Need For Appropriate Care Research Articles

ASSESSMENT OF THE QUALITY OF LIFE OF CHILDREN WITH CHRONIC KIDNEY DISEASE IS IMPORTANT INFORMATION IN PROVIDING SERVICES: SYSTEMATIC REVIEW

ABSTRACT Background: Children with chronic kidney disease (CKD) continue to face significant health challenges, with a growing morbidity rate that lowers their quality of life (QoL). Children with CKD experience complex problems physically, emotionally, socially and at school, requiring different problem solving for each child. At the assessment stage, assessing the quality of life is very important, the results of which determine the next steps regarding the child's care and treatment. Purpose: The aim of this research is to determine the best service delivery based on assessing the quality of life of CKD children based on research results. Methods: Systematic review study was for children determine the best service delivery based on assessing the QoL with CKD. Electronic database and reference list of relevant articles from 2016 to 2023. Guided by PRISMA guidelines, five electronic database PubMed, EBSCO, PROQUEST, Science Direct, and Google Scholar-were searched for relevant articles published in Indonesia and English. Results: From 11 studies, it was found that the majority of children with CKD had a low quality of life in terms of physical, emotional, social and academic function, even though the quality of life of children who underwent a renal transplant (RT) was better than children who underwent a RT, undergoing hemodialysis (HD) and peritoneal dialysis (PD), to improve the QoL proper care is needed, one of which is camping activities by camping, children assess their quality of life positively, with self-esteem as the most felt dimension. Short stature, low family income, use of dialysis, and depression are risk factors associated with lower overall QoL. Conclusion: Research reveals that almost all children with CKD score poorly on QoL assessments. Children with CKD experience a poor quality of life, and require team and comprehensive work to improve the child's quality of life. Quality of life assessment is a reflection of the need for appropriate care and treatment for the child and family. Keywords: Quality of life, Children, Chronic kidney disease

Neonatal Transport Facilities and Its Effect on Outcome: An Experience from Tertiary Care Hospital of Central Gujarat

Background: This study regarding the transport facilities prevailing in areas surrounding our hospital and the immediate outcome of such transported neonates in terms of morbidity and mortality will provide us an insight into the scope for improvement in the facilities and thus will help in the reduction of mortality of the extramural neonates. Material and method: In this prospective observational study, details of all transported extramural sick neonates were obtained regarding the transport facility availed by the patient. The physiology on arrival and immediate outcome were compared between survived and expired neonates. Results: Out of 82 neonates enrolled in the study, the majority (38 [48.7%]) had sepsis. The majority of neonates were low birth weight (49 [59.8%]) and preterm (47 [57.3%]). In all, 80.5% of the transported neonates were referred from private pediatric hospitals. Free Government ambulance facility (108) was utilized by only 6 (7.3%). Significantly a greater number of moderately hypothermic neonates were there in the expired group versus the survived group (66.7% vs 20%, p =0.013). Capillary refill time of ≥3 seconds on arrival was significantly associated with poor outcomes (66.7% vs 20%, p =0.013). Saturation levels of <70% on arrival are significantly associated with poor outcome (66.7% vs 6%, p <.0001). Conclusion: This study emphasizes the need for appropriate care and management to be provided to critical neonates during transport to maintain hemodynamic stability and improved vitals on arrival to the referred center for a better final outcome.

A phenomenological exploration of self-identified origins and experiences of body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a debilitating mental health condition that presently affects ~2% of the general population. Individuals with BDD experience distressing preoccupations regarding one or more perceived defects in their physical appearance. These preoccupations and perceived distortions can have a profound impact on key areas of social functioning and psychological health. Individuals’ BDD origins have not been explored in significant depth and have been, often unhelpfully, conflated with social media usage and exposure to idealistic imagery of the body. Such generalisations fail to acknowledge the complexity of BDD development and onset, highlighting the importance of moving towards an understanding of people’s implicit theories regarding their own experience. It is therefore essential to gain insight into how individuals make sense of the experiences which they believe led to the development and onset of BDD. The aim of this exploratory study was to elicit and phenomenologically analyse the accounts of individuals with lived experience of BDD in order to examine their beliefs about its origins and understand how they navigate the world with a distorted sense of self. Participants provided written and verbal accounts regarding both their BDD onset and experiences of living with the disorder. Both components of the study were analysed using Interpretative Phenomenological Analysis. Four main themes were generated from the data: Exposure to bullying and external critique of appearance; Experiencing rejection, shame, and a sense of not being enough; Developing an awareness of the solidification of concerns, and Learning about and reflecting upon triggers. Participants attributed their BDD onset to adverse experiences such as childhood bullying, receiving appearance-focused criticism, rejection and being subjected to emotional and physical abuse. The findings from this study highlight the complexity of BDD development and onset in individuals, and the need for appropriate care and treatment for those affected by BDD.

Crusted scabies in systemic lupus erythematosus: More than a mite contagious case

Crusted scabies is characterized by hyperkeratosis and crusting of the skin due to the profuse proliferation of mites. It is resulting from an altered host response to the infestation. There are some various cutaneous and immunologic diseases that have been described to predispose to crusted scabies. It is typically associated with congenital and acquired immunocompromised conditions including human immunodeficiency virus (HIV), hematologic malignancy, and connective tissue diseases, including systemic lupus erythematosus (SLE). Adults with crusted scabies may lack the characteristic rash or itching. Sites of presentation have been reported on the scalp, face, neck, extremities, trunk, hands, and feet. The severe condition of SLE and super infection of scabies in the immunocompromised state highlight the need for appropriate care to avoid further morbidity. This case report aims to describe the characteristic of skin lesions and clinical aspects of crusted scabies in SLE. A 28-year-old man was diagnosed with crusted scabies who was treated more intensely with permethrin 5% cream that was combined with 2-4 ointment. There was clinical improvement and no side effect found during this study.

PO-0886 Picu In The Future; Needs And Expectations Of Nurses

Introduction The aim of this study was to understand the present nursing roles at the PICU and the changes nurses want to be accounted for or are seen as a valuable addition to their nursing profession. Methods A qualitative study. Data were collected by face-to-face focus groups. Results After three focus-group meetings, seventeen themes were identified. Major specific nursing roles were 1) nurse led weaning from the ventilator was identified by nurses as well as physicians. 2) case management to improve PICU care and transition of the long stay patient, identified by nurses as well as physicians. 3) More effective painmanagement when the nurse was responsible for titration. 4) the role of a consultative nurse. This role was mentioned by nurses only. In the subthemes main subjects were the need for appropriate care for the long stay patient and the need of ongoing education. Discussion Both, nurses and physicians recognised a need for change in nursing care for the long stay patient at the PICU. This suits with the changing PICU environment. Nurses could have a role in bedside procedures such as pain and sedation management and weaning from the ventilator. This will enhance the area of nursing autonomy, control and responsibility and from literature we know satisfaction in the workplace also will grow. The deployment of a consultative nurse may improve the satisfaction of patients and parents after discharge from the PICU and will unburden the growing responsibility of the nurses on the paediatric ward.

Prevalence and associations of anxiety disorders in adults with intellectual disabilities

Anxiety disorders are known to be common in the general population. Previous studies with adults with intellectual disabilities (IDs) report a prevalence of general anxiety disorder ranging from <2% to 17.4%. Little is known about associated factors in this population. This study investigates point prevalence of anxiety disorders and determines the factors independently associated with them. Information was collected with 1023 adults with IDs who participated in a large-scale, population-based study. All had a comprehensive physical and mental health assessment. The point prevalence of anxiety disorders according to different diagnostic criteria was determined, as were independently associated factors by using logistic regression analysis. Three point eight per cent (95% CI=2.7-5.2%) of the cohort had an anxiety disorder at the time of assessment. Generalised anxiety disorder was the most common (1.7%), then agoraphobia (0.7%). Factors independently associated with having an anxiety disorder were not having any daytime employment, and having a recent history of life events. Having previously been a long-term hospital resident was independently associated with not having an anxiety disorder. Anxiety disorders are common in the ID population. At times of significant life events, it might be sensible for carers to consider proactively providing additional support and being vigilant to seek early health-care interventions should there be any suggestion of emerging mental ill-health. The study further highlights the range of mental ill-health that is experienced by the population with IDs, and therefore the need for appropriate care, supports and development of effective interventions.

Breast Cancer under 40 Years of Age: Increasing Number and Worse Prognosis

Breast cancer at a relatively young age with a poor prognosis is currently exhibiting an increasing incidence. In a retrospective cohort analysis of early breast cancer cases after surgery from our institutional patient registry, 141 patients aged ≤ 40 years constituted the younger group, with 300 randomly selected patients aged >40 years as controls. A significant and steady increase was found in the relative number of younger cases during the years 2004-2009. The histological type and grade and the lymph node status of the cancers differed significantly between the two groups, with more aggressive biological behaviour, a more advanced stage and a worse prognosis in the younger group. Half of the cancers in the younger cohort were ER-negative, while two-thirds in the control group were ER-positive. Comparatively more tumours were PR-positive and HER2-negative in the control group than in the younger group. The rates of triple-negative cases were 25% and 13% in the younger age and the control group, respectively (p = 0.026). Significantly higher mastectomy and axillary block dissection rates were observed in the younger age group, and more chemotherapy was administered than in the control group. Our findings demonstrate the significance of breast cancer in cases aged <40 years, and draw attention to the need for appropriate care in these cases.

Quality Improvement for Depression in Primary Care: Do Patients With Subthreshold Depression Benefit in the Long Run?

Quality improvement programs for depression can improve outcomes, but the utility of including patients with subthreshold depression in quality improvement programs is unclear. The authors examined 57-month effects of quality improvement on clinical outcomes and mental health care utilization of primary care patients with depressive disorder and subthreshold depression. In a group-level, randomized, controlled trial, 46 primary care clinics were randomly assigned to provide usual care or care with a quality improvement intervention that included provider training and other resources for either medication management (medications quality improvement) or evidence-based psychotherapy (therapy quality improvement). Among 1,356 enrolled depressed patients, 991 completed the 57-month follow-up interview (604 patients with depressive disorder and 387 with subthreshold depression). Outcomes measured at 57 months were presence of probable depressive disorder, unmet need for appropriate care (untreated probable disorder), and mental health care utilization in the prior 6 months. Among patients with subthreshold depression at baseline, those seen in clinics with quality improvement programs with special resources for therapy were less likely to have probable depressive disorder and unmet need for care at follow-up, compared with those seen in clinics that provided usual care. Among patients with depressive disorder at baseline, those seen in clinics with quality improvement programs with special resources for medication management were less likely to have unmet need for care at follow-up, compared with those seen in clinics that provided usual care. Patients with subthreshold depression at baseline seen in clinics with a quality improvement intervention were less likely at follow-up to have had a mental health visit (in primary care or specialty care, depending on the intervention) in the prior 6 months. Relative to usual care, quality improvement interventions improved 57-month outcomes (probable depression, unmet need, or both) for primary care patients with depressive disorder and subthreshold depression and lowered use of mental health visits for those with subthreshold depression. The results highlight the feasibility and utility of including patients with subthreshold depression in such programs.

A nurse-managed inpatient program for patients with chronic mental disorders

The deinstitutionalization movement has left a legacy of need for appropriate care for inpatients with chronic refractory mental illness. This article describes a nurse managed program for such patients based on the principles of a therapeutic milieu. The program was formally defined for a 6-month period with an effort to include outcome measures for program evaluation. Multidisciplinary treatment team planning with a psychiatric nursing clinical specialist as team leader provided a format for putting therapeutic concepts into practice. The nurse clinical specialist and two nurse practitioners served as case managers as well as primary care providers. Program evaluation showed that cost-effective quality care could be achieved with a reduction in polypharmacy and overall neuroleptic usage. The notion of a restraint appropriate environment, with the goal of minimizing restraint use, was introduced and put into practice.