Care Guidance Research Articles

Family Caregivers of Older Adults with Physical Disabilities in Rural Thailand

Thailand is one of many countries experiencing changes in the demographics of its population. People are living longer and having fewer children resulting in an increasing percentage of older adults in the general population. This presents a challenge in providing care for older adults, especially in countries where there is a culture of family caregiving. This study aims to investigate the experience of family caregivers, exploring the problems of caring for older people with physical disabilities and the needs of family caregivers. This is done to better understand ways to support caregivers. Using a descriptive qualitative approach, 15 family caregivers were enrolled who provide care to older adults with physical disabilities in a rural community in Northern Thailand. The interviews were conducted face-to-face and were analyzed by thematic analysis. Findings showed two main categories from the data: problem areas and needs. The “problem area” themes are low-income households, management of activities of daily living, and access to resources. The “needs” themes are home modifications and adaptive equipment and development of a support system. The identified themes provide guidance for long term care, home adaptation, and assistive products. Future research can be done into the impact of these interventions.

Understanding Trauma-Informed Care in the PALTC Setting

Understanding Trauma-Informed Care in the PALTC Setting

Analysis of Health Care Methods and Effect and Efficiency of Health Care Guidance for Children with Malnutrition

Analysis of Health Care Methods and Effect and Efficiency of Health Care Guidance for Children with Malnutrition

The Effect of Environmental Enrichment on Laboratory Rare Minnows (Gobiocypris rarus): Growth, Physiology, and Behavior.

Simple SummaryEnvironmental enrichment is an important part of animal welfare. In this study, rare minnow in different rearing conditions underwent comprehensive evaluation regarding growth, anxiety-like behavior, and physiology parameters. Results showed that there were no differences in SGR, anxiety-like behavior, DA, DOPAC, and 5-HIAA levels between control and enriched groups. However, the enriched group had higher cortisol and 5-HT levels. Therefore, researchers should focus on the effect of environmental enrichment regarding the welfare of rare minnow and how it effects the validity of data from laboratory studies.Environmental enrichment is a method to increase environmental heterogeneity, which may reduce stress and improve animal welfare. Previous studies have shown that environmental enrichment can increase the growth rate, decrease aggressive and anxiety-like behaviors, improve learning ability and agility, and reduce cortisol levels in animals. These effects usually differ between species. Unfortunately, habitat enrichment on laboratory fish is poorly studied and seldom adopted in care guidance. Rare minnows (Gobiocypris rarus) have been cultured as a native laboratory fish in China in barren banks without environmental enrichment since 1990; they have been widely used in studies on ecotoxicology, environmental science, and other topics. The purpose of this study was to investigate the effect of environment enrichment on the growth, physiological status, and anxiety-like behavior of laboratory rare minnows. We observed and analyzed SGR, cortisol levels, DA, DOPAC, 5-HT and 5-HIAA, and anxiety-like behavior indexes after one month of treatment in barren (control) and enrichment tanks. We found that there were no significant differences in SGR, anxiety-like behavior, DA, DOPAC, or 5-HIAA levels between the two treatments. However, higher cortisol and 5-HT levels were observed in the enrichment tanks. This study suggests that rare minnows might be influenced by their living environment, and future related studies should consider their environmental enrichment.

A Call for Evidence-Based Conservative Management of Nail Unit Malignancies.

Nail unit squamous cell carcinoma and melanoma are the most common malignancies of the nail apparatus. Compared to their cutaneous counterparts, they are diagnosed later and perceived as more aggressive. This may result in overzealous management, including radiographic imaging with poor sensitivity and specificity, interventional nodal staging by sentinel lymph node biopsy, amputation over digit-sparing tumor resections, and elaborate reconstructions after tumor extirpation. In this review article, the authors evaluate the evidence behind several misconceptions in nail malignancy management and provide evidence-based guidance for more conservative care.

Hospital organizational structure factors related to discharge planning activities for alcoholics by nurses in Japan.

Nurses play a significant role in providing discharge support for alcoholics. We aimed to explore the organizational structures of hospitals that are related to effective discharge planning activities provided by nurses. We conducted a cross-sectional survey of Japanese hospitals with psychiatric wards that accept alcoholics. The survey questionnaire was administered to one nurse per hospital from August to September 2019. The Discharge Planning Scale for Ward Nurses (DPWN) was used to assess the actual status of the hospital nurse teams' discharge planning activities. The DPWN consists of four subscales: subscale I, "collect information from patients and their families"; subscale II, "supports for decision-making for the patients and families"; subscale III, "utilization of social resources"; and subscale IV, "discharge guidance by cooperating with community support teams and multidisciplinary teams." From the valid responses of 116 hospitals, scores on subscale IV were significantly lower than scores on subscales I, II, and III, indicating that medical care guidance through multidisciplinary collaboration between hospitals and the community was inadequate. In addition, multiple regression analysis showed that "hospital management and administrators understanding about nurses' discharge support activities," and "planning discharge schedules, such as using clinical paths" were significantly and independently related to the total DPWN and each of subscale scores, regardless of the hospital's establishment body and size. "Multidisciplinary discharge support" was significantly related to subscale II. These findings have implications for the management of discharge planning activities provided by nurses for alcoholics through multidisciplinary collaboration.

Priority recommendations for the implementation of patient-reported outcomes in clinical cancer care: a Delphi study

PurposeThe aim of this study was to develop priority recommendations for the service level implementation of patient-reported outcomes (PROs) into clinical cancer care.MethodsDevelopment of draft guidance statements was informed by a literature review, the Knowledge to Action (KTA) implementation framework, and discussion with PRO experts and cancer survivors. A two-round modified Delphi survey with key stakeholders including cancer survivors, clinical and research experts, and Information Technology specialists was undertaken. Round 1 rated the importance of the statements and round 2 ranked statements in order of priority.ResultsRound 1 was completed by 70 participants with round 2 completed by 45 participants. Forty-seven statements were rated in round 2. In round 1, the highest agreement items (>90% agreement) included those that focused on the formation of strong stakeholder partnerships, ensuring ongoing communication within these partnerships, and the use of PROs for improvement and guidance in clinical care. Items ranked as the highest priorities in round 2 included assessment of current staff capabilities and service requirements, mapping of workflows and processes to enable collection, and using collected PROs to guide improved health outcomes.ConclusionsThis stakeholder consultation process has identified key priorities in PRO implementation into clinical cancer care that include clinical relevance, stakeholder engagement, communication, and integration within the existing processes and capabilities.Implication for Cancer SurvivorsRoutine adoption of PRO collection by clinical cancer services requires multiple implementation steps; of highest priority is strong engagement and communication with key stakeholders including cancer survivors.

A Survey on Treatment Status of Korean Medicine Doctors for the Behavioral and Psychological Symptoms of Dementia: Preliminary Data for Guidance of Integrative Care.

Behavioral and psychological symptoms of dementia (BPSD) are major causes of care burden in patients with dementia. Integrative care, including Western medicine (WM) and Korean medicine (KM), can be an attractive option for this condition. To investigate the experience and perceptions of dementia care; experience, knowledge, and perceptions of management for BPSD; the need for guidance of integrative care for BPSD management, KM doctors were surveyed. A total of 137 KM doctors completed the survey. Most institutions where the participants worked were able to provide integrative care services (88.32%). The rate of referral for dementia patients from the WM to KM departments was also highest in the convalescent hospital setting (94.92%), while the rate was lowest in the public health center setting (38.46%). The common purpose of KM treatments for patients with dementia included “psychological symptom treatment” (37.23%); however, the number of referrals from WM to KM departments for BPSD management was relatively few (25.64%). Participants perceived that knowledge about KM or integrative care for BPSD of non-KMD personnel working at the same institution was generally low. Based on these results, facilitating mutual exchange between WM and KM can help establish integrative care for dementia management in Korea.

Telehealth education improves parental care ability and postoperative nutritional status of infants after CHD surgery: A prospective randomized controlled study.

This study aimed to explore the effect of telehealth education on improving the parental care ability and postoperative nutritional status of infants after congenital heart disease surgery. A prospective randomized controlled study was conducted at a provincial maternal and child hospital in southeastern China. A total of 84 infants were enrolled in the study, with 42 infants in the intervention group and 42 infants in the control group. Body weight, albumin, prealbumin, and hemoglobin of infants in the intervention group were significantly higher than those in the control group one month after discharge (P<0.05). The STRONGkids score of infants in the intervention group was significantly higher than that of those in the control group one month after discharge (P<0.05). The Family Caregiver Task Inventory score of infants in the intervention group was significantly lower than that of those in the control group one month after discharge (P<0.05). Performing telehealth education about home feeding and care guidance for parents of infants after congenital heart disease surgery can greatly improve parental care ability so that infants get better feeding and care, which can effectively improve the postoperative nutritional status of the infants.

Systematic evaluation of qualitative research on the real experience of burn patients during rehabilitation

Objective: To systematically evaluate and integrate the real experience of burn patients during rehabilitation, and to provide theoretical guidance for the continual nursing care for burn patients. Methods: The systematic evaluation method was adopted. Databases including the China National Knowledge Internet, Wanfang Database, China Biology Medicine disc were retrieved with the search terms in Chinese version of "/, //, ////", and PubMed, Embase, CINAHL, PsycINFO, Cochrane Library were retrieved with the search terms of "burn/burns, rehabilitation/recovery/survivor/survive, experience/views/perceptions/, qualitative/phenomenon/interview/grounded theory". The qualitative studies on the real experience of burn patients during rehabilitation published from the establishment of each database to June 2020 were searched. The quality of the included studies was evaluated according to the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. The research country, research method, research object, research content, and main research result were summarized, and meta-synthesis of the research results was conducted with the aggregative integration method. Results: A total of 12 studies were included, and the quality of all the studies was grade B. The studies were conducted in 8 countries including Australia, Canada, Norway, etc., the research method mainly was phenomenological research method, and all the studies were focused on adult burn patients. A total of 46 specific themes were extracted with totally 10 new categories formed after summarization, and 3 integrated results were obtained as follows: burn patients suffered from both physical and psychological burdens, and their normal life was broken; burn patients gained post-traumatic growth and could actively adjust to cope with life difficulties; burn patients had multiple needs. Conclusions: Burn patients experience both physical and psychological pains during rehabilitation, so they long for multiple support from family and society. Medical staff, social groups, and family members should pay attention to the psychological experience and needs of burn patients with different characteristics during rehabilitation, and build a multi-directional social support system to help patients return to the society and rebuild their lives.

Standards of care guidance for sweat testing; phase two of the ECFS quality improvement programme

More than five decades after the introduction of the quantitative pilocarpine iontophoresis technique, surveys still highlight inconsistencies in the performance and reporting of sweat tests in Europe. The sweat test remains key for the Cystic Fibrosis (CF) diagnostic pathway for all age groups, as it reflects the basic pathophysiological defect in the sweat gland. It is also critical following newborn screening as a confirmatory diagnostic step. Despite its importance, sweat test quality is variable whether performed in the laboratory or as a point of care test. The ECFS DNWG aims to improve sweat test performance, taking into account the barriers and issues identified in the European survey; the previous step in the ECFS sweat test project. This manuscript proposes a grading of sweat test guidance from "acceptable" to "optimal", aiming to pragmatically improve quality while taking into account local situations, especially in resource-limited settings.

National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project

BackgroundIn the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON).MethodsMixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified.DiscussionFor a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

Pedi-R-MAPP: The development of a nutritional awareness tool for use in remote paediatric consultations using a modified Delphi consensus

The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool. The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n=110) reported that 5.7±10.6 out of every 10 appointments were completed in person; compared to paediatricians (n=182) who reported 7.5±7.0 out of every 10 appointments to be in person (p<0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n=89/104) of statements reached consensus, whereas in round-two 12.5% (n=13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised. The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.

Mongolian Medical Theory and Health Care Guidance of Cervical Spondylosis

Mongolian Medical Theory and Health Care Guidance of Cervical Spondylosis

Recognising our community as we head towards JEB's centenary in 2023.

Recognising our community as we head towards JEB's centenary in 2023.

Telehealth Education via WeChat Improves the Quality of Life of Parents of Children with Type-1 Diabetes Mellitus.

The purpose of this study was to explore the effect of telehealth education and care guidance via WeChat (Tencent Ltd., Shenzhen, China; a popular smartphone-based social media application) on improving the quality of life of parents of children with type-1 diabetes mellitus. A prospective randomized controlled study was conducted in our hospital from March 2019 to September 2020 to compare the quality of life of parents of children with type-1 diabetes mellitus in the intervention group and the control group. Six months after discharge, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of parents in the intervention group were significantly lower than those in the control group (p < 0.05). Compared with the SAS and SDS scores at discharge time, those scores of parents at 6 months after discharge time in intervention group were significantly lower (p < 0.05), while those scores of parents at 6 months after discharge time in control was similar (p > 0.05). Six months after discharge, the scores of the physiological field, psychological field, social relationship field, and environmental field in the intervention group were significantly higher than those of the control group according to the result of the World Health Organization Quality of Life Brief Scale (WHOQOL-BREF; p < 0.05). Using WeChat to provide telehealth education and home care guidance to the parents of children with type-1 diabetes mellitus can effectively relieve the anxiety and depression of the parents and improve their quality of life.

Antipsychotics, Antiepileptics, and Fabrication: Are We Making It or Faking It?

Antipsychotics, Antiepileptics, and Fabrication: Are We Making It or Faking It?

Construction of a nursing care protocol for children in post-hematopoietic stem cell transplantation.

To construct a nursing care protocol for children in post-hematopoietic stem cell transplantation. Methodological research carried out from January to September 2019, in three steps: (a) integrative review (nursing care was identified); (b) theoretical structuring and organization of healthcare based on the Theory of Basic Human Needs and on the International Classification for Nursing Practice (supplementing the review data); and (c) development of a protocol in the three previously mentioned stages. Analysis of the understanding of the protocol's items/care was performed by three specialist nurses. The care protocol consists of 40 nursing problems and is organized in accordance with the psychobiological, psychosocial, and psycho-spiritual needs of children undergoing transplantation, integrating practical and guidance care. The care protocol is an important technology for nursing care to transplanted children, aimed to prevent and manage transplantation complications.

Mitigating the effects of COVID-19 on HIV treatment and care in Lusaka, Zambia: a before–after cohort study using mixed effects regression

IntroductionThe Zambian Ministry of Health (MoH) issued COVID-19 mitigation guidance for HIV care immediately after the first COVID-19 case was confirmed in Zambia on 18 March 2020. The Centre for...

Users' perspectives on the quality of family planning services in Mozambique: a case study.

Introductionuser satisfaction assessment has been increasingly important in ensuring health care quality and guidance in the health sector. Africa is the region in the world with the lowest prevalence of contraception use. Universal access to family planning has one of the highest rates of benefits for cost among strategic options for development. Family planning can reduce mortality associated with pregnancy, childbirth, and postpartum, and family planning consultations are available in primary health care in Mozambique since 1980, with services delivered at all different levels of the national public health system. In 2017 this country had a high maternal mortality rate and one of the known causes was the low use of family planning. Among other causes for low utilization is the bias introduced by health professionals in the prescription of contraceptives and service deficiencies. We intended to assess the users’ opinion about family planning visit quality at the Marrere Health Center, to understand how we might consequently increase the use and quality of these services. This study was designed as a planned intermediary evaluation, as part of a larger implementation research project, aiming to reduce maternal and newborn mortality rates in Natikiri neighbourhood, in Nampula peri-urban area.Methodswe carried out a descriptive cross- sectional quantitative case study, where the target population was users of family planning services at a local health center. A random sample of 137 individuals answered a survey consisting of satisfaction, and we consulted family planning service statistical indicators. Users were considered satisfied if they answered “satisfied” or “very satisfied” on questions. Frequencies were calculated with statistical package for the social sciences (SPSS) 22.0 with a confidence interval of 95% and a 5% margin of error. The study protocol was approved by Lúrio University and the University of Saskatchewan (Canada) Ethics Committees.Resultsalmost all respondents (93%), were adult women with low levels of education. They stated, in general (88%), they were satisfied with the quality of care in the family planning consultation. There was minor participation of men in family planning. However, health professionals were found to not generally follow a patient-centered service protocol, with weaknesses in communication and information sharing, more commonly with adolescent clients.Conclusionmost family planning visits users were adult women, satisfied with the service provided. Successful changes in family planning practice require broad support from political, religious and community sectors. Additionally, proper technical and professional training of health professionals is necessary to achieve a positive impact on individuals, families, communities, and government. Family planning promotion in primary health care is recommended as an important strategy for achieving universal health coverage, protecting the lives of women, and promoting the country's development.