Outcome Monitoring Research Articles

Playing with Protic Additives to Improve the Outcome of Rhodium‐Catalyzed Hydroarylation of Fullerene C60 with Arylboronic Acids

AbstractA new one‐phase process for hydroarylation of C60 fullerene using arylboronic acids and a rhodium catalyst in an aromatic solvent containing soluble protic additives is described. Yields of monohydroarylated product with tert‐butanol and water as the protic additive range from 14 to 50 % depending on which arylboronic acid is used after reaction times of 4 hours or less which is a significant improvement from the outcome of reactions carried out using conditions from the literature. Accurate monitoring of reaction outcomes was achieved by a combination of UV‐Vis spectroscopy and 1H‐NMR spectroscopy: C60 conversion was determined using an analytical HPLC‐UV‐vis method employing commonly available columns for the separation, while product formation was quantified by 1H‐NMR spectroscopy with an internal standard. Moreover, two new arylboronic acids carrying 4‐alkynyl aryl substituents, synthesized using Sonogashira couplings, are reported, as well as the use of these in the hydroarylation of C60.

Changes in dental visits and oral health for children by race and ethnicity during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic created new barriers to oral health care, which may worsen oral health and exacerbate disparities. The authors quantified changes in children’s dental care receipt and oral health outcomes during the pandemic and examined differences among racial and ethnic groups. MethodsUsing the National Survey of Children’s Health (163,948 child observations from 2017-2021), the authors used weighted modified Poisson models to examine caregiver-reported receipt of a dental visit (for any reason and for preventive care) and adverse oral health outcomes (teeth in fair or poor condition; difficulty with toothaches, cavities, or bleeding gums) from 2017 through 2019 (prepandemic) compared with 2020 and 2021. The authors examined outcomes within and across racial and ethnic groups. ResultsChildren from all racial and ethnic groups experienced declines in receipt of dental visits, but there were limited changes in adverse oral health outcomes during 2020 and 2021. Prepandemic disparities in receipt of dental visits persisted for Black children and Asian children compared with White children. Hispanic children experienced larger increases in risk of experiencing both adverse oral health outcomes compared with White children in 2020 and in having teeth in fair or poor condition in 2021. ConclusionsThe pandemic did not create new disparities in receipt of dental visits or oral health outcomes, but disparities in care persisted, and the oral health of Hispanic children was affected differentially. Practical ImplicationsContinued monitoring of dental visits and adverse oral health outcomes by race and ethnicity is critical to ensuring all children have access to oral health care. This information can help develop targeted interventions to improve children’s oral health, including for minoritized racial and ethnic groups.

Use of Novel National Data Sets to Monitor Chemotherapy Use and Outcomes: A Retrospective Cohort Study of Non-Small-Cell Lung Cancer in Aotearoa New Zealand.

Te Aho o Te Kahu, the New Zealand Cancer Control Agency, is establishing a systemic anticancer therapy (SACT) database (Anti-Cancer Therapy-Nationally Organized Workstream [ACT-NOW]) which can be linked to other national health data collections. In this article, we explore the application of ACT-NOW data in the monitoring of uptake and outcomes after the public funding of pemetrexed in Aotearoa New Zealand. We used the ACT-NOW collection to identify patients with advanced nonsquamous non-small-cell lung cancer, who were treated with first-line platinum-based doublet chemotherapy over an 8-year period. Data were extracted for a period of 4 years before and 4 years after the national funding of pemetrexed (November 1, 2017). Treatments were classified as historical platinum doublet (cisplatin or carboplatin with gemcitabine, vinorelbine, paclitaxel, or docetaxel) or platinum pemetrexed doublet (cisplatin or carboplatin with pemetrexed). The primary outcome was the proportion of patients receiving each treatment type, before and after November 1, 2017. To prototype linkage to outcomes data, we evaluated hospitalization and 1-year overall survival (OS) rates by treatment. A total of 331 patients were included from four cancer centers. All patients (116 of 116) who were treated with first-line platinum-based doublet chemotherapy between November 2013 and November 2017 received historical platinum doublet chemotherapy. After the introduction of pemetrexed, between November 2017 and November 2021, 94% (203 of 215) were treated with platinum pemetrexed doublet chemotherapy and 6% (12 of 215) with historical platinum doublet chemotherapy. Linkage to outcomes data for 1-year OS, hospitalization rates, and lengths of stay outcome data were achievable. The ACT-NOW data set has the potential to facilitate evaluation of the impact of national-level SACT funding decisions on prescribing practice and specific patient outcomes. Our results support the use of these data to inform resource planning and quality improvement.

The Rhinoplasty Health Care Monitor: An Update on the Practical and Clinical Benefits after 10 Years of Prospective Outcome Measurements.

The era of value-based health care is characterized by an increasing interest in patient-reported health outcomes. For this purpose we developed the rhinoplasty health care monitor (RHM), a streamlined outcome measurement protocol, including all rhinoplasty patients since 2014. Statistical analyses of patient-reported outcome data are automated and visually presented on a custom web-based dashboard. We describe the clinical and practical benefits of the RHM and discuss how routine prospective outcome measurements have upgraded our care standards. For this prospective study, 979 consecutive patients referred for functional (revision) rhinoplasty from April 2014 to August 2023 were included. Preoperative and 3- and 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation scale (NOSE), Utrecht Questionnaire (UQ), and visual analog scales (VAS) were obtained. Of 979 referred patients, 599 (61.2%) were eligible for rhinoplasty. One year postoperatively, mean NOSE scale sum score improved from 69.1 ± 22.8 to 23.1 ± 23.5 (p < 0.001). Functional VAS scores improved from 4.1 ± 2.8 (left) and 4.1 ± 2.8 (right) to 7.5 ± 1.9 (left) and 7.3 ± 2.0 (right; p < 0.001). Mean UQ sum score improved from 12.0 ± 6.4 to 6.8 ± 3.3 and aesthetic VAS score improved from 4.5 ± 2.5 to 7.4 ± 1.7 (p < 0.001) 1 year postoperatively. Benefits of the outcome routine were improved patient selection, data-driven expectation management and patient empowerment, and targeted critical appraisals of surgical performance. In conclusion, routine, automated, prospective outcome monitoring provides physicians with a response to the increasing demand for data-driven insights in health outcomes. The limited effort that is needed to gather and monitor outcome data is heavily repaid by valuable insights into aspects of care that can be improved.

Cost-Effectiveness of Onasemnogene Abeparvovec Compared With Nusinersen and Risdiplam in Patients With Spinal Muscular Atrophy Type 1 in Brazil: Custo-Efetividade do Onasemnogeno Abeparvoveque (AVXS-101) em Comparação ao Nusinersena e Risdiplam em Pacientes com Atrofia Muscular Espinhal Tipo 1 no Brasil

ObjectivesThis study aimed to evaluate the cost-effectiveness of the onasemnogene abeparvovec in relation to nusinersen and risdiplam in the treatment of spinal muscular atrophy type 1 from the perspective of the Brazilian Unified Health System. MethodsA Markov model was built on a lifetime horizon. Short-term data were obtained from clinical trials of the technologies and from published cohort survival curves (long term). Costs were measured in current 2022 local currency (R$) values and benefits in quality-adjusted life-years (QALYs). Utility values were derived from type 1 spinal muscular atrophy literature, whereas costs related to technologies and maintenance care in each health state were obtained from official sources of reimbursement in Brazil. Deterministic and probabilistic, as well as scenario, sensitivity analyses were performed. ResultsCompared with the less costly strategy (nusinersen), the use of onasemnogene abeparvovec resulted in an incremental cost of R$2.468.448,06 ($975 671.169 – purchasing power parity [PPP]) and a 3-QALY increment and incremental cost-effectiveness ratio of R$742.890,92 ($293 632.774 – PPP)/QALY. Risdiplam had an extended dominance from other strategies, resulting in an incremental cost-effectiveness ratio of R$926.586,22 ($366 239.612 – PPP)/QALY compared with nusinersen. Sensitivity analysis showed a significant impact of the follow-up time of the cohort and the cost of acquiring onasemnogene abeparvovec. ConclusionsOver a lifetime horizon, onasemnogene abeparvovec seems to be a potentially more effective option than nusinersen and risdiplam, albeit with an incremental cost. Such a trade-off should be weighed in efficiency criteria during decision making and outcome monitoring from the perspective of the Brazilian Unified Health System.

Pilot trial of an electronic patient-reported outcome monitoring system in patients with metastatic breast cancer undergoing chemotherapy.

Electronic patient-reported outcomes monitoring (ePROM) is a useful communication tool for patients and healthcare providers in cancer chemotherapy. In this study, we examined the feasibility of our newly developed ePROM system, which we refer to as "Hibilog". An ePROM app was developed by extracting 18 items from the Patient-Reported Outcome-Common Terminology Criteria for Adverse Events (PRO-CTCAE). Symptom monitoring was conducted every two weeks for patients with metastatic breast cancer undergoing chemotherapy. The primary outcome was the response rate to the ePROM system. The secondary outcomes were response time, item missing rate, and distribution of responses for each symptom. A total of 71 cases (mean age 52.6years) were analyzed. Performance status was 0 in 76% of the cases and 1 or higher in 24%. First-line treatment was being administered in 30% of cases, second-line treatment in 17%, and third-line or higher treatment in 53%. The response rate to the ePROM system from registration to week 40 remained high at around 80%, indicating good compliance. The average response time was 5.5min and the missing rate for each item was below 0.4%. Among 1,093 responses, the top 3 symptoms causing interference with daily life were Fatigue (63%), Numbness and tingling (48%), and General pain (46%). Our developed ePROM system was able to capture symptoms accurately in patients with metastatic breast cancer undergoing chemotherapy while maintaining a high response compliance.

Long term improvement of knee osteoarthritis after injection of single high/very high volume of very pure PRP: A retrospective analysis of patients optimally managed in dedicated centers

IntroductionPRP is gaining increasing interest for pain relief and improvement of joint function in patients with knee osteoarthritis (KOA) but practices and results remain heterogeneous limiting its adoption as standard of care. Current international recommendations are to collect real-life evidence of efficacy with a systematic monitoring of PRP quality and patients' outcomes. We aimed to analyze the response of patients presenting KOA and treated with standardized PRP injection in routine care. We also investigated the potential contributing factors including patient's phenotype and PRP characteristics. MethodsPatients with symptomatic KOA and that failed first-line therapy received a single injection of a qualified PRP prepared using medical devices allowing to recover a high/very high volume of very pure PRP. Visual analogue scale (VAS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded at baseline and during 18 months follow-up. Results431 patients had available follow-up data at 3 months, 291 at 6 months, 137 at 12 months and 44 at 18 months. PRP induced a significant decrease of WOMAC score at all follow up endpoints (29.2 ± 19.2 at 3 months, p < 0.001 and 25.9 ± 19.7 at 12 months, p < 0.01, compared to 39.7 ± 18.9 at baseline). Similar results were observed for pain VAS (38.9 ± 23.3 at 3 months, p < 0.001 and 35.3 ± 24.1 at 12 months, p < 0.05, compared to 56.0 ± 20.7 at baseline). Changes at 12 months were correlated to baseline scores and to the level of improvement at 3 months. The proportion of OMERACT OARSI responders reached 56.2 % for the total cohort and 60.4 % for severe patients at 6 months. Treatment failure occurred for 8.4 % of patients. Age, BMI or Kellgren–Lawrence grade did not impact on efficacy. ConclusionThis real-life study evidences the clinical benefit of a standardized high or very high-volume injection of very pure PRP in patients with KOA, including those with a severe grade. It opens perspectives in the positioning of such strategy to delay arthroplasty and provide insights on factors able to anticipate long term efficacy.

Assessing the Impact of a 1.5 T Transverse Magnetic Field in Radiotherapy for Esophageal Cancer Patients.

Purpose: Magnetic resonance (MR)-guided radiotherapy enables visualization of static anatomy, capturing tumor motion, and extracting quantitative image features for treatment verification and outcome monitoring. However, magnetic fields in online MR imaging (MRI) require efforts to ensure accurate dose measurements. This study aimed to assess the dosimetric impact of a 1.5 T magnetic field in esophageal cancer radiotherapy using MR-linac, exploring treatment adaptation potential and personalized medicine benefits. Methods: A prospective cohort study enrolled 100 esophageal squamous cell carcinoma patients undergoing 4DCT and 3DCT scans before radiotherapy. The heart was contoured on 3DCT, 4DCT end expiration (EE), and 4DCT end inhalation (EI) images by the same radiation oncologist. Reference RT plans were designed on 3DCT, with adjustments for different phases generating 5 plan types per patient. Variations in dose-volume parameters for organs at risk and the target area among different plans were compared using Monaco 5.40.04. Results: Slight dose distortions at air-tissue interfaces were observed in the magnetic field's presence. Dose at air-tissue interfaces (chest wall and heart wall) was slightly higher in some patients (3.0% tissue increased by 4.3 Gy on average) compared to nonmagnetic conditions. Average clinical target volume coverage V100 dropped from 99% to 95% compared to reference plans (planEI and planEE). Dose-volume histogram variation between the original plan and reference plans was within 2.3%. Superior-inferior (SI) direction displacement was significantly larger than lateral and anterior-posterior directions (P < .05). Conclusion: Significant SI direction shift in lower esophageal cancerous regions during RT indicates the magnetic field's dosimetric impact, including the electron return effect at tissue-air boundaries. Changes in OAR dose could serve as valuable indicators of organ impairment and target dose alterations, especially for cardiac tissue when using the 1.5 T linac method. Reoptimizing the plan with the magnetic field enhances the feasibility of achieving a clinically acceptable treatment plan for esophageal cancer patients.

Therapeutic drug monitoring of mycophenolic acid and clinical outcomes of lupus nephritis: a systematic review and meta-analysis

IntroductionMycophenolic acid (MPA) is a primary immunosuppressive agent used in the treatment of lupus nephritis (LN). While therapeutic drug monitoring (TDM) of MPA is well established in organ transplantation, its...

A multi-faceted exploration of unmet needs in the continuing improvement and development of fertility care amidst a pandemic.

The continuous improvement and development of fertility care, internationally, requires ongoing monitoring of current delivery processes and outcomes in clinical practice. This descriptive and exploratory mixed-methods study was conducted in eight countries (Brazil, China, France, Germany, Italy, Mexico, Spain and the United Kingdom) to assess the unmet needs of fertility patients (male and female), and existing challenges, barriers and educational gaps of physicians and laboratory specialists involved in human fertility care during the COVID-19 pandemic. The study was deployed sequentially in two phases: 1) in-depth 45-minute semi-structured interviews (n=76), transcribed, coded and thematically analysed using an inductive reasoning approach, 2) an online survey (n=303) informed by the findings of the qualitative interviews, face validated by experts in reproductive medicine, and analysed using descriptive and inferential statistical methods. The integrated results of both phases indicated numerous areas of challenges, including: 1) investigating male-related infertility; 2) deciding appropriate treatment for men and selective use of assisted reproductive technology; and 3) maintaining access to high-quality fertility care during a pandemic. The paper presents a reflective piece on knowledge and skills that warrant ongoing monitoring and improvement amongst reproductive medicine healthcare professionals amidst future pandemics and unanticipated health system disruptions. Moreover, these findings suggest that there is an additional need to better understand the required changes in policies and organizational processes that would facilitate access to andrology services for male infertility and specialized care, as needed.

Informed Enforcement: Lessons from Pollution Monitoring in China

Government regulations are often imperfectly enforced by public officials. In this study, we exploit the introduction of air pollution monitors in China to investigate whether real-time monitoring of policy outcomes affects the enforcement of existing regulations. Using assignment criteria established by the central government and new georeferenced data on local enforcement activities, we show that monitoring (i) increases enforcement against local firms, (ii) improves the targeting of enforcement, and (iii) reduces aggregate pollution. These effects are driven by officials facing performance incentives and are stronger when there is limited scope for data manipulation, suggesting that real-time monitoring improves top-down accountability. (JEL K32, L51, O13, P25, P28, Q52, Q53)

Association of RAP Compensatory Reserve Index with Continuous Multimodal Monitoring Cerebral Physiology, Neuroimaging, and Patient Outcome in Adult Acute Traumatic Neural Injury: A Scoping Review.

Acute traumatic neural injury, known as traumatic brain injury (TBI), stands as a significant contributor to global mortality and disability. Ideally, continuously monitoring cerebral compliance/cerebral compensatory reserve would enable timely interventions and avert further substantial deterioration in TBI cases. RAP, defined as the moving Pearson's correlation between intracranial pressure (ICP) pulse amplitude waveform and ICP, has been proposed as a continuously updating index in this context. However, the literature remains scattered and difficult to navigate. Thus, the goal of this scoping review was to comprehensively characterize the literature regarding RAP and its association with (1) other multimodal cerebral physiological monitoring, (2) neuroimaging features, and (3) long-term patient outcomes. We subsequently conducted a systematic scoping review of the human literature to highlight the association of RAP with continuous multimodal monitoring of cerebral physiology, neuroimaging, and patient outcomes in the context of adult TBI patients. Our review encompassed 21 studies focusing on these topics. The primary findings involve meticulous analysis of studies, categorizing findings into three states of RAP to clearly understand its relation to cerebral physiology and clinical outcomes. State 1 signifies a healthy condition with a small positive value near zero (RAP <0.5). Conversely, state 2, a predominant characterization of TBI patients, indicates compromised compensatory reserve, featuring a large positive RAP value (RAP > 0.4). State 3 emerges in worsened conditions, showcasing further compromised compensatory reserve, exhausted cerebrovascular reactivity, and disturbed cerebral autoregulation. A substantial number of patients with fatal outcomes was found in state 3, marked by a notable occurrence of decreasing and, in some instances, negative RAP. The significance of this review lies in establishing a platform for future research directions to enhance the precision and clinical implications of RAP in TBI care, ultimately aiming to prevent the transition from state 2 to state 3 and mitigate fatal outcomes.

Microbe-material hybrids for therapeutic applications.

As natural living substances, microorganisms have emerged as useful resources in medicine for creating microbe-material hybrids ranging from nano to macro dimensions. The engineering of microbe-involved nanomedicine capitalizes on the distinctive physiological attributes of microbes, particularly their intrinsic "living" properties such as hypoxia tendency and oxygen production capabilities. Exploiting these remarkable characteristics in combination with other functional materials or molecules enables synergistic enhancements that hold tremendous promise for improved drug delivery, site-specific therapy, and enhanced monitoring of treatment outcomes, presenting substantial opportunities for amplifying the efficacy of disease treatments. This comprehensive review outlines the microorganisms and microbial derivatives used in biomedicine and their specific advantages for therapeutic application. In addition, we delineate the fundamental strategies and mechanisms employed for constructing microbe-material hybrids. The diverse biomedical applications of the constructed microbe-material hybrids, encompassing bioimaging, anti-tumor, anti-bacteria, anti-inflammation and other diseases therapy are exhaustively illustrated. We also discuss the current challenges and prospects associated with the clinical translation of microbe-material hybrid platforms. Therefore, the unique versatility and potential exhibited by microbe-material hybrids position them as promising candidates for the development of next-generation nanomedicine and biomaterials with unique theranostic properties and functionalities.

Investigating the effect of an online enhanced care program on the emotional and physical wellbeing of patients discharged from hospital with acute decompensated heart failure: Study protocol for a randomised controlled trial: Enhanced care program for heart failure.

Depression is highly prevalent and associated with increased hospitalisations and mortality among patients with heart failure (HF). This study will evaluate the effectiveness and cost-effectiveness of an online wellbeing program for patients discharged from hospital with acute decompensated heart failure (ADHF) in (i) improving emotional and physical wellbeing, and (ii) decreasing healthcare utilisation. Two-arm randomised controlled trial. Eligible patients with ADHF will be recruited pre-discharge from two hospitals. Five hundred and seventy participants will be randomised to receive the intervention (online enhanced care program for HF: 'Enhanced HF Care') or usual care. Enhanced HF Care includes health education (11 micro-learning modules) and monitoring of depression and clinical outcomes via fortnightly/monthly surveys for 6 months, with participants offered tailored advice via video email and SMS. Cardiac nurses track real-time patient data from a dashboard and receive automated email alerts when patients report medium- or high-risk levels of depression or clinical symptoms, to action where needed. General practitioners also receive automated alerts if patients report medium- or high-risk survey responses and are encouraged to schedule a patient consultation. Sixty-five participants enrolled to-date. Co-primary outcomes ('Minnesota Living with Heart Failure Questionnaire' Emotional and Physical subscales) and healthcare utilisation (secondary outcome) at 1- and 6-month post-recruitment will be compared between treatment arms using linear mixed effects regression models. This study has the potential to reduce the burden of depression for patients with HF by prioritising urgent mental health needs and clinical symptoms while simultaneously empowering patients with self-care knowledge. The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12622001289707. Issue date: 4 October 2022.

Deaths in Immigration and Customs Enforcement (ICE) detention: A Fiscal Year (FY) 2021-2023 update.

This study describes the deaths of individuals in Immigration and Customs Enforcement (ICE) detention between FY2021-2023, updating a report from FY2018-2020, which identified an increased death rate amidst the COVID-19 pandemic. Data was extracted from death reports published online by ICE. Causes of deaths were recorded, and death rates per 100,000 admissions were calculated using population statistics reported by ICE. Reports of individuals released from ICE custody just prior to death were also identified and described. There were 12 deaths reported from FY2021-2023, compared to 38 deaths from FY2018-2020. The death rate per 100,000 admissions in ICE detention was 3.251 in FY2021, 0.939 in FY2022, and 1.457 in FY2023, compared with a pandemic-era high of 10.833 in FY2020. Suicide caused 1 of 12 (8.3%) deaths in FY2021-2023 compared with 9 of 38 (23.7%) deaths in FY2018-2020. COVID-19 was contributory in 3 of 11 (25%) medical deaths in FY2021-2023, compared with 8 of 11 (72.7%) in the COVID-era months of FY2020 (p = 0.030). Overall, 4 of 11 (36.3%) medical deaths in FY2021-2023 resulted from cardiac arrest in detention facilities, compared with 6 of 29 (20.3%) in FY2018-2020. Three deaths of hospitalized individuals released from ICE custody with grave prognoses were identified. The death rate among individuals in ICE custody decreased in FY2021-2023, which may be explained in part by the release of vulnerable individuals following recent federal legal determinations (e.g., Fraihat v. ICE). Identification of medically complex individuals released from ICE custody just prior to death and not reported by ICE indicates that reported deaths underestimate total deaths associated with ICE detention. Attentive monitoring of mortality outcomes following release from ICE custody is warranted.

EuReCa_Srbija Subotica 2014-2021 - epidemiologija vanbolničkog srčanog zastoja

Aims and goals Continuous monitoring of epidemiology, treatment and outcome of out of hospital cardiac arrest on the territory of Subotica municipality. Methodology EuReCa Serbia is a part of international, prospective, multicentric, EuReCa_One project, which records survival of patients (epidemiology, treatment, outcome) with out of hospital cardiac arrest in Europe, who are registered on "clinicaltrials.gov (registration number: NCT02236819) by ERC. Data gathered by research center Subotica from October 1, 2014 to December 31, 2021. have been observed. Statistical software SPSS Statistics for Windows v27.0 was used for analysis. Variables are presented through incidence and percentage, and Chi-Square test was used for connection testing between categorical variables. Results During the observed time period, the incidence of EuReCa events was 171,67/100.000. Annual incidence of initiated cardiopulmonary resuscitation was 60.75/100000. Age Median for both sexes was 71 (IQR 62-81). Incidence of out of hospital cardiac arrest in patients" residences, per year, was 157.08 /100.000. Yearly Incidence of provided basic life support was 11.07. Return of spontaneous circulation (ROSC) was achieved in 164 patients of 516 cases (31.78%), which makes the incidence of achieved ROSC, per year, 19.31/100 000. Conclusion Incidence of initiated cardiopulmonary resuscitation and achieved return of spontaneous circulation can be compared with results of European countries. Further monitoring of OHCA is necessary so that the reasons for poor laymen involvement can be determined.

Levofloxacin prophylaxis for pediatric leukemia patients: monitoring of outcomes for sustained benefit and consequences.

Levofloxacin prophylaxis reduces bloodstream infections in neutropenic patients with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. A retrospective, longitudinal cohort study compares incidence of bacteremia, multidrug-resistant organisms (MDRO), and Clostridioides difficile (CDI) between time periods of levofloxacin prophylaxis implementation. Benefits were sustained without increasing MDRO or CDI.

Informing policy makers in developing countries: Practices and limitations of geriatric home medication review in Malaysia-A qualitative inquiry

Objective: To explore existing practices and challenges in the delivery of geriatric home medication review (HMR). The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR. Methods: This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals. The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR. Results: Based on the emerging themes from the qualitative data, the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits, encompassing a diverse patient population with various healthcare needs. However, it faces challenges such as the lack of outcome monitoring, formal training, and workforce constraints. Despite these hurdles, there is a pressing need for the expansion of this service to better serve the community, and collaboration with community pharmacists holds potential to broaden its scope. Ultimately, the findings suggest that pharmacist- led HMR is both warranted and feasible within the Malaysian healthcare context. In order to optimize medicine-use among older people living in the community, approaches for expanding geriatric HMR services in Malaysia must be developed. Conclusions: This study holds profound implications as it attempts to illuminate policy makers in developing countries, enabling them to formulate effective HMR plans. By considering the challenges highlighted within this research, policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.

The implementation of I.ROC as a way to use client goals as drivers to organise mental health care and improve mental health care through outcome monitoring.

De MaRe uses the Indivdual recovery outcome counter (I.ROC) as a way to organise mental health care starting from the individual client needs and goals. Clients are put in the drivers seat of their own recovery proces by being able to set their goals on the HOPE-framework (home, opportunity, people, empowerment) and determing their own needs in health care. Health care workers developed a toolkit to meet clients needs and facilitate the recovery proces.&#x0D; By processing the data the health care facility can use generalised input as an outcome monitor and improve the health care service for clients.&#x0D; Generalised data can also be used to benchmark the provided care with peer centers in Flanders

Transdisciplinary assessment frame as leverage for integrated care

In patients with severe, complex, and long-lasting psychiatric problems, psychopathology becomes intrinsically intertwined with personality, biological, social, and existential well-being. Consequently, the share of experience of general well-being becomes more critical. Therefore, apart from standard evidence-based treatment, added guidelines and good practices concerning suicidality, lifestyle, family impact and resource, human custodial measures, collaboration with patients and their expertise, and spiritual and existential guidance, complement standard guidelines. Unfortunately, these extra guidelines are used only as an add-on with traditional treatments or separated in a recovery approach where treatment would no longer be the focus. Because of the lasting need for integrated and precision care in these patients, UPC Duffel Belgium started an integrated plan for precision care. The first step in this plan was the development of a three-level assessment frame, a 'general treatment' backbone as leverage for uniting the different specializations, and a frame in which all interdisciplinary and transdisciplinary activities find their place. The next step is the collaborative use of the system and implementation of the associated skills and attitudes for all participants.&#x0D; The first person-centered level is the individual psychotherapeutic level at which criteria for treatment indication are evaluated in an overview that prioritizes with the patients’ different problems, systematically organized in four axes. Axis I, of distant fixed factors of nature and nurture is associated with the latent intrapersonal or permanent contextual or cultural factors (Axis II). The outcome behavior Axis III shows problem behaviors as a flip side of their associated therapeutic goals, followed by Axis IV with direct behavior-triggering and factual temporary, environmental, and relational/contextual factors. This case conceptualization is feasibly visualized and translated into a short explanation and hope inspiring narrative with the patient. &#x0D; The second interdisciplinary level is the team level, at which treatment criteria are evaluated in the context of the treatment history. The staff and the patient check ten points: identification of the patient, triggering events for admission, previous treatments with successes and failures, important influences of personality, contextual or cultural factors as far as conditional for the present treatment, preferences of the patient, short term risks, long term risks, treatment priorities, ultimate goal and deselected treatment targets, criteria for dismission and contextual points of attention. Experience experts coach patients, using these points as a guide, to emancipate these patients to equality and to informed negotiator in their treatment, thus obliging the teams to prepare for a transparent discussion. &#x0D; The third transdisciplinary level is the hospital level which automatically and repeatedly evaluates the stay's effect by Routine Outcome Monitoring in all domains of functioning as in the International Classification of Functioning model (ICF). This model provides an overview of functioning, activity, and participation problems and resources and indicates the right places for engaging in transdisciplinary actions and collaboration beyond the restricted cure field of psychiatry. The functioning chart is a hinge that connects the psychopathology frame and the complementary positive health domains as both map on the same ICF scheme.