Medical Care Support Research Articles

Explaining the Amount and Consistency of Medical Care and Self-Management Support in Asthma: A Survey of Primary Care Providers in France and the United Kingdom

The quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement. To examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention. An online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants was completed by 276 HCPs. Mokken scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support. On average, HCPs reported delivering 74.2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r= 0.58 and r= 0.57, P < .001). UK HCPs provided more and more consistent asthma self-management support-but not medical care-than French HCPs, which was explained by the presence of practice nurses in the United Kingdom. More training, positive social norms, and higher behavioral control explained better quality of care across all HCPs. Using carefully developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.

The Usability and Effectiveness of Mobile Health Technology-Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review.

BackgroundA growing number of mobile health (mHealth) technology–based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation.ObjectiveThis study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others.MethodsWe performed a systematic review searching the following electronic databases for studies on mHealth technology–based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed.ResultsOur search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects.ConclusionsMost studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care.

THE DEVELOPMENT AND IMPLEMENTATION OF THE MOST OPTIMAL SYSTEM OF INTERACTION OF A LARGE MULTI-FIELD CHILDREN HOSPITAL WITH INSURANCE COMPANIES CONCERNING PROGRAMS OF VOLUNTARY MEDICAL INSURANCE

Actuality of the study. Nowadays, in the Russian Federation, medical organizations have, independently of organizational legal form, a right to provide paid services both to population and legal persons. The purpose is to develop and implement an optimal system of interaction of large multi-type children hospital with insurance organizations. Materials and methods. The process of development of organization of medical services provision was studied within the frameworks of voluntary medical insurance during 2011-2017 in the Z.A. Bashliaeva children municipal clinical hospital. Results. During 2011-2016 an increasing of annual amount of funds received from medical services provision according voluntary medical insurance programs up to 14 times. The experience of optimal interaction of medical organization with insurance companies according voluntary medical insurance programs. Conclusion. It is appropriate to pay a special attention to effective interaction between medical organization and insurance company, to algorithm of functioning of medical organization during qualitative medical care support of children population in conditions of multi-type hospital complex.

Determinants of Pediatric EMS Utilization in Children with High-Acuity Conditions

Background: Underutilization of emergency medical services (EMS) for children with high-acuity conditions is poorly understood. Our objective was to identify differences in demographic factors and describe caregivers' knowledge, beliefs, and attitudes regarding EMS utilization for children with high-acuity conditions. Design/Methods: This was a mixed-methods study of children with high acuity conditions, defined as requiring immediate medical or surgical intervention and intensive care admission, over a one year period. Demographic data were collected through a retrospective chart review. Qualitative analysis of semi-structured interviews from a purposive sample of caregivers was conducted until thematic saturation was achieved. Results: Three hundred seventy-four charts were reviewed; 19 caregivers were interviewed (17 in-person, 2 via telephone). The 232 (62%) children not arriving by EMS tended to be younger (1.58 years vs. 2.31 years, p = 0.02), privately insured (30% vs. 19%, p = 0.04), and lived further from the hospital (16.80 miles vs. 12.45 miles, p = 0.001). Patient gender, ethnicity, comorbidities and caregiver language were not associated with EMS underutilization. Immediate invasive medical interventions were more often required for EMS utilizers (85% vs. 60%, p < 0.001). EMS utilizers were more likely to require intubation (78% vs. 47%, p < 0.001) and cardiopulmonary resuscitation (CPR) (26% vs. 2%, p < 0.001), and had shorter hospital stays (4.70 vs. 8.16 days; p-value < 0.001). Three principal themes determined EMS utilization: expectations, knowledge, and perceived barriers. Three principal themes determined EMS utilization: expectations, knowledge, and perceived barriers. Caretakers expected EMS would provide timely, safe transportation that expedited medical care and emotional support. Medical knowledge and prior experience with EMS influenced decision-making about arrival mode. Timeliness, cost, socioeconomic and demographic characteristics, loss of autonomy, and the logistics of EMS activation and transport were the most commonly reported barriers. Conclusions: Young age, private insurance status, and greater distance from the hospital were associated with EMS underutilization. Understanding caregiver expectations, knowledge, and perceived barriers may have important implications for the use of EMS for children. These findings reveal opportunities for improved public education on EMS systems to enhance appropriate EMS utilization for children with high acuity conditions.

On the Results of Analysis of Quality of Life of Paramedical Personnel

The quality of life of paramedical personnel is an important and little-studied characteristic of health that directly conditions quality of medical care support. The survey of 400 paramedical workers using questionnaire SF-36 demonstrated that an average grade of quality of life made up to 68.1±1.2. This grade decreases as increases age of workers. It is minimal in case of employment service 11-15 years and it is lower in medical nurses as compared with administrators of nursing services. The similar tendency is noted in workers of out-patient network as compared with workers of hospitals. Among all the components of quality of life a minimal grade is specific to level of social functioning and maximal grade -- to level of physical functioning. The analysis of level of quality of life of workers with different conditions of their life activity demonstrated that the most differences were specific to such factors as chronic diseases, level of income, character of personnel relationships, availability of organizational problems at work, prestige of medical nurse profession. The study substantiated importance of factors of non-material motivation of labor of paramedical personnel that can promote increasing of their quality of life and stimulate more effective work: amelioration of organizational conditions, target activity in development of optimal psychological climate in personnel staff, increasing of level of organizational, including deontological culture of all workers, increasing of prestige of profession of paramedical personnel, necessity of further development of system of labor remuneration.

The Post-Operative Complications as an Evaluation Indicator of Efficiency of Functioning of Three-Level System of Medical Care Support According to Urology Profile in the Voronezh Oblast

In the Voronezh Oblast, the modernization of system of medical care support of patients with urological pathology was implemented with the purpose of increasing efficiency of the urological service functioning. This action affected all levels: early active detection of urological pathology, standardization of examination and treatment, routing of patients, strict control by way of monthly reports of medical institutions of the Oblast at the level of hospital and out-patient services, supervisory visits of specialists to districts and efficient control on part of the Oblast Chief Out-of-Staff Urologist. In the course of study it is established that key indices characterizing efficiency of functioning of the regional system of urological care of population are admitted the levels of unreasonably prolonged conservative treatment and also reasonably application of low invasive and high-tech intervention, implementation of standardization of the curative diagnostic process, rate of post-operative complications, level of economic costs of diagnostic and treatment, level of medical competence of personnel and degree of early detection of urological pathology that is validated by statistically reliable positive effect at the expense of their adjustment. The detection of advanced forms of diseases results in increased disability, increased economic costs per each patient in need of several operative interventions and highly qualified care. The number of post-operative complications is considered as an indicator of timeliness and adequacy of provided medical care to patients. The article presents an analysis of efficiency of the three-level system of medical care support according indicator of post-operative complications.

The Organization of Specialized Medical Care Support to Victims of Road Traffic Accidents Using the Informational System for Issuing Passports of Traumatological Centers of The Moscow Oblast

Within the framework of the Moscow Oblast Integrated Medical Informational Analytical System an informational system of issuing passports of traumatological centers was developed. This system permits to implement statistical and economic analysis with the purpose of applying financial modeling of functioning of traumatological centers for the benefit of supporting high quality treatment, prevention of economic losses and decreasing of lethality after road accidents in medical organizations.

The Modern Characteristics of Anti-Tuberculosis Care Support of Population of the Chechen Republic

Despite a steady tendency of decreasing of indices of morbidity of tuberculosis of population of the Chechen Republic, the problems related to early diagnosis of tuberculosis and organization of specialized medical care of patients continue to be unresolved. The questionnaire survey of administrators of anti-tuberculosis medical organizations of the Chechen Republic was carried out with the purpose of establishing difficulties in medical care support of patients with tuberculosis and determining main directions of their overcoming. The results of study demonstrated that main problems are asocial behavior of patients, inadequate staffing of institutions with medical and paramedical personnel, absence of proper relationship with other medical organizations, inadequate level of financing. The administrators indicated as main directions of solving problems increasing of remuneration of labor of medical personnel of anti-tuberculosis medical organizations, development of social defense of patients, physicians and population, alteration of actual normative legal base according to modern social economic conditions, enhancement of preventive direction of work, optimization of manning table and standards of work load of physicians and also development of tactics of treatment and re-organization of dispensary observation of patients with tuberculosis.

Adverse Events in Home Care: Identifying and Responding with interRAI Scales and Clinical Assessment Protocols.

Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.

Нормативно-правовое обеспечение организации медицинской помощи пациентам с ВИЧ-инфекцией на федеральном и региональном уровнях (историческая справка)

Prevention and control of HIV infection in the Russian Federation are recognized as a nation-wide one and are one of the priorities for Russia's healthcare. The main principle of implementation of the State Strategy for the Prevention of the Spread of HIV Infection in the Russian Federation until 2010 and beyond is interdepartmental interaction and increase of the availability and quality of medical care and social support for patients with this pathology. The study of the regulatory and legal framework that determines the organization and provision of medical care to HIV-infected persons has been conducted. A number of legislative contradictions, which require the improvement of legislation regarding HIV-infected persons, were established.

Clinical survey of pediatric patients with vertigo at a regional medical care support hospital

Clinical survey of pediatric patients with vertigo at a regional medical care support hospital

Medical Care Support System for the International Sporting Events

Medical Care Support System for the International Sporting Events

THE MEDIATION IN HEALTH CARE: FROM LAW ENFORCEMENT TO DIALOG ABOUT RIGHTS

The normative base and publications were analyzed to review present notions «defect of medical care», «medical error». The absence of unified comprehension of the given definitions in the Russian legal practice was established. The established situation has advantages of pretrial and extrajudicial mode of settlement of disputes (mediation) in case of consideration of conflicts related to medical care support as an instrument directed to quick searching of decision mutually acceptable for both sides, including necessity of compensation of damage done.

THE COMPLEX ASPECTS OF MENTAL HEALTH OF PATIENTS WITH ONCOLOGIC PATHOLOGY

The article considers issues of mental health of patients with oncologic pathology from position of bio-psychosocial approach and in the context of psycho-oncology, an actual direction of practical medicine. The prevalence of marginal mental disorders in this contingent of female patients is demonstrated on the example of women with oncologic diseases of reproductive system. The psychotherapeutic approaches to their correction are outlined. The original view on ratio of pathogenic factors effecting mental health of patients with oncologic pathology at various stages of medical care support. The genuine point of view on functional diagnosis of patient with oncologic disorder including somatic, clinical psychological and social components. The conclusions are made concerning necessity in timely modern psychosocial and psychotherapeutic care of the given contingent of patients.

Therapeutic Targets for the Multi-system Pathophysiology of Heart Failure: Exercise Training.

Adult chronic heart failure (HF) is a terminal syndrome. While the HF phenotype is inhomogeneous across the ejection fraction spectrum, exercise intolerance remains a cardinal feature of all HF patients. Impairment of a single organ system cannot independently account for exercise intolerance in HF. Thus, the multi-system integrative pathophysiology of HF leads to challenges in identifying an effective medical therapy aimed at targeting a single mechanism to improve exercise tolerance. This unresolved medical care approach raises a number of points for discussion in this field as it is well-recognized that exercise intolerance is accompanied by increased hospitalizations and mortality across the HF spectrum. Practitioner-guided individualized exercise training represents an intrinsic multi-level therapeutic approach that inclusively "targets" integrated physiological systems. A rapidly evolving body of evidence provides firm support that structured exercise therapy is safe while leading to improved exercise tolerance (peak oxygen uptake [V̇O2]) followed by reduced hospitalizations and cardiovascular mortality across the HF spectrum. The benefits of guided exercise therapy in HF have been directly attributed to integrative improvements in peak V̇O2, skeletal muscle strength, cardiac function, micro- to macro-vascular function, circulation/organ perfusion, and nervous system function, among others. Despite the sound clinical evidence in support of exercise-based medical care, there remains an appreciable gap in translation of current scientific evidence and implementation of this therapeutic paradigm into routine clinical practice as well as universal insurance coverage for HF patients. In the following review, the theme of discussion is framed in a manner that carries a sense of urgency for the need to increase awareness of the up-to-date evidence-based support for the clinical implementation of structured exercise therapy as a necessary routine component of primary medical care practices for reducing hospitalizations, morbidity, and mortality in all HF patients.

P7-1 - Home Medical Care Support for Patients With Left Ventricular Assist Device Using Social Networking Service

Continuous-flow left ventricular assist devices (CF-LVAD) are increasingly used to support for the patients with advanced heart failure as bridge to heart transplantation. However, various complications management is necessary for patients at home after discharge. For two patients needed treatment for driveline infection site, we started management using Social Networking Service (SNS), evaluate the pictures taken by patients themselves, sharing how to care of wound site with visiting nurses. Subsequently, multidisciplinary medical staff such as Certified Nurse, Clinical Engineer, Wound Ostomy and Continence Nurse and Collaborating hospital doctor participated, we have started comprehensive VAD management including not only wound management but also anticoagulant therapy and device management. On the screen used only by medical staff, we can share patient condition smoothly anywhere and discuss treatment strategies with all staff. When a patient's device failure or pump thrombus was suspected, we instructed the patient an emergency visit, exchanged controller and adjusted acute phase anticoagulant therapy in short-term hospitalization. Then patient continued drip infusion at home care and collaborating hospital, performed safe anticoagulant therapy by measuring INR themselves every other day and adjusting the medication using SNS. Discussion: By using SNS, we could share more medical information and provide appropriate support system, which led to support of patient self-monitoring and to maintain both safety and quality of life.

Effective expression of Drebrin in hippocampus improves cognitive function and alleviates lesions of Alzheimer's disease in APP (swe)/PS1 (ΔE9) mice

Alzheimer's disease (AD), a progressive development dementia, is increasingly impacting patients' living conditions worldwide. Despite medical care and funding support, there are still no highly individualized drugs and practical strategies for clinical prevention and treatment. Developmentally regulated brain protein (abbreviated as Drebrin or Dbn, also known as Dbn1 in mouse) exists in neurons, especially in dendrites, and is an actin-binding protein that modulates synaptic morphology and long-term memory. However, the majority of previous studies have focused on its upstream proteins and neglected the impact Drebrin has on behavior and AD in vivo. Here, we tracked the behavioral performances of 4-, 8-, 12-, and 16-month-old AD mice and investigated the expression level of Drebrin in their hippocampi. A Pearson correlation analysis between Drebrin levels and behavioral data was performed. Subsequently, 2-month-old AD mice were injected with rAAV-zsGreen-Dbn1 vector, composing the APP/PS1-Dbn1 group, and sex- and age-matched AD mice were injected with rAAV-tdTomato vector to serve as the control group. All mice were conducted behavioral tests and molecular detection 6months later. (i) The expression of Drebrin is decreased in the hippocampus of aged AD mice compared with that of age-matched WT and young adult AD mice; (ii) cognitive ability of APP/PS1 mice decreases with age; (iii) Drebrin protein expression in the hippocampus correlates with behavioral performance in different aged AD mice; (iv) cognitive ability improved significantly in APP/PS1-Dbn1 mice; (v) the expression level of Drebrin in APP/PS1-Dbn1 mouse hippocampus was significantly increased; (vi) the pathological lesion of AD was alleviated in APP/PS1-Dbn1 mice; (vii) the filamentous actin (F-actin) and microtubule-associated protein 2(MAP-2) in APP/PS1-Dbn1 mice were notably more than control mice. In this study, an effective expression of Drebrin improves cognitive abilities and alleviates lesions in an AD mouse model. These results may provide some valid resources for therapy and research of AD.

The sexuality of a colostomized person as a major component of quality of life and nursing care

The colostomized person's perceptions regarding sexuality and sexual activity is a major component of quality of life and nursing care, however due to several limitations, the questionnaire only approach, although validated for such applications, has not enough resolution, due to its qualitative approach, to capture more delicate aspects of the impact of an ostomy onto a otherwise healthy patient. In order to correct such bias, a exploratory-descriptive study of a qualitative approach based on Bardain’s content analysis was conducted. 80 colostomized participants were recruited from Stomatology Outpatient Clinics in the Hospital de Base, Regional Hospital of Asa Norte and the Regional Hospital of Gama, Distrito Federal, Brazil. Data was collected through a clinical and sociodemographic questionnaire, as well as an individual interview. The results are presented in five categories: self-concept, leakage issues, odor and gases, stigma, sexual activity and companionship. The analysis suggests that the fulfillment of nursing care ideals, through clear and objective communication, results in the colostomized person's care and can favor in the acceptance of their new way of living. The exchange of knowledge and practices between the colostomized patient and the medical care support crew, in special the nursing care, allows the establishment of strategies that contribute gradually to the full health care, promoting the improvement of the QoL of both the colostomized person as well his/her partner. It is concluded that health services should provide care process in health and nursing, with the purpose of guaranteeing means for the planning of a holistic implementation of health care. This planning should include the psychological support and the educational process that develops one's ability for self-care, which may interfere in the role of sexuality and sexual activity, in addition to the physiological, psychological and social issues.

Se-atlas - the health service information platform for people with rare diseases : Supporting research on medical care institutions and support groups

se-atlas - the health service information platform for rare diseases - is part of the German National Action Plan for People with Rare Diseases and is funded by the German Federal Ministry of Health. The objective of se-atlas as aweb-based platform is to illustrate those medical care institutions that are linked to rare diseases, in atransparent and user-friendly way. The website provides an overview of medical care institutions and support groups focusing on rare diseases in Germany. The primary target groups of se-atlas are affected patients, their relatives and physicians but can also include non-medical professionals and the general public. In order to make it easier to look up medical care institutions or support groups and optimize the search results displayed, various strategies are being developed and evaluated. Hence, the allocation of diseases to appropriate medical care institutions and support groups is currently amain focus. Since its launch in 2015, se-atlas has grown continuously and now incorporates five times more entries than were included 20months prior. Among this data are the current rare diseases centres in Germany, which play amajor role in providing patient-centred healthcare by acting as primary contact points for people with rare diseases. Further expansion and maintenance of the data base raises several organisational and software-related challenges. For one, the data should be completed by adding more high-quality information, while not neglecting the existing entries and maintaining their high level of quality in the long term.

INTRINSIC AND EXTRINSIC INJURY RISK FACTORS OF ELITE WINTER SPORTS ATHLETE IN TRAINING

BackgroundMulti-factorial sport injury related models are well accepted for sport medicine scientists and experts. However, injury risk factors research involved with winter sport athletes seems not well documented due to...