Conventional Care Model Research Articles

Effects of multiple protection model in the operating room on physiological stress and risk events in patients undergoing coronary artery stent implantation

ObjectiveTo analyze the impact of multiple protection model in the operating room on patients’ physiological stress and risk events after coronary artery stent implantation (CASI).MethodsDuring October 2021 to October 2022, 150 patients with coronary heart disease (CHD) were picked as the research subjects, all of whom underwent CASI. The clinical data were retrospectively analyzed, and the patients were divided into two groups according to different nursing methods, with 75 cases in each group. Patients in the intervention group received multiple protection model intervention in the operating room, and the patients in the control group adopted conventional care model. The patient satisfaction with nursing, postoperative recovery, psychological stress scores, physiological stress indicators, and adverse cardiac risk events were recorded.ResultsPatients in the intervention group had much higher percentage of the patient satisfaction with nursing than those in the control group (P < 0.05). The time to get out of bed and hospital stay was significantly shorter and the 6-min walking distance was markedly longer in the intervention group than the control (P < 0.05). The Hamilton Anxiety (HAMA) scale and Hamilton Depression (HAMD) scale score of patients in two groups were sharply decreased after the intervention (P < 0.05), which were strongly lower in the intervention group than the control (P < 0.001). After the intervention, the heart rate, cortisol and epinephrine of patients were all sensibly elevated in two groups (P < 0.05), which were all memorably lower in the intervention group than the control (P < 0.001). The incidence of adverse cardiac risk events in the intervention group was 5.33%, which was dramatically lower than 16.00% in the control group (P < 0.05).ConclusionThe application of multiple protection model in the operating room on patients undergoing coronary stent implantation promoted postoperative recovery, reduced patients' psychological and physiological stress, maintained blood pressure and other vital signs, reduced the incidence of adverse cardiac risk events, and improved the patient satisfaction with nursing.

The Specialized Donor Care Facility Model Improves Operating Room Efficiency

BackgroundOrgan procurement organizations coordinate organ donation through 2 distinct models of care: the conventional model, in which donors are managed at hospitals where brain death occurs, and the specialized donor care facility (SDCF) model, where brain dead donors are transferred to a freestanding facility. The aim of this study is to compare operating room efficiency for procurements between the SDCF and conventional models of care. MethodsWe performed a prospective analysis of operating room efficiency between thoracic donor procurement operations performed at a SDCF and other organ procurement organizations using the conventional model of care. Key domains of efficiency were chosen based on a literature review and expert panel consensus. Data were collected in real time over a 12-month period via direct observation and personnel interviews. ResultsBetween January 1 and December 31, 2018, data were obtained from 54 procurement operations (n = 17 SDCF; n = 37 conventional). Donors in the 2 groups were similar in baseline characteristics. Procurements at the SDCF were performed with fewer nonsurgeon team members (2 vs 4, P < .001) without any difference in the organ yield. SDCF procurements more closely adhered to planned start times (6 vs 61 minute difference, P < .001), and a trend was observed for SDCF-based procurements to facilitate daytime transplant operations. ConclusionsThe SDCF model of donor care outperforms the conventional model in several important measures of operating room efficiency. These differences are likely to result in cost savings and improved healthcare provider satisfaction in the highly effort- and resource-intensive landscape of organ transplantation.

Satisfaction with service delivery among HIV treatment clients enrolled in differentiated and conventional models of care in South Africa: a baseline survey.

Differentiated service delivery (DSD) models aim to increase the responsiveness of HIV treatment programmes to the individual needs of antiretroviral therapy (ART) clients to improve treatment outcomes and quality of life. Little is known about how DSD client experiences differ from conventional care. From May to November 2021, we interviewed adult (≥18) ART clients at 21 primary clinics in four districts of South Africa. Participants were enrolled consecutively at routine visits and stratified into four groups: conventional care-not eligible for DSD (conventional-not-eligible); conventional care eligible for but not enrolled in DSD (conventional-not-enrolled); facility pickup point DSD model; and external pickup point DSD model. Satisfaction was assessed using questions with 5-point Likert-scale responses. Mean scores were categorized as not satisfied (score ≤3) or satisfied (>3). We used logistic regression to assess differences and report crude and adjusted odds ratios (aORs). Qualitative themes were identified through content analysis. Eight hundred and sixty-seven participants (70% female, median age 39) were surveyed: 24% facility pick-up points; 27% external pick-up points; 25% conventional-not-eligible; and 24% conventional-not-enrolled. Seventy-four percent of all study participants expressed satisfaction with their HIV care. Those enrolled in DSD models were more likely to be satisfied, with an aOR of 6.24 (95% CI [3.18-12.24]) for external pick-up point versus conventional-not-eligible and an aOR of 3.30 (1.95-5.58) for facility pick-up point versus conventional-not-eligible. Conventional-not-enrolled clients were slightly but not significantly more satisfied than conventional-not-eligible clients (1.29, 0.85-1.96). Those seeking outside healthcare (crude OR 0.57, 0.41-0.81) or reporting more annual clinic visits (0.52, 0.29-0.93) were less likely to be satisfied. Conventional care participants reporting satisfaction with their current model of care perceived providers as helpful, respectful, and friendly and were satisfied with care despite long queues. DSD model participants emphasized ease and convenience, particularly not having to queue. Most adult ART clients in South Africa were satisfied with their care, but those enrolled in DSD models expressed slightly greater satisfaction than those remaining in conventional care. Efforts should focus on enrolling more eligible patients into DSD models, expanding eligibility criteria to cover a wider client base, and further improving the models' desirable characteristics.

Recognizing and Predicting the Risk of Malnutrition in the Elderly Using Artificial Intelligence: A Systematic Review

The global population is aging at an alarming rate, endangering conventional care models that have always relied on in-person supervision. Elderly malnutrition has been found to be a serious health problem associated with health deterioration, which has several, immediate effects on everyday activities and standard of living. Deficiency in nutrients is a frequent and serious concern in older adults and might have an impact on the emergence of geriatric diseases. The two most obvious indicators of malnutrition in the elderly include unintentional weight loss and a lower value of the body mass index (BMI). However, non-symptomatic or unnoticed insufficiencies, such as lower than expected level of different crucial micronutrients, which are quite challenging to diagnose and are typically disregarded among older residents of their communities. Artificial intelligence (AI) permeates every aspect of human existence. The current systematic review looks at how AI-based technology is currently being used and how it affects elderly malnutrition. Using the following keywords, computerized literature searches of many reliable data bases were used to compile relevant published articles: malnutrition, artificial intelligence (AI), machine learning (ML), elderly nutrition, risk factors of malnutrition among the elderly, chronic diseases, elderly. Prospective studies with original data were chosen, and their significant findings were integrated into the analysis of the state of malnutrition at the moment. In conclusion, it is challenging to deploy AI-based food and nutrient intake monitoring data because no single program is suitable for all international cuisines and eating customs. Geographic variations in the dietary habits of the population make it challenging to compile the necessary data sets for deep learning. Furthermore, even within a same region, hospital menus differ from patient to patient. It is suggested that meals served in hospitals under the same management be standardized to facilitate the procedure.

Impact of extended nursing model after multi-disciplinary treatment on young patient with post-stroke

Stroke has become one of the most serious life-threatening diseases due to its high morbidity, disability, recurrence and mortality rates. To explore the intervention effect of multi-disciplinary treatment (MDT) extended nursing model on negative emotions and quality of life of young patients with post-stroke. A total of 60 young stroke patients who were hospitalized in the neurology department of our hospital from January 2020 to December 2021 were selected and randomly divided into a control group and an experimental group, with 30 patients in each group. The control group used the conventional care model and the experimental group used the MDT extended nursing model. After the in-hospital and 3-mo post-discharge interventions, the differences in negative emotions and quality of life scores between the two groups were evaluated and analyzed at the time of admission, at the time of discharge and after discharge, respectively. There are no statistically significant differences in the negative emotions scores between the two groups at admission, while there are statistically significant differences in the negative emotions scores within each group at admission and discharge, at discharge and post-discharge, and at discharge and post-discharge. In addition, the negative emotions scores were all statistically significant at discharge and after discharge when compared between the two groups. There was no statistically significant difference in quality of life scores at the time of admission between the two groups, and the difference between quality of life scores at the time of admission and discharge, at the time of discharge and post-discharge, and at the time of admission and post-discharge for each group of patients was statistically significant. The MDT extended nursing mode can improve the negative emotion of patients and improve their quality of life. Therefore, it can be applied in future clinical practice and is worthy of promotion.

To What Extent Are ACO and PCMH Models Advancing the Triple Aim Objective? Implications and Considerations for Primary Care Medical Practices.

Accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) have emerged to advance the health care system by achieving the Triple Aim of improving population health, reducing costs, and enhancing the patient experience. This review examines evidence regarding the relationship between these innovative care models and care outcomes, costs, and patient experiences. The 28 articles summarized in this review show that ACO and PCMH models play an important role in achieving the Triple Aim, when compared with conventional care models. However, there can be drawbacks associated with model implementation. The long-term success of these models still merits further investigation.

Systematic Review of Outcomes and Patient Experience With Virtual Care in Rheumatoid Arthritis.

To conduct a systematic review on patient outcomes of virtual care compared to conventional care in rheumatoid arthritis (RA), including disease activity and patient experience. A systematic search of Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials was performed from database inception to March 19, 2020. Observational and randomized controlled trials (RCTs) describing the use of RA virtual care supplanting conventional visits and reporting on disease activity and/or patient experience were included. A narrative synthesis of results was conducted, as a meta-analysis was not possible due to heterogeneity of study designs and outcome reporting. A total of 352 studies were identified, and 6 were selected for final inclusion: 3 RCTs and 3 observational studies. Disease activity and patient experience were comparable between virtual and conventional care models. In addition, 1 RCT found no difference in observed outcomes between virtual care delivered by a rheumatologist and by a rheumatology nurse. Virtual care was found to have additional benefits for improved treatment adherence, maintenance of functional status, and quality of life. The overall risk of bias was low in 2 of 3 RCTs, but high in the observational studies. Study quality was limited by incomplete data reporting, lack of sample size justification, and sufficient timeframe to assess objectives. Limited evidence exists that virtual RA care is an acceptable alternative to conventional care, maintaining comparable patient outcomes and experience of care. Additional research into effective implementation strategies and long-term health system and patient outcomes of virtual care are needed.

Abstract P4-12-07: Incremental benefit of an interdisciplinary care team model for resource identification in adolescents and young adults with breast cancer

Abstract Background: Breast cancer is the most common cancer seen in adolescents and young adults (AYAs, defined as patients aged 15-39 years). As conventional care models insufficiently address their unique needs, AYA programs have been established. There is limited data, however, to support the most effective AYA care model, particularly for individual AYA tumor types. In the context of survey data at the University of Wisconsin Carbone Cancer Center (UWCCC) that showed that AYAs with breast cancer had decreased satisfaction with AYA resources despite higher self-identified supportive care service utilization as compared with other tumor types, we sought to compare resource identification in AYAs with breast cancer versus other tumor types. Methods: We identified patients seen in the UWCCC AYA Oncology program between 1/21/2021-5/27/2021. Patients in this program have a one-on-one clinic visit with an AYA physician followed four days later by case presentation at an AYA interdisciplinary team (IDT) meeting. We conducted retrospective chart review to evaluate AYA-specific resources (see services listed in table 1) that were utilized prior to the AYA clinic visit compared to novel AYA-specific resources identified by the one-on-one AYA clinic visit versus the AYA IDT meeting. Resources identified by the AYA Oncology program (clinic visit + IDT) had to be novel from those already used by the patient. We specifically compared resources for AYAs with breast cancer versus other tumor types to identify unique needs and resource identification for AYAs with breast cancer. Results: We identified 35 patients seen by the UWCCC AYA Oncology program, including 10 patients with breast cancer (10/35, 29%) with a mean age at diagnosis of 33.4 years. Reviewing AYA-specific resources obtained prior to being seen in the UWCCC AYA Oncology program, AYAs with breast cancer saw an average 2.0 AYA-specific resources/patient as compared with an average 2.9 AYA-specific resources/patient in AYAs with other tumor types. As seen in table 1, a higher number of novel AYA-specific resources were identified during the one-on-one AYA physician clinic visit for AYAs with other tumor types (average 2.8 novel AYA-specific resources/patient) versus AYAs with breast cancer (average 2.0 novel AYA-specific resources/patient). Most notably, the AYA IDT meeting showed a higher incremental benefit in AYAs with breast cancer, with an average of 2.9 novel AYA-specific resources identified through the AYA IDT meeting for breast cancer patients versus 1.6 additional resources identified for AYAs with other tumor types. Considering all resources identified by the AYA Oncology program (clinic visit + IDT), AYA breast cancer patients had an average of 4.9 novel AYA-specific resources identified per patient versus an average of 4.4 novel resources for AYAs with other tumor types. Conclusions: Consistent with our survey findings, we found high resource needs in all AYAs, with a slightly higher number of novel AYA-specific resources identified by our AYA Oncology program for AYAs with breast cancer versus other tumor types. Most significantly, AYA-specific resources for breast cancer patients were best identified by the interdisciplinary care team. This novel study reports objective data to support the critical importance of incorporating an interdisciplinary team model in the care of AYAs, particularly those with breast cancer. Table 1.Novel Resources Identified During AYA One-On-One Clinic Visit versus AYA IDT Meeting (n=35)AYA-Specific Resources n (%)One-On-One Clinic Visit Breast Cancer (n=10)One-On-One Clinic Visit Other Tumor Types (n=25)IDT Meeting Breast Cancer (n=10)IDT Meeting Other Tumor Types (n=25)Social Work1 (10)4 (16)2 (20)4 (16)Fertility &amp; Sexual Health1 (10)9 (36)2 (20)3 (12)Genetics1 (10)7 (28)4 (40)2 (8)Psychology &amp; Psychiatry3 (30)11 (44)2 (20)2 (8)Physical &amp; Occupational Therapy3 (30)5 (20)5 (50)5 (20)Vocational Resources0 (0)5 (20)1 (10)2 (8)Peer Support5 (50)14 (56)3 (30)5 (20)Nutrition3 (30)6 (24)5 (50)4 (16)Other3 (30)12 (48)5 (50)12 (48)Average Novel Resources/Patient2.02.82.91.6 Citation Format: Leah Gruen, Cathy Lee-Miller, Amanda Parkes. Incremental benefit of an interdisciplinary care team model for resource identification in adolescents and young adults with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-07.

A Study on the Effect of Comprehensive Intervention Based on Transition Theory on the Readiness for Discharge of Post-Operative Breast Cancer Patients

Purpose: To explore the effect of comprehensive intervention based on transition theory in enhancing the readiness for discharge of post-operative breast cancer patients. Method: In a non-simultaneous controlled study test, 99 post-operative breast cancer patients hospitalized between August 2019 and February 2020 were selected as the control group and 93 post-operative breast cancer patients hospitalized between March and August 2020 were selected as the test group at a Grade A tertiary tumor hospital. While the control group used the conventional care model, the test group added a comprehensive intervention based on transition theory to the routine nursing, which focused on stimulating patients’ awareness of health transitions, assisting patients to identify health critical events, strengthening social support and promoting self-management. The differences between the two groups were compared in terms of patient readiness for discharge and patient evaluation of the quality of discharge teaching. Result: The total score of readiness for discharge was higher in the test group than in the control group (171.7 ± 24.5 vs. 155.9 ± 28.9) and the scores for “Self-condition” (55.6 ± 8.2 vs. 50.8 ± 9.7), “Disease Knowledge” (64.7 ± 13.1 vs. 57.7 ± 13.8), “Coping Ability after Discharge” (24.6 ± 4.8 vs. 22.2 ± 5.6), “Expected Social Support after Discharge” (26.8 ± 4.5 vs. 25.2 ± 4.8) were higher than those of the control group, and all differences were statistically significant (p “Content that Patients Actually Acquired before Discharge” (51.2 ± 9.2 vs. 48.3 ± 11.3) and “Guiding Skills and Effects of Discharge for Nurses” (110.9 ± 12.6 vs. 104.3 ± 19.00) were also higher than those of the control group (p Conclusion: Comprehensive intervention based on transition theory for post-operative breast cancer patients is beneficial to improve the quality of discharge nursing guidance, thereby improving the readiness for discharge of patients and enhancing the sense of control and identity of patients after discharge.

Impact of pharmacist-involved collaborative care on diabetes management in a primary healthcare setting using real-world data.

Background Diabetes mellitus is a complex multi-system disorder, requiring multi-disciplinary care. The conventional care model, where physicians are the sole caregivers may not be optimal. Addition of other healthcare team members improves healthcare outcomes for patients with diabetes. Aim To evaluate the impact of pharmacist-involved collaborative care on diabetes-related outcomes among patients with diabetes attending a primary healthcare setting in Qatarusing real-world data. Method A retrospective cohort study was conducted among patients with diabetes attending Qatar Petroleum Diabetes Clinic. Patients were categorized as either receiving pharmacist-involved collaborative care (intervention group) or usual care (control group). Data were analyzed using SPSS®. Glycemic control (glycated hemoglobin A1c, HbA1c), blood pressure, lipid profile, and body mass index were evaluated at baseline and up to 17 months of follow-up. Results After 17 months of follow-up, pharmacist-involved collaborative care compared to usual care resulted in a significant decrease in HbA1c (6.8 ± 1.2% vs. 7.1 ± 1.3%, p < 0.01). Moreover, compared to baseline, pharmacist-involved collaborative care significantly improved (p < 0.05) the levels of HbA1c (7.5% vs. 6.8%), low-density lipoprotein cholesterol (3.7mmol/L vs. 2.8mmol/L), total cholesterol (5.43mmol/L vs. 4.34mmol/L), and body mass index (30.42kg/m2 vs. 30.17kg/m2) after 17 months within the intervention group. However, no significant changes for these parametersoccurred within the control group. Conclusion The implementation of pharmacist-involved collaborative care in a primary healthcare setting improved several diabetes-related outcomes over 17months. Future studies should determine the long-termimpact of this caremodel.

Transdisciplinary Care for Adolescents With Type 1 Diabetes: Development of a Provider Cross-Discipline Training Curriculum.

Only 17% of adolescents with type 1 diabetes achieve glycemic control targets (1), and many are at risk for psychological concerns (e.g., depression, anxiety, and diabetes distress) (2,3), diminished quality of life (4), and the development of diabetes complications (5,6). Psychological functioning and the quality of parent-child interactions can heavily influence self-management in adolescents with type 1 diabetes and are therefore among the greatest concerns of adolescents with type 1 diabetes, their parents, and their health care providers (HCPs) (7). However, conventional models of care are ill equipped to address these issues effectively. Approximately 30% of diabetes teams do not have access to mental health providers (8), and teams with access to such professionals struggle to efficiently incorporate them into routine care (9). The increasing incidence of youths diagnosed with type 1 diabetes each year (10,11), coupled with the limited supply of pediatric endocrinologists (12) to treat these patients, exacerbates these challenges. Thus, there is a need for novel and alternative models of health care delivery for adolescents with type 1 diabetes that address behavioral and psychological barriers to diabetes management and dietary management and are more time-efficient for diabetes clinicians. Multiple models for integrated pediatric care of type 1 diabetes exist and aim to meet American Diabetes Association (ADA) guidelines for care (13). The ADA recommends a collaborative care approach among HCPs and families, including the incorporation of shared decision-making, medical nutrition therapy, and psychosocial support during routine ambulatory care visits (13). These treatment teams may include endocrinologists, advanced practice nurses, physician assistants, dietitians, certified diabetes care and education specialists (CDCESs), social workers, and psychologists. Multidisciplinary care, typifying much of type 1 diabetes care in the United States, engages several disciplines, but each discipline stays within its boundaries, and knowledge of other disciplines …

Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub-Saharan Africa: a rapid systematic review.

IntroductionDifferentiated service delivery (DSD) models for antiretroviral treatment (ART) for HIV are being scaled up in the expectation that they will better meet the needs of patients, improve the quality and efficiency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes. We reviewed the recent literature on DSD models to describe what is known about clinical outcomes.MethodsWe conducted a rapid systematic review of peer‐reviewed publications in PubMed, Embase and the Web of Science and major international conference abstracts that reported outcomes of DSD models for the provision of ART in sub‐Saharan Africa from January 1, 2016 to September 12, 2019. Sources reporting standard clinical HIV treatment metrics, primarily retention in care and viral load suppression, were reviewed and categorized by DSD model and source quality assessed.Results and discussionTwenty‐nine papers and abstracts describing 37 DSD models and reporting 52 discrete outcomes met search inclusion criteria. Of the 37 models, 7 (19%) were facility‐based individual models, 12 (32%) out‐of‐facility‐based individual models, 5 (14%) client‐led groups and 13 (35%) healthcare worker‐led groups. Retention was reported for 29 (78%) of the models and viral suppression for 22 (59%). Where a comparison with conventional care was provided, retention in most DSD models was within 5% of that for conventional care; where no comparison was provided, retention generally exceeded 80% (range 47% to 100%). For viral suppression, all those with a comparison to conventional care reported a small increase in suppression in the DSD model; reported suppression exceeded 90% (range 77% to 98%) in 11/21 models. Analysis was limited by the extensive heterogeneity of study designs, outcomes, models and populations. Most sources did not provide comparisons with conventional care, and metrics for assessing outcomes varied widely and were in many cases poorly defined.ConclusionsExisting evidence on the clinical outcomes of DSD models for HIV treatment in sub‐Saharan Africa is limited in both quantity and quality but suggests that retention in care and viral suppression are roughly equivalent to those in conventional models of care.

Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

The current coronavirus disease 2019 (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as a means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change management effort and the redesign of conventional models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.

530-P: Early Insulin Initiation in T2DM Is Associated with Prevention of eGFR Decline and Lower Insulin Dose Requirements

Early initiation of insulin therapy often remains contentious due to various patient and physician-related barriers. Insulin is delayed by several years despite high A1c and is the foremost reason for costly future complications. In addition, the problem of early aggressive use of insulin depleting drugs causes β-cell fatigue leading to "brittle diabetes" and higher insulin dose requirements. In this observational cohort study, a comparison has been made between early insulin initiators (EII) (within 7-8 years of diabetes onset) and late insulin initiators (LII) (&amp;gt;8 years of onset), in terms of progression of CKD (eGFR decline), if any. A total of 200 subjects in each arm were matched at baseline for T2DM duration (16.78±4.32 year), BP, BMI, HbA1c and presence of co-morbid illnesses. Both groups were closely followed-up through our Diabetes Tele Management System based health care model that have previously shown to be successful in safely achieving glycemic targets compared to conventional models of care. A paired t test was done for analyzing the eGFR decline within each arm. EII arm required a significantly lower total daily dose of insulin (TDD) (average of 9 units/day) to maintain glycemic control throughout than the LII arm (average of 30 units/day). The decline in eGFR was significant in the LII arm, whereas in the EII arm, eGFR was maintained throughout. Change in A1c was also significant. Disclosure J. Kesavadev: None. R. Warrier: None. L. Ramachandran: None. A. Shankar: None. A. David: None. N.A. Ajai: None. G. Sanal: None. K. Thampiraj: None. G. Krishnan: None. S. Jothydev: None.

Application effect of continuous 4C nursing in patients' coronary heart disease rehabilitation

Objective To investigate the effect of continuous 4C nursing model on coronary heart disease rehabilitation and provide basis for nursing intervention. Methods From January to June 2015, 90 patients with coronary heart disease hospitalized in Shaoxing People's Hospital were selected as the research object by convenient sampling method. Patients were divided into two groups according to the sequence of hospital admission, with the single number as the control group and the even number as the observation group, each group had 45 patients. Patients in the control group received conventional care model. Patients in the observation received continuous 4C intervention model. The quality of life of two groups of patients and readmission rates were compared. Results All dimensions of quality of life in observation group were higher than those of control group 6 months after discharge, the differences were statistically significant (t=4.159, 3.373, 2.150, 2.162, 3.597, 2.042, 3.913, 2.144; P<0.05) . There was no significant difference in readmission rates between the two groups (χ2=0.714, P=0.398) . Conclusions The continuous 4C nursing model can improve the quality of life of patients with coronary heart disease, which is worth popularizing and applying. Key words: Rehabilitation; Coronary heart disease; Continuous 4C nursing model; Quality of life

Mortality and readmission following hip fracture surgery: a retrospective study comparing conventional and fast-track care

ObjectiveTo compare the efficacies of two pathways—conventional and fast-track care—in patients with hip fracture.DesignRetrospective single-centre study.SettingUniversity hospital in middle Norway.Participants1820 patients aged ≥65 years with hip fracture (intracapsular, intertrochanteric or...

Effect of humanistic nursing on room nursing

Objective To investigate the role of humanistic nursing on operating room nursing. Methods 243 cases of surgery patients were divided into experimental group and control group. Patients in the experimental group were treated with humanistic care model of operating room nursing, in the control group were treated with conventional care model for nursing. Anxiety, depression and blood pressure, heart rate, nursing satisfaction and so on were compared with the two groups. Results SAS score of experimental group patients at entering into the operating room and postoperative was significantly lower than that of the control group(P <0.05). SDS score of experimental group patients at entering into the operating room and postoperative was significantly lower than that of the control group(P< 0.05). Blood pressure and heart rate of experimental group patients at entering the operating room were lower than those of the control group(P< 0.05). Patients satisfaction of experimental group was 93.01%(133/143), which were better than that of the control group (40.00%, 40/100, P< 0.05). Conclusion The humanized care mode in the operating room nursing, could reduce the incidence of patients with adverse psychological events, improve patient satisfaction with care. Key words: Humanistic nursing; Operating room nursing; Depression

The evolution of physical activity: from health to leisure

Introduction: In order to facilitate delivery of a musculo-skeletal (MSK) service in adherence with the evidence base outlined in the National Physical Activity Implementation plan for care pathways, which include physical activity as part of the recognised treatment for many long term conditions and physical limitations due to disability, in a climate of reduced funding and waiting time targets, our department undertook a service wide redesign to deliver a supported continuum of integrated care for our patients, from healthcare to self-management in the community. Practice change implemented: A process of skill mix was undertaken to facilitate the creation of 2 unique roles; Exercise Specialist and Community Health and Activity Officer. The development of these roles included leisure staff in the healthcare setting and healthcare staff in the local authority/leisure environment. Following a substantial pilot, post holders created two symbiotic services; PACE (Physical Activity and Community Education) service within East & Midlothian Physiotherapy service and ACE (Active Choices in East Lothian) in East Lothian Council. These changes ensured patients were fully supported from MSK health care to community, through the development of a clear and simple clinical pathway. Aim and theory of change: 1. Reduce MSK waiting times by challenging conventional models of care 2. Support change of physical activity behaviour in line with Transtheoretical Model of Behaviour Change [1] 3. Normalise activity in the community through promotion of independent lifestyle change Targeted population and stakeholders: The targeted population is all MSK patients. Stakeholders included NHS Lothian, East Lothian Council, Enjoy leisure and 3rd sector organisations. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117096– http://www.ijic.org/ Timeline: Our model was piloted in 2008. PACE was then established in 2009, and ACE established in 2011. Highlights (innovation, impact, outcomes): This redesign led to: enhanced patient rehabilitation, decreased physiotherapy waiting times, with reduced pressure on review slots; enhancement of partnership working between health and leisure; and increased participation in, and maintenance of, physical activity in the community. Sustainability: Based on average staff costing, this service model allows for 4 times as much service provision to the patient, in comparison to a standard physiotherapy only service, at half the cost. Strong partnerships are essential to sustain this model. Appropriate training of Exercise Specialists is an ongoing issue across leisure, but can be overcome. Working with existing established community groups allows for longevity with smaller financial impact. Transferability: This model of delivery translates to a range of services including MSK, Learning Disability, Mental Health and weight management services, though success is directly dependent on good partnership working, peer leadership, and shared understanding of delivery priorities and therefore implementation may vary between service areas. Discussion and Conclusion: (key findings) Resistance when challenging conventional delivery of care is always a consideration. Clear communication of transparent goals has been essential in mitigating the impact of this on service delivery. Patient feedback has been very positive about the new model of care. This is an excellent example of financial adversity driving transformational change in service delivery facilitating a decrease in waiting time and an increase in capacity. Lessons learned: Establishing common goals with key partners at the outset is essential. Articulating these clearly and concisely to all stakeholders is vital.

Provision of individualized care and built environment of nursing homes in Japan

The Japanese government introduced the concept of ‘unit-care model’ (a large-scale facility which consists of small-scale groups) in 2003 into nursing homes. The governmental requirements are mainly about structure and staffing, not about the way of care provision. We aimed to examine if the requirements affect actual care provision. We sent a questionnaire to 300 unit-care model nursing homes and 900 conventional model nursing homes. 81 unit-care model facilities, 164 conventional care model facilities, and 103 conventional care facilities which created small groupings of people within larger buildings as an alternative to multiple small separate units (group-care model) were included in the analysis. We asked the administrator of the facilities about their principles for care provision by the dimensions of (1) wake-up, (2) dressing assistance in the morning, (3) meal, (4) bathing, (5) toileting assistance, and (6) spare time. We mainly asked about flexibility of scheduling and choice for menu, programs, and utensils. Unit-care model facilities and group-care model facilities were negatively associated with principles of fixed time and all-at-once assistance for waking up, dressing, and toileting. Residents had more choice for menu and programs for spare time in unit-care model facilities and group-care model facilities. The governmental requirements affected principles for care provision by defining the structure of facilities and staffing for desirable care provision. Raising fees for the group-care model can be an effective measure to achieve it in facilities with conventional structure.

Influence of systematic nursing model on treatment compliance and clinical efficacy of elderly patients with diabetes

Objective To probe into the effect of systematic nursing model on treatment compliance and clinical efficacy of elderly patients with diabetes. Methods 100 elderly patients with diabetes in our hospital were selected from January 2008 to December 2010.The patients were divided into the study group and the control group randomly,50 cases in each group.The patients in the control group were treated with conventional care model,while the patients in the study group were treated with systematic nursing model.The compliance,clinical treatment effect,and improvement of clinical indicators were compared and ana lyzed in two groups respectively. Results Compared with the control group,treatment compliance indexes such as self-monitoring,diet control,medication compliance,exercise therapy in the study group were significantly improved,the difference was statistically significant.Compared with the control group,the clinical efficacy of patients in the study group was significantly improved.Compared with the control group,the FBG,PBG and HbAlc were improved significantly,the difference was statistically significant. Conclusions Systematic nursing model plays a positive role in promoting treatment compliance and clinical effects of elderly patients with diabetes mellitus.The interventions need to be further enriched and perfected. Key words: Systematic nursing model; Treatment compliance; Clinical efficacy; Elderly patients with diabetes mellitus