Multidimensional Care Research Articles

Predictors of the Disability in Activities of Daily Living in Nursing Home Residents: A Descriptive Study

ABSTRACT Background: Disability in activities of daily living (ADL) is a common problem among nursing home residents. The purpose of this research was to evaluate the geriatric syndromes that contribute to disability in nursing home residents. Method: The cross-sectional study included 124 older adults from two nursing homes. ADL disability was assessed with the Barthel Index. The sociodemographic characteristics and geriatric syndromes, including malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were evaluated. Results: The 124 residents had a mean age of 80.12 ± 9.20 years and included 55.67% males. Age, malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were all significantly correlated with the Barthel Index. However, only malnutrition, immobility, and urinary incontinence were found to account for 84.9% of the variance in disability of nursing home residents in regression analysis. These geriatric syndromes are the best predictors of ADL disability in all models (p < .05). Conclusion: This study found that malnutrition, immobility, and urinary incontinence considerably contributed to the disability profile of nursing home residents. Health professionals need to develop multi-dimensional care and prevention strategies, especially for geriatric syndromes such as malnutrition, immobility, and urinary incontinence.

Effectiveness of the re-engineered discharge (RED) care model in patients with rheumatoid arthritis.

This study aims to investigate whether the re-engineered discharge (RED) model can significantly improve the quality of life, enhance the health status, and reduce the levels of depression and anxiety in patients with rheumatoid arthritis during hospitalization. This study selected 108 rheumatoid arthritis patients treated at our facility between February 2023 and February 2024. Based on the different treatment methods, these patients were divided into a control group and an observation group, with 54 patients in each group. During hospitalization, both groups received standardized routine care provided by the hospital. After discharge, the control group continued with regular follow-up visits, while the observation group received a more comprehensive and multidimensional extended care based on the RED model. The intervention period for both groups was set to 3 months. The core observation indicators of this study focused on the emotional fluctuations, symptom improvement, and changes in self-care ability of the patients before and after the intervention. After the intervention, the scores of the Self-Rating Anxiety Scale and Self-Rating Depression Scale in both groups showed significant decreases, with the scores in the observation group being significantly lower than those in the control group, showing a highly significant statistical difference (P < .01). Additionally, the joint pain scores in both groups were alleviated, reflected by shorter morning stiffness times, reduced joint swelling, and increased grip strength. The observation group had lower joint pain scores, shorter morning stiffness times, fewer swollen joints, and stronger grip strength, all of which were statistically significant (P < .01). Furthermore, the distribution of self-care abilities in the observation group showed a significant difference compared to the control group (P < .05), with the observation group having a higher proportion of self-care abilities, which was also statistically significant (P < .05). For patients with rheumatoid arthritis, the implementation of the RED model nursing strategy can significantly alleviate negative emotions, reduce the distress caused by symptoms, and markedly improve their quality of life, providing a more comfortable and reassuring treatment experience.

Application effect of task-oriented multi-dimensional nursing intervention in patients with coronary atherosclerotic heart disease and concurrent hypertension

Background: The purpose of this study was to explore the application effect of task-oriented multi-dimensional nursing interventionin patients with coronary atherosclerotic heart disease (CAD) and concurrent hypertension. Methodology: The clinical data of 196 patients with CAD and concurrent hypertension in our hospital between January 2019 and January 2022 were retrospectively analysed. The patients receiving task-oriented multi-dimensional nursing were set as study group (n=98), while those given routine nursing as control group (n=98). The two groups were compared in the Hamilton Anxiety Scale (HAMA) scores, left ventricular end-diastolic diameter (LVEDD), 36-Item Short Form Health Survey (SF-36) scores, left ventricular ejection fraction (LVEF), Hamilton Depression Scale (HAMD) scores, systolic blood pressure (SBP), treatment compliance and incidence rates of adverse events. Results: After intervention, study group showed lower HAMA and HAMD scores, SBP and LVEDD, but higher SF-36 scores and LVEF than control group (P&lt;0.05). The treatment compliance rate was higher in control group than that in study group (92.86% vs. 80.61%), while an opposite result was detected in the total incidence rate 5.10% vs. 13.27%, P&lt;0.05). Conclusion: Multidimensional nursing benefits CAD patients with hypertension, improving emotions, compliance, and quality of life, reducing adverse events, and promoting recovery. Recommended for clinical use. Keywords: Coronary atherosclerotic heart disease; task-oriented theory; multi-dimensional nursing care; clinical nursing.

Navigating Neurologic Illness: Skills in Neuropalliative Care for Persons Hospitalized with Neurologic Disease.

Persons hospitalized for neurologic illness face multidimensional care needs. They can benefit from a palliative care approach that focuses on quality of life for persons with serious illness. We describe neurology provider "skills" to help meet these palliative needs: assessing the patient as a whole; facilitating conversations with patients to connect prognosis to care preferences; navigating neurologic illness to prepare patients and care partners for the future; providing high-quality end-of-life care to promote peace in death; and addressing disparities in care delivery.

Frailty Assessment and Management: A Qualitative Study of the Educational and Training Experiences of Postgraduate Doctors

Abstract Background Understanding and addressing frailty, a complex syndrome commonly found in older adults, demands a deep understanding and proficiency across various health domains. Existing research indicates a disparity between medical education and the hands-on management of frailty in practice. There is a scarcity of research on the educational requirements of postgraduate doctors in caring for frail patients. Methods Qualitative semi-structured interviews were conducted with post-internship doctors working in an AMU, using transcripts to analyse themes. The focus was on frailty conceptualisation, educational training, and clinical experience. Results Several themes were noted, particularly the lack of focus and variation on frailty teaching in undergraduate curriculums. This, coupled with limited hands-on experience, an emphasis on acute care over chronic management, inadequate multidisciplinary training, and a need for more structured education on frailty assessment tools, underscores the need for ongoing education and support. Many interviewees shared their experiences of being well-equipped to handle acute medical emergencies, demonstrating the effectiveness of their current medical education. However, they also pointed out that this preparation did not adequately equip them for the ongoing, multidimensional care that frail patients require. Several interviewees stressed the role of continued education and support for healthcare professionals managing frailty, suggesting ongoing professional development opportunities could effectively bridge the gap between initial medical education and the evolving demands of clinical practice. The potential of mentorship from experienced geriatricians adds invaluable guidance for early career doctors. Conclusion This qualitative study underscores a significant gap between medical education and the practical management of frailty. Addressing this gap requires a multifaceted approach that integrates frailty-focused content into undergraduate curricula, provides hands-on experience, fosters multidisciplinary collaboration, and offers ongoing professional development. By enhancing frailty education and training, healthcare systems can improve the quality of care for this vulnerable population, leading to better patient outcomes and more efficient use of resources.

The effect of Orem's Self-Care Deficit Theory-based care during pregnancy and postpartum period on health outcomes: A systematic review and meta-analysis.

To examine the effect of the provision of care on health outcomes when provided based on Orem's Self-Care Deficit Theory during perinatal period. The perinatal period is a process with multidimensional care needs for the mother, baby and family. Care based on nursing theories can improve the quality of perinatal care. A systematic review and meta-analysis. Studies on this topic from 2006 to 2020 have been accessed by nine database searches. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies, developed by the Joanna Briggs Institute. This study was conducted by following the Preferred Reporting System for Systematic Reviews and Meta-Analyses. This systematic review included nine studies with a total sample size of 839 women. These studies showed that care based on Orem's theory significantly helped prolong the mean duration of pregnancy, reduced the incidence of preterm labor, improved hygiene behaviour and increased empowerment. Concerning the perinatal period, this intervention significantly improved self-care and readiness for hospital discharge, adaptation and breastfeeding self-efficacy and reduced nipple pain and pain due to abdominal distension. The implementation of this theory into care during the perinatal period can contribute to improved health outcomes. What is already known about this topic? The quality of pregnancy and postpartum care is important for the maternal health. The use of nursing theories-which nursing knowledge is produced-improves care quality and ensures that care is organized systematically. What this paper adds? There is insufficient research that supports Orem's theory of self-care deficit in pregnancy and postpartum care and also no systematic review about this topic, but the current meta-analysis showed that postnatal and prenatal treatments based on Orem's theory have a positive impact on the self-care agency. The implications of this paper: The use of Orem's theory helps nurses understand women and their needs during pregnancy and postpartum periods. Integrating Orem's theory of self-care deficit into pregnancy and postpartum nursing care services can help increase women's self-care power.

Multidimensional Care Poverty Among East Asian and Nordic Older Adults.

This study uses the care poverty framework, focusing on both individuals and structures. In this context, structures are represented by 2 welfare states: Taiwan, an East Asian welfare system and Finland, a Nordic welfare state. This study explores multidimensional care poverty rates and examines 3 realms of individual factors (health status, sociodemographic factors, and care support availability) among older adults in these long-term care (LTC) models. We analyzed data from the 2019 Taiwan Longitudinal Study on Ageing Survey and the 2020 Daily Life and Care in Old Age Survey in Finland to compare the rates and factors of care poverty in these 2 culturally and structurally different countries. Our analysis revealed different rates of care poverty in personal, practical, and socioemotional care needs in the 2 countries. Under a familistic welfare regime, Taiwanese older adults had higher personal care poverty rates than their Finnish counterparts. Those living alone faced more personal and practical care poverty. Conversely, Finnish older adults, under the Nordic welfare model, experienced more practical and socioemotional care poverty. Those with high care needs and disadvantaged social status and support were more likely to experience personal and practical care poverty. Socioemotional care poverty varied with the availability of support and health status in both countries. The study highlights the impact of 2 LTC policies and cultures on older adults' multidimensional care poverty, identifying disadvantaged older adults under different welfare-transforming LTC models. Taiwan's budget-constrained LTC policies and high family reliance contrast with Finland's inadequate attention to the practical and socioemotional needs of its aging population. This study suggests that holistic LTC policies are needed in both countries to improve the well-being of older adults with limited support and health issues.

Glycemic Control in Diabetic Patients Receiving a Diabetes-Specific Nutritional Enteral Formula: A Case Series in Home Care Settings.

In patients with Diabetes Mellitus (DM), Enteral Nutrition (EN) is associated with less hyperglycemia and lower insulin requirements compared to Parenteral Nutrition (PN). The primary aim of this study was to assess changes in glycemic control (GC) in DM patients on EN therapy. The secondary objectives included evaluating the impact of the specialized formula on various clinical parameters and the tolerability of the nutritional formula by monitoring potential gastrointestinal side effects. We report a case series on the effects of a Diabetes-Specific Formula (DSF) on GC, lipid profile (LP), and renal and hepatic function in a DM cohort receiving EN support. Twenty-two DM subjects with total dysphagia (thirteen men, nine women) on continuous EN were observed. The use of a DSF in EN was associated with an improvement in glycemic indices across all patients studied, leading to a reduction in average insulin demand. No hospitalizations were reported during the study period. The study demonstrated that the use of DSFs in a multi-dimensional home care management setting can improve glycemic control, reduce glycemic variability and insulin need, and positively impact the lipid profile of the DM cohort. The metabolic improvements were supported by the clinical outcomes observed.

Patients’ and caregivers’ perception of multidimensional and palliative care in amyotrophic lateral sclerosis – protocol of a German multicentre study

IntroductionAmyotrophic lateral sclerosis (ALS) is an inevitably fatal condition that leads to a progressive loss of physical functioning, which results in a high psychosocial burden and organizational challenges related to medical care. Multidimensional and multiprofessional care is advised to meet the complex needs of patients and their families. Many healthcare systems, including Germany, may not be able to meet these needs because non-medical services such as psychological support or social counselling are not regularly included in the care of patients with ALS (pwALS). Specialised neuropalliative care is not routinely implemented nor widely available. Caregivers of pwALS are also highly burdened, but there is still a lack of support services for them.MethodsThis project aims to assess the perceptions and satisfaction with ALS care in Germany in pwALS and their caregivers. This will be achieved by means of a cross-sectional, multicentre survey. The examination will assess, to which extend the patients’ needs in the six domains of physical, psychological, social, spiritual, practical and informational are being met by current care structures. This assessment will be linked to mental well-being, subjective quality of life, attitudes toward life-sustaining measures and physician-assisted suicide, and caregiver burden. The study aims to recruit 500 participants from nationwide ALS centres in order to draw comprehensive conclusions for Germany. A total of 29 centres, mostly acquired via the clinical and scientific German Network for Motor Neuron Diseases (MND-NET), will take part in the project, 25 of which have already started recruitment.PerspectiveIt is intended to provide data-based starting points on how current practice of care in Germany is perceived pwALS and their caregivers and how it can be improved according to their needs. Planning and initiation of the study has been completed.Trial registrationThe study is registered at ClinicalTrails.gov; NCT06418646

Personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery: a systematic synthesis of mixed methods research.

To offer a holistic view of the personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery. This systematic synthesis of mixed methods research involved a comprehensive search for articles in English databases, including PubMed, Cochrane Library, Web of Science, EBSCO, Scopus, and Embase, as well as Chinese databases. The search encompassed articles published from the inception of the database up to June 2023. Following the evaluation of literature quality and extraction of relevant information from the selected studies, data from both quantitative and qualitative studies were integrated. The extracted data were analyzed separately, and themes were identified and summarized to elucidate the factors influencing adherence to nutritional and dietary guidelines. The methodology adhered to the guidelines recommended by the Joanna Briggs Institute (JBI) for mixed methods systematic evaluations. Three themes and their corresponding descriptive elements were identified, including: (1) Personal factors: subjective factors (attitude, capability, awareness, behaviors), objective factors (age, sex, work status, economic level, physical activity, dietary habits, weight change); (2) External factors: medication (quantity of pills, complexity of intake times, side effects, unpleasant smell or taste), surgery factor, social influences (family members, dietitians, and peers); (3) Psychological factors: self-efficacy, attachment anxiety, and mental health problems. The synthesis provided a comprehensive overview of the factors influencing postoperative compliance of nutrition and diet among patients undergoing metabolic and bariatric surgery. It emphasizes the necessity for clinical staff to tailor interventions based on these diverse factors, as well as to attach importance to patients' mental health, giving multidimensional dietary guidance and health care.

A qualitative evaluation of the oncologists’, neurologists’, and pain specialists’ views on the management and care of chemotherapy-induced peripheral neuropathy in The Netherlands

PurposeIn treating cancer, different chemotherapy regimens cause chemotherapy-induced peripheral neuropathy (CIPN). Despite recent international guidelines, a gold standard for diagnosis, treatment, and care is lacking. To identify the current clinical practice and the physicians’ point of view and ideas for improvement, we evaluated CIPN care by interviewing different specialists involved.MethodsWe performed semi-structured, audio-recorded, transcribed, and coded interviews with a purposive sample of oncologists, pain specialists, and neurologists involved in CIPN patients’ care. Data is analyzed by a constant comparative method for content analysis, using ATLAS.ti software. Codes, categories, and themes are extracted, generating common denominators and conclusions.ResultsWith oncologists, pain specialists, and neurologists, nine, nine, and eight interviews were taken respectively (including three, two, and two interviews after thematic saturation occurred). While useful preventive measures and predictors are lacking, patient education (e.g., on symptoms and timely reporting) is deemed pivotal, as is low-threshold screening (e.g., anamnesis and questionnaires). Diagnosis focusses on a temporal relationship to chemotherapy, with adjuvant testing (e.g., EMG) used in severe or atypical cases. Symptomatic antineuropathic and topical medication are often prescribed, but personalized and multidimensional care based on individual symptoms and preferences is highly valued. The limited efficacy of existing treatments, and the lack of standardized protocols, interdisciplinary coordination, and awareness among healthcare providers pose significant challenges.ConclusionBesides the obvious need for better therapeutic options, and multidisciplinary exploration of patients’ perspectives, a structured and collaborative approach towards diagnosis, treatment, referral, and follow-up, nurtured by improving knowledge and use of existing CIPN guidelines, could enhance care.

A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study

Background: Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. Aim: To develop a multidimensional international palliative care goals model in dementia for use in practice. Design: International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. Setting/participants: Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. Results: Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss−person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. Conclusion: A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.

Perceptions of the spiritual dimension of patients under palliative care for gastric câncer

Introduction: The relationship between health and spirituality gained relevance from the recognition of the importance of multidimensional patient care, respecting the biopsychosocial and spiritual aspects. Spirituality integrated into Palliative Care (PC) allows patients affected by neoplasms in the non-curative phase of treatment to have greater understanding and acceptance of the diagnosis of the disease, thus enabling the humanization of care. Methodology: Qualitative and descriptive cross-sectional research, carried out with patients diagnosed with GC in PC. The assessment of the spiritual dimension of the chosen patients was conducted through the application of the Spiritual Anamnesis, using the FICA script. Based on the results, discourse analysis was carried out using the thematic content analysis technique. Results: Of the total of 83 patients with GC, between 2021 and 2023, 35 eligible to form the study sample were included. Following the analysis of the FICA script, it was observed that in the “Faith or Belief” category, 44.44% of patients demonstrated that they had faith or belief in God and 26.38% considered spirituality as a positive factor in their lives. In the “Importance” category, 23.77% used faith as support to deal with psychological issues and 22.13% believed in the improvement of the clinical state through faith/belief in God. In relation to the “Community” category, 33.05% reported having spiritual support from a religious community and 26.27% found support related to family/friend ties. In the “Action” category, 40.0% of patients considered the medical/health team approach to spirituality during treatment to be relevant and 31.42% denied the approach to spirituality during medical treatment. Conclusions: The analysis of spiritual anamnesis revealed that spirituality had positive impacts on patients with GC under PC, playing, for the majority, a significant supporting role at the time of diagnosis and throughout the treatment of the disease.

Multidimensional care for people with ALS and their families

Liebe Leserin, lieber Leser,wie Sie vermutlich im klinischen Alltag immer wieder erleben, stellt die Amyotrophe Lateralsklerose (ALS) besondere Anforderungen an eine optimale Versorgung der Betroffenen. Das Informationslevel der Hilfesuchenden ist meist hoch, ebenso die Erwartungen an ein neues „Wundermedikament“, das in Meldungen der Medien immer wieder in Aussicht gestellt wird.

The Impact of Multidimensional Psychological Care on the Mental Health and Sleep of Hospitalized Patients with Intracranial Tumors

The Impact of Multidimensional Psychological Care on the Mental Health and Sleep of Hospitalized Patients with Intracranial Tumors

Therapeutic Management of Malignant Wounds: An Update.

Malignant fungating wounds (MFW) are severe skin conditions generating tremendous distress in oncological patients with advanced cancer stages because of pain, malodor, exudation, pruritus, inflammation, edema, and bleeding. The classical therapeutic approaches such as surgery, opioids, antimicrobials, and application of different wound dressings are failing in handling pain, odor, and infection control, thus urgently requiring the development of alternative strategies. The aim of this review was to provide an update on the current therapeutic strategies and the perspectives on developing novel alternatives for better malignant wound management. The last decade screened literature evidenced an increasing interest in developing natural treatment alternatives based on beehive, plant extracts, pure vegetal compounds, and bacteriocins. Promising therapeutics can also be envisaged by involving nanotechnology due to either intrinsic biological activities or drug delivery properties of nanomaterials. Despite recent progress in the field of malignant wound care, the literature is still mainly based on in vitro and in vivo studies on small animal models, while the case reports and clinical trials (less than 10 and only one providing public results) remain scarce. Some innovative treatment approaches are used in clinical practice without prior extensive testing in fungating wound patients. Extensive research is urgently needed to fill this knowledge gap and translate the identified promising therapeutic approaches to more advanced testing stages toward creating multidimensional wound care strategies.

The History and Legacy of the Foker Process for the Treatment of Long Gap Esophageal Atresia

Historically, children afflicted with long gap esophageal atresia (LGEA) had few options, either esophageal replacement or a life of gastrostomy feeds. In 1997, John Foker from Minnesota revolutionized the treatment of LGEA. His new procedure focused on “traction-induced growth” when the proximal and distal esophageal segments were too far apart for primary repair. Foker's approach involved placement of pledgeted sutures on both esophageal pouches connected to an externalized traction system which could be serially tightened, allowing for tension-induced esophageal growth and a delayed primary repair.Despite its potential, the Foker process was received with criticism and disbelief, and to this day, controversy remains regarding its mechanism of action - esophageal growth versus stretch. Nonetheless, early adopters such as Rusty Jennings of Boston embraced Foker's central principle that “one's own esophagus is best” and was instrumental to the implementation and rise in popularity of the Foker process. The downstream effects of this emphasis on esophageal preservation would uncover the need for a focused yet multidisciplinary approach to the many challenges that EA children face beyond “just the esophagus”, leading to the first Esophageal and Airway Treatment Center for children. Consequently, the development of new techniques for the multidimensional care of the LGEA child evolved such as the posterior tracheopexy for associated tracheomalacia, the supercharged jejunal interposition, as well as minimally invasive internalized esophageal traction systems. We recognize the work of Foker and Jennings as key catalysts of an era of esophageal preservation and multidisciplinary care of children with EA.

Cross-cultural adaptation of the Persian version of “Spiritual Dryness Scale” in patients with cancer: from low perception of sacredness of life to depressive symptoms and emotional exhaustion

ABSTRACT The first step to evaluate spiritual health as an essential component of multidimensional patient care is using a valid scale. This study aimed to provide a psychometric evaluation of the Spiritual Dryness Scale. This cross-sectional study was conducted on 136 patients with cancer in Arak city, Iran. Face and content validity, and confirmatory factor analysis were used to assess the validity and construct validity respectively, and Cronbach's alpha, and test-retest were calculated to measure internal consistency. The results indicated that the scale had appropriate face validity and the total mean score was 1.514 ± .74. All items had suitable CVR and CVI higher than .8. The ICC of the scale was .999, and Cronbach's alpha was .899 in the test– retest. The fit index was satisfactory (χ2 /df = 1.187). This scale had appropriate validity and reliability after translation into Farsi and was convenient, accessible, inexpensive, and easy-to-use.

Pilot study of remote electronic patient-reported outcomes (ePRO) symptom monitoring of palliative care needs among outpatients with advanced solid cancers.

250 Background: Early specialty palliative care for patients with advanced cancer is an evidence-based practice that improves health outcomes, yet patients do not receive timely referrals. ePRO symptom monitoring provides a ready care delivery platform to monitor patients for unmet palliative care needs and direct palliative care referral based on patient report. This study sought to obtain feasibility data for ePRO symptom monitoring of palliative care needs. Methods: We conducted a single-arm pilot study of longitudinal ePRO symptom monitoring of multidimensional palliative care needs among outpatients with advanced breast, gastrointestinal, and gynecologic cancers at an academic oncology practice. Adult patients on active treatment with a prognosis &gt; 6 months were approached consecutively. Patients completed baseline measures and enrolled on a third-party symptom monitoring platform for 12 weeks. Patients received weekly monitoring of 14 common symptoms using the National Cancer Institute's PRO version of the common terminology criteria for adverse events (PRO-CTCAEs). Patients received monthly monitoring of palliative needs using 11 PRO items from validated measures and a clinician-developed item for patient request for palliative care. Weekly symptom alerts and monthly palliative care PRO assessments were reported to the primary oncology team for interdisciplinary clinical management. Acceptability and appropriateness of the intervention were assessed using the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM). Results: From May 2022 to April 2023, 29 of 37 eligible patients (78%) consented to the study, of which 25 completed baseline measures and enrolled on the platform (68% enrollment rate; most common reason for refusal was not enough time). Median age was 53 years (range 29-77), 18 (72%) female, 12 (48%) non-Hispanic White, 32% reported an ECOG-PRO score 2-3. 96% of patients met pre-defined ePRO adherence thresholds and 92% completed study end measures (1 patient censored for death). Completion of the palliative PRO items was &gt; 94% for 9 of 11 items. Two PRO items for spiritual distress screening were skipped most often. 80% of patients reported a severe score for at least one palliative PRO symptom during the study period. Mean AIM and IAM scores were 3.92 and 4.26, respectively (range 3.25 – 5; best possible total score 5). Conclusions: Expanding evidence-based ePRO symptom monitoring to include monthly palliative care needs assessment is highly feasible, acceptable, and appropriate to patients. Adherence to PRO items was high, and most patients had at least one area of need. Future work will refine the ePRO palliative assessment with attention to spiritual distress screening and determine severity thresholds to develop a PRO-directed referral system to specialty palliative care.

Influence of immigrant background on the outcome of total hip arthroplasty: better outcome in 280 native patients in Bosnia and Herzegovina than in 449 immigrants living in Sweden.

Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS). Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups. There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (p < 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (p < 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (p = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (p ⩽ 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (p < 0.0005). Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.