) registries can capture unique data on FH concerning real-world practice, clinic epidemiology, natural history, cascade testing, cardiovascular consequences of late diagnosis, and use of healthcare resources. Such registries are also valuable for identifying and bridging the gaps between guidelines and clinical practice. We reviewed recent findings from the principal FH registries. Most adult patients with heterozygous FH (HeFH) are diagnosed late, undertreated, and do not reach guideline-recommended low density lipoprotein-cholesterol (LDL-C) goals. In children and adolescents with HeFH, detection relies principally on genetic testing and measurement of LDL-C levels. Similarly, the majority of patients with homozygous FH (HoFH) receive sub-optimal cholesterol-lowering treatments and do not attain recommended LDL-C goals, gaps being wider in lower income than higher income countries. In HeFH patients, men have a higher risk of atherosclerotic cardiovascular disease than women. The evolving data from FH registries provide real-world evidence for developing implementation strategies to address gaps across the continuum of care of FH worldwide.