Integrated Care Research Articles

A Qualitative Exploration of the Role of Culturally Relevant Social Prescribing in Supporting Pakistani Carers Living in the UK.

Approximately 5.7 million people in the UK are providing informal care. Carers across all ethnic groups can experience negative impacts on their physical and mental health but some minority ethnic groups face greater challenges. Higher levels of social isolation exist among Pakistani carers compared to White British carers, yet the needs of Pakistani carers and how well support services meet these needs is less well understood. Social prescribing can help people get more control over their health care in a nonmedical way. South Asian and other ethnically diverse populations are under-served in social prescribing and there is little evidence available on why this is the case. To explore the potential role of culturally relevant and adapted social prescribing in assisting Pakistani carers and identify the cultural and religious influences and barriers on carer health behaviours. Semi-structured one-to-one interviews with Pakistani family carers (n = 27) and social prescribing stakeholders (n = 10) living in London and Sheffield, UK. Participants were recruited through voluntary and community sector organisations (VCSOs), social media, religious organisations, and word of mouth. Interview data was analysed in NVivo using reflexive thematic analysis methods. Two themes were developed; (1) Individual and community level influences: Navigating and accessing carer support within Pakistani communities, including carer identity and cultural barriers to accessing support provision, and cultural adaptation to facilitate support for Pakistani carer health and well-being, (2) societal and structural level challenges: Accessing and providing social prescribing for Pakistani carers, including funding challenges for the provision of culturally relevant carer support, integration of primary care and social prescribing, and enhancing cultural awareness and competence in social prescribing for Pakistani carers. There are complexities surrounding carer identity, family dynamics, stigma, and a lack of knowledge of social prescribing within Pakistani communities. There is a need for more culturally competent support, culturally relevant education, awareness-raising, and collaboration among primary care and VCSO's to better support Pakistani carers through social prescribing, which acknowledges and addresses the complexities. The study included a patient advisory group comprised of two South Asian family carers who contributed towards all stages of the study. They provided feedback on study documents (topic guides and recruitment materials) and recruitment strategy, supported with translation of study documents and interpretation of the interview data, and helped with facilitation of our dissemination activities.

The Rare Instance of Uterine Adenocarcinoma Metastasizing to the Skull Base, Manifesting as Blindness and Ptosis

Metastasis to the skull base is a rare but serious complication of various malignancies. This case report discusses a 50-year-old woman with a history of advanced endometrial adenocarcinoma who presented with progressive headache, left-eye blindness, and ptosis. Imaging revealed a mass along the left optic nerve, raising suspicions of mucormycosis, but biopsy confirmed metastatic endometrial adenocarcinoma. Despite undergoing skull base radiotherapy, the patient’s vision did not improve. This case underscores the importance of considering metastatic endometrial adenocarcinoma in differential diagnoses for skull base lesions, particularly when other conditions are ruled out. Accurate diagnosis requires careful integration of clinical, radiological, and histopathological data.

Fatigue and Sleep-related Impairment as Predictors of the Effect of Nonpharmacological Therapies for Active duty Service Members With Chronic Pain: A Secondary Analysis of a Pragmatic Randomized Clinical Trial.

First-line treatments for chronic pain include selected complementary and integrative health therapies, including spinal manipulation, acupuncture, yoga, and massage; and standard rehabilitative care, including physical and occupational therapies. This study aimed to uncover critical factors that contribute to pain impact and the effectiveness of complementary and integrative health therapies and standard rehabilitative care among people with chronic pain, with a focus on the role of sleep-related impairment. We conducted a secondary analysis of data from a pragmatic randomized clinical trial of 280 U.S. active duty service members with chronic pain. Our study's multiple mediation analysis examined the indirect effect of complementary and integrative health therapies on pain impact through fatigue (β = - 0.43; 95% CI, -0.99 to -0.07). When stratified by sleep-related impairment, participants with T scores above the median of 62 demonstrated a significant negative indirect effect of complementary and integrative health therapies through fatigue (β = - 0.80; 95% CI, -2.31 to -0.14). This negative indirect effect was not significant for participants with sleep-related impairment T scores below the median (β = - 0.64; 95% CI, -1.48 to 0.07). These findings suggest that complementary and integrative health therapies are particularly effective in reducing pain impact for individuals with higher levels of sleep-related impairment, and that the effect of complementary and integrative health therapies is supported primarily by reducing fatigue.

A roadmap for a middleware as a federation service for integrative data retrieval of agricultural data.

Agriculture is confronted with several challenges such as climate change, the loss of biodiversity and stagnating productivity. The massive increasing amount of data and new digital technologies promise to overcome them, but they necessitate careful data integration and data management to make them usable. The FAIRagro consortium is part of the National Research Data Infrastructure (NFDI) in Germany and will develop FAIR compliant infrastructure services for the agrosystems science community, which will be integrated in the existing research data infrastructure service landscape. Here we present the initial steps of designing and implementing the FAIRagro middleware infrastructure to connect existing data infrastructures. The middleware will feature services for the seamless data integration across diverse infrastructures. Data and metadata are streamlined for research in agrosystems science by downstream processing in the central FAIRagro Search and Inventory Portal and the data integration and analysis workflow system "SciWIn".

ChatGPT and radiology report: potential applications and limitations.

Large language models like ChatGPT, with their growing accessibility, are attracting increasing interest within the artificial intelligence medical field, particularly in the analysis of radiology reports. These present a valuable opportunity to explore the potential clinical applications of large language models, given their huge capabilities in processing and understanding written language. Early research indicates that ChatGPT could offer benefits in radiology reporting. ChatGPT can assist but not replace radiologists in achieving diagnoses, generating structured reports, extracting data, identifying errors or incidental findings, and can also serve as a support in creating patient-friendly reports. However, ChatGPT also has intrinsic limitations, such as hallucinations, stochasticity, biases, deficiencies in complex clinical scenarios, data privacy and legal concerns. To fully utilize the potential of ChatGPT in radiology reporting, careful integration planning and rigorous validation of their outputs are crucial, especially for tasks requiring abstract reasoning or nuanced medical context. Radiologists' expertise in medical imaging and data analysis positions them exceptionally well to lead the responsible integration and utilization of ChatGPT within the field of radiology. This article offers a topical overview of the potential strengths and limitations of ChatGPT in radiological reporting.

Importância da Enfermagem na Implementação de Protocolos de Cuidado Integral para Gestantes com Pré-Eclâmpsia: Estratégias e Desafios

Introduction: The article investigates the importance of nursing in the implementation of comprehensive care protocols for pregnant women with preeclampsia, highlighting the strategies adopted and the challenges faced by healthcare professionals. Objective: Analyze the importance of nursing in implementing comprehensive care protocols for pregnant women with pre-eclampsia, highlighting the strategies used and the challenges faced. Methodology: This study was developed based on a bibliographical review of scientific literature and national and international guidelines on the management of pre-eclampsia, as well as practical case studies and reports from health units. The search was carried out in the PubMed, Scielo and Google Scholar databases, using the following descriptors: “pre-eclampsia”, “integral care”, “nursing”, “pregnant women” and “health protocols”, where as inclusion criteria Of the articles selected for data collection, we delimited the period from 2014 to 2024, which was in accordance with the present study. Data collection was carried out from July to October 2024, on the other hand, productions that were unrelated or did not correspond to the theme were excluded. Results: Evidence suggests that there are significant challenges in clinical practice, such as a lack of resources and the need for ongoing training, which hinder the effective implementation of care. Furthermore, it was also observed that the pregnant woman’s lack of knowledge regarding her condition, poor appreciation of the work of health professionals and operational challenges faced by nursing are obstacles that directly impact the quality of care and their satisfaction. Conclusion: The adoption of comprehensive protocols improves clinical results and better meets the needs of pregnant women, highlighting the relevance of nursing in promoting maternal-fetal health and well-being.

A Intervenção do Serviço de Atenção Domiciliar junto ao usuário e cuidador na rede de atenção à saúde

**Introduction**: Population aging drives the development of home care practices, expanding the role of healthcare teams. The Home Care Service (SAD) is characterized by comprehensive actions in health promotion, prevention, treatment, and rehabilitation performed at home, ensuring continuity of care and effective integration with healthcare networks and the user. **Objective**: To highlight the relationship between the Home Care Service (SAD) and healthcare networks. **Methodology**: This is a descriptive study in the form of a narrative literature review, which sought to highlight the relationship between the Home Care Service (SAD) and healthcare networks. The research was conducted through online access to the PubMed, Medline, and Scielo databases, using the descriptors "home care services," "SUS," and "healthcare networks." Inclusion criteria were: articles available in full text, in Portuguese and English, addressing the topic, and published between 2019 and 2023. **Results**: The results highlight the importance of home care services in assessing, identifying, and training caregivers, promoting self-care and user autonomy. The lack of professional guidance for caregivers presents an opportunity for improvement in care practices. Furthermore, SAD stands out as an innovative strategy in healthcare, surpassing primary care and emergency services, adopting a humanized approach aligned with SUS. By replacing or complementing hospital stays, it seeks equity in resource distribution for efficient access to home care, with active intervention in caregiver training, playing a crucial role in preventing complications, and consolidating itself as a key agent for a patient-centered approach within the SUS framework. **Conclusion**: The intervention of SAD with the user and caregiver is of utmost importance in training caregivers to assist users, avoiding unnecessary complications and ensuring continuity of care within SUS. Thus, the service complements the care provided in primary care and emergency services and substitutes or complements hospital stays.

A forensic overview of deaths in mountainous terrain.

Deaths at high altitudes may arise from a range of quite disparate entities including trauma (e.g. falls), environmental factors (e.g. hypothermia and hypoxia), and pre-existing medical conditions (e.g. coronary artery disease). Unique conditions include high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) which may contribute to lethal mechanisms or precipitate a traumatic event. Forensic issues that may arise in these cases are logistical problems due to remote locations, sometimes with failure to find a body, delay in discovery and/or repatriation, prior local autopsies being performed with embalming, and the non-specificity of pathology markers. Traumatic deaths involve blunt force impacts, falls, suffocation, crush asphyxia and hypothermia. The assessment of cases requires careful integration of the autopsy findings with the medical history of the decedent and an accurate description of their behaviour in the hours leading up to death.

Spirituality in Professional Patient-Centered Care for Adults with Primary Brain Tumors: An Exploratory Scoping Review.

People with primary brain tumors face spiritual challenges due to neuro-cognitive disturbances such as aphasia and rapid neurological deterioration. This scoping review aimed to map the evidence regarding professional spiritual care in this neuro-oncological population. The literature search was conducted utilizing two databases (PubMed, CINAHL) and two peer-reviewed journals ('Spiritual Care', 'Journal of Religion and Health'). In total, 27 studies were analyzed, and five thematic categories were identified: (1) spiritual needs, (2) integrating the spiritual dimension in care, (3) spiritual care generalist interventions, (4) spiritual care specialist interventions, (5) assessments. Early integration of spiritual care and specific training are important.

Precision Cut Lung Slices: Emerging Tools for Preclinical and Translational Lung Research. An Official American Thoracic Society Workshop Report.

The urgent need for effective treatments for acute and chronic lung diseases underscores the significance of developing innovative preclinical human research tools. The 2023 ATS Workshop on Precision Cut Lung Slices (PCLS) brought together 35 experts to discuss and address the role of human tissue-derived PCLS as a unique tool for target and drug discovery and validation in pulmonary medicine. With increasing interest and usage, along with advancements in methods and technology, there is a growing need for consensus on PCLS methodology and readouts. The current document recommends standard reporting criteria and emphasizes the requirement for careful collection and integration of clinical metadata. We further discuss current clinically relevant readouts that can be applied to PCLS and highlight recent developments and future steps for implementing novel technologies for PCLS modeling and analysis. The collection and correlation of clinical metadata and multiomic analysis will further advent the integration of this preclinical platform into patient endotyping and the development of tailored therapies for lung disease patients.

The Ecological Map of Adolescent Athletes: Examining Integrative Care Approaches

This qualitative study explores the importance of an integrated care approach for adolescent athletes living with physical illness. The researcher used a phenomenological approach to provide this population with a platform to share their stories and to make meaning of their lived experiences. Using snowball sampling, the researcher gathered nine participants, ages 18-35, who resided within the United States. The researcher interviewed the participants via an online platform and analyzed their scripts using an interpretive phenomenological analysis approach. Through their exploration and sharing of consciousness, several important implications and contributions were unveiled to the social work profession. Their stories highlight the impact illness has on their psychological, psychosocial, physical, and overall functioning. Through the lens of the ecological systems theory, the study emphasizes the need for integrated and collaborative care between those who are directly or indirectly involved in the adolescent’s treatment. Ultimately, this preliminary study serves as a framework for clinical social workers as well as those who are involved in research, policy, and community-based work like schools and medical facilities. Through these stories, social workers and other helping professionals learn the power of connection and the importance of safeguarding the dignity and worth of the adolescent athlete.

Palliative Care in the Midst of Adversity: Insights from a Low-Income Country.

The integration of palliative care into conventional healthcare services has demonstrated significant benefits in alleviating serious health-related suffering (SHRS), reducing symptom burden, and lowering healthcare expenditure for patients and families. Despite Lebanon's initial steps towards palliative care development, its integration remains inadequate, particularly due to the country's socio-political and economic challenges. This paper examines the current landscape of palliative care services in Lebanon, including their geographical distribution and care models, while addressing the obstacles impeding their progress. Data on palliative care services were gathered from the presentations of stakeholders at the 2023 National Palliative Care Conference. Currently, three nonprofit organizations provide home-based palliative care primarily for end-of-life patients, while seven hospitals offer palliative care through inpatient consultation teams, three of which have specialized palliative care wards and two outpatient clinics. Hospital-based palliative care services are primarily located in the capital city Beirut and operate within private healthcare facilities. Notably, only home-based services are provided free of charge, while hospital-based care is not reimbursed, thus limiting access to palliative care for only those who can afford it. The political and economic instability, inadequate policies and insufficient reimbursement, shortage of trained expertise and essential medicines like morphine, and inconsistent health education are some of the challenges that Lebanon faces in developing palliative care. A multilevel coordinated response and advocacy are crucial to drive policy reforms, enhance education, promote public awareness, and improve clinical practice ensuring quality and equitable palliative care access to all.

Is the integration of health and social care meeting the growing demand?

Is the integration of health and social care meeting the growing demand?

Scaling up integrated care: Can community hospitals be an answer? A multiple-case study from the Emilia-Romagna region in Italy

Integrated care is considered to be essential in improving care for people with chronic conditions who need continuous care. In 2022, the Italian Government asked all regions to build or renovate a massive number of community care facilities, employing European Next Generation funds, to be spent by 2026. Under the theoretical lens of the Structural Contingency Theory, the paper aims at aims at describing the contextual and organizational factors underlying the interconnection between integrated care and community hospitals. The study employs a multiple-case study design, relying both on quantitative and qualitative data, conducted in a 6 months-period. It investigated seven community hospitals belonging to a single Local Health Authority in Emilia-Romagna region in Italy. The choice of the empirical context was driven by Emilia-Romagna's long- and well-established tradition of community-based care. Overall, our analysis shows that community hospitals offers opportunities of integrated care, including better integration between care sectors, between primary care and specialist staff, between healthcare structures and their local community. The study confirms the value of the Structural Contingency Theory and its key message: implementation is not a mechanical step of the policy cycle and requires important adjustments to the planning phase according to environment and organizational factors.

(Re)conceptualising Good Care in Hospital Settings From the Perspectives of Older Persons: A Concept Analysis Using Pragmatic Utility.

To understand good care from the perspective of hospitalised older persons. Older persons are the largest group of hospital users, and numbers will increase in the next decades. Hospital organisations are attempting to transform traditional care models to meet the specialised needs of hospitalised older persons. To achieve this, healthcare providers including nurses and administrators need to understand the perspectives of hospitalised older persons on what constitutes good care. This knowledge is critical to nursing to ensure that care aligns with the perceived needs of hospitalised older persons. However, good care from the viewpoints of hospitalised older persons remains ambiguous and poorly delineated in the literature. We conducted a concept analysis using the pragmatic utility method. To identify peer-reviewed articles, we searched CINAHL, MedLine, PsycINFO, Scopus and Embase databases for related literature using the keywords and related terms to 'good care', 'hospital or acute care' and 'older persons'. Twenty-two peer-reviewed articles out of 2144 search results were included. The heterogeneity of older persons' perspectives and limitations in the literature on good care led to a tentative understanding. Good care, a partially mature concept, is the provision of person-centred, culturally sensitive, holistic and integrated care that fosters autonomy, control and participation, resulting in a sense of belonging, smooth transitions, optimal management of clinical conditions, satisfaction in care and informed older persons and family caregivers. Older persons are a heterogeneous group with diverse perceptions of good care. Instead of seeking a common understanding of good care, efforts should be focused on identifying individual preferences, values and goals of hospitalised older persons. The components of good care are important for many hospitalised older persons and can serve as a starting point for improvements in practice settings. However, this understanding is tentative and may overlook critical aspects of care at an individual level. Hospital organisations, healthcare providers and nurses should be cognizant of this limitation and cultivate adaptability for an individualised approach to care.

Scoping review of enablers and challenges of implementing pharmacogenomics testing in the primary care settings.

Pharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings. To systematically review the current state of PGx in the primary care settings and determine the enablers and challenges of its implementation. A scoping review was carried out by adhering to Arksey and O'Malley's 6-stage methodological framework and the 2020 Joanna Briggs Institute and Levac et al. DATA SOURCES: Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed were searched up to 17 July 2023. All peer-reviewed studies in English, reporting the enablers and the challenges of implementing PGx in the primary care settings were included. Two independent reviewers extracted the data. Information was synthesised based on the reported enablers and the challenges of implementing PGx testing in the primary care settings. Information was then presented to stakeholders for their inputs. 78 studies discussing the implementation of PGx testing are included, of which 57% were published between 2019 and 2023. 68% of the studies discussed PGx testing in the primary care setting as a disease-specific themes. Healthcare professionals were the major stakeholders, with primary care physicians (55%) being the most represented. Enablers encompassed various advantages such as diagnostic and therapeutic benefits, cost reduction and the empowerment of healthcare professionals. Challenges included the absence of sufficient scientific evidence, insufficient training for healthcare professionals, ethical and legal aspects of PGx data, low patient awareness and acceptance and the high costs linked to PGx testing. PGx testing integration in primary care requires increased consumer awareness, comprehensive healthcare provider training on legal and ethical aspects and global feasibility studies to better understand its implementation challenges. Managing high costs entails streamlining processes, advocating for reimbursement policies and investing in research on innovation and affordability research to improve life expectancy.

Integrative organization of the care pathway for the elderly bronchial cancer patient at Rennes University Hospital

In response to the need for high-quality care for elderly patients with bronchial cancer, the pneumology and oncogeriatrics units have developed an integrative care pathway. It is the result of collaboration between the advanced practice nurse in oncopneumology, the coordinating nurse and the oncogeriatric physician.

Midwifery Care Continuity of Care at Delta Mutiara Clinic and Maternity Hospital, Sidoarjo

Continuity of Care is a program to improve the provision of midwifery services continuously carried out by Midwives and as the final project for midwifery students by promoting holistic and integrated midwifery care. The aim of this study was to provide continuous midwifery care , 25 year old, Mrs. A at the Delta Mutiara Clinic, Sidoarjo. The research design is descriptive with the case type of study research. The results showed that the midwifery care provided to Mrs. A, starting from pregnancy, childbirth, postpartum, newborns, and family planning, went according to midwifery care standards. Conclusions after being given Continuity of Care midwifery care, the mother feels comfortable, the occurring complications can be resolved and detected since the beginning of pregnancy, the mother and baby received adequate and integrated care.

Integrated care for older people improved intrinsic capacity in elderly patients: a case control study

ObjectivesObserve the effect of integrated care for older people on intrinsic capacity in elderly patients.MethodsSixty elderly patients from department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between June 2021 and December 2021 were selected and divided into control group and intervention group with 30 patients in each group using random sampling method. Two groups implement routine care, and the intervention group implement integrated care by a “hospital-community-family” multidisciplinary team. After 12 weeks of intervention, the differences in frailty, cognition, depression scores, comprehension social support scores, and World Quality of Life Scale scores were compared between the two groups.ResultsBefore intervention, there was no significant difference in the grip strength, step speed, frailty scores, cognition, depression scores, social support and quality of survival between the control group and the intervention group. After intervention, grip strength and depression scores improved both in the control group and the intervention group, but there was no difference between the two groups. Cognitive scores, comprehension social support and quality of survival scores improved only in the intervention group, while only the cognitive ability showed significant differences between the intervention group and the control group after 12 weeks of intervention (P<0.05).ConclusionsIntegrated care for older people intervention can help to improve the intrinsic capacity of the patients, especially cognitive abilities.

Identifying transdiagnostic and multidimensional prognostic indicators among veterans with PTSD symptoms in brief integrated care settings.

Brief integrated care settings hold promise for accessible and effective trauma-informed interventions. However, clinicians often have difficulty efficiently forecasting who is most appropriate for interventions in such settings and how to target individualized care. Multidimensional and transdiagnostic evaluations may provide valuable information to improve stepped-care and treatment practices for veterans. A middle-out approach was used to concurrently evaluate self-reported posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and physical health problems using cross-sectional (latent profile analysis) and longitudinal (latent growth mixture modeling) analyses that identified unique symptom profiles, trajectories of traumatic stress reactions, and correlates of these health outcomes. Data from 234 veterans who participated in a randomized controlled trial of primary care PTSD intervention were analyzed at 0, 8, 16, and 24 weeks. Latent profile analysis identified two homogenous baseline profiles: global symptoms (33.8%); low dysphoria-lower negative cognitions, mood, and depressive symptoms (66.2%). Low dysphoria participants reported more social relationships (OR = 1.32) and fewer environmental (OR = 0.89) and financial (OR = 0.23-0.35) stressors. Latent growth mixture modeling identified three trajectories: (a) reducing symptoms ("responders"; 21.3%) and chronic symptoms of (b) moderate (59.6%) and (c) high (19.1%) severity. Low dysphoria participants were 4.35 times more likely to be responders over time compared to participants with moderate severity symptoms. Findings indicated that veterans with moderate PTSD symptoms and physical health problems but low dysphoria may respond best to trauma-informed intervention in brief integrated care settings, while others may require further individualized stepped care. Findings demonstrate unique traumatic stress reactions that support individualized stepped care and may offer greater treatment utilization, retention, and efficacy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).