Continuity Of Care For Patients Research Articles

Nurses’ perceptions of discharge planning implementation: A descriptive qualitative study

Background: Discharge planning is crucial in hospitals to ensure continuous patient care, thereby preventing re-admissions or complications. However, its implementation still requires improvement due to various obstacles and variances in nurses’ perceptions. Objective: This research aims to explore nurses’ perceptions regarding the implementation of discharge planning. Methods: This study is a descriptive qualitative research involving 14 participants selected through purposive random sampling. Data was collected from April to June 2023 through in-depth interviews, with notes taken and recordings made for transcription. Data analysis was conducted using the Colaizzi method. Results: Participants exhibited a good understanding of discharge planning, yet disparities emerged in their perceptions regarding ten key themes: knowledge, goals, and benefits; organizational aspects in implementation management; activity mechanisms; methods and media employed; implementation steps/flow; implementation content; particularly notable was the theme of implementation timing; evaluation processes in implementation; availability of specialized formats and documentation procedures/format completion; and encountered implementation categories and room-related obstacles. These themes emerged as significant areas needing attention based on the research findings. Conclusion: Nurses’ perceptions regarding the implementation of discharge planning have not been optimized due to constraints imposed by hospital management policies and room management, differences in nurses’ perceptions and attitudes towards implementation, and factors related to patients and their families.

Experiences of injured patients referred to higher levels of care after initial assessment and management at non-tertiary hospitals in Ghana

BackgroundThe experiences of trauma patients referred from Ghanaian non-tertiary hospitals for definitive care at higher levels is not well-known. Understanding the motivations of injured patients who do not attend their referral for definitive management may inform interventions to improve injury outcomes. MethodsThis study is a follow-up survey of participants of a larger study involving initial management of injured patients presenting to 8 non-tertiary hospitals in Ghana from October 2020 to March 2022. Injured patients referred to higher levels of care were surveyed by phone using a structured questionnaire and patients who could not be reached were excluded. The main outcome was referral non-attendance and differences between patients who attended the referral and those who did not were determined with chi squared tests. Variables with intergroup differences were included in a multivariable logistic regression. Open-ended survey responses were analyzed using thematic content analysis. ResultsOf 335 referred patients surveyed, 17 % did not attend the referral. Factors associated with referral non-attendance included being male (Adjusted odds ratio (AOR)=2.70, p = 0.013), sustaining a fracture (AOR=2.83, p = 0.003), and having less severe injury (AOR 2.84, p = 0.017). Primary drivers of referral non-attendance included financial problems (59 %), family influence (45 %), and lack of transportation (20 %). The majority of patients (77 %) not attending the referral sought treatment from traditional healers, citing lower cost, faster service, and a perception of equivalent outcomes. Reported facilitators of referral attendance included positive hospital staff experiences and treatment while barriers included higher hospital costs, lack of bed space, and poor interhospital communication. ConclusionsAn important proportion of injured patients in Ghana do not attend referrals for definitive management, with many seeking care from traditional healers. Our study identified possible targets for interventions aimed at maintaining the continuum of hospital-based care for injured patients in order to improve outcomes.

The Effectiveness of Telemedicine in the Management of Chronic Diseases (Diabetes, Hypertension, and Coronary Heart Disease) at Primary Care Facilities in Eastern Trinidad During the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, Trinidad and Tobago's government implemented lockdowns and limited the availability of outpatient clinics to curb virus transmission. Subsequently, telemedicine via telephone calls was utilized to address infection control and continuity of care for chronic disease patients. Methods: An observational study was conducted at three primary care facilities in Eastern Trinidad using convenience sampling to review retrospectively telemedicine patients' medical records from October 2019 to February 2020 (before telemedicine) and from March 2020 to September 2020 (during telemedicine) for comparative analysis. Data were analyzed using IBM SPSS Statistics 28.0 software and Microsoft Excel. Results: A total of 199 patient files were analyzed; 57.3% of these were female; 52.3% were 60 years and older. A Wilcoxon signed-rank test demonstrated no statistically significant differences between random blood sugar (RBS) readings (0.355), weight (0.621), or systolic and diastolic blood pressure (BP; 0.239 and 0.232, respectively) before and during the 6-month period of telemedicine consultation. Patients compliant with medication before the use of telemedicine were 14 times more likely to attain target BPs. There was no significant association between compliance with prescribed therapy and BP control (0.335) during the period of telemedicine. Discussion: The findings support the use of telemedicine to manage chronic diseases such as hypertension, diabetes mellitus, and coronary heart disease, as the standard of care was preserved, and no inferiority of recorded outcomes was demonstrated. Although there was an overall decrease in compliance during the telemedicine period compared with before, comparative analysis exhibited no statistically significant differences in BP or RBS readings.

The Impact of Primary Care Clinic and Family Physician Continuity on Patient Health Outcomes: A Retrospective Analysis From Alberta, Canada.

Continuity of care is broadly associated with better patient health outcomes. The relative contributions of continuity with an individual physician and with a practice, however, have not generally been distinguished. This retrospective observational study examined the impact of continuity of care for patients seen at their main clinic but by different family physicians. We analyzed linked health administrative data from 2015-2018 from Alberta, Canada to explore the association of physician and clinic continuity with rates of emergency department (ED) visits and hospitalizations across varying levels of patient complexity. Physician continuity was calculated using the known provider of care index and clinic continuity with an analogous measure. We developed zero-inflated negative binomial models to assess the association of each with all-cause ED visits and hospitalizations. High physician continuity was associated with lower ED use across all levels of patient complexity and with fewer hospitalizations for highly complex patients. Broadly, no (0%) clinic continuity was associated with increased use and complete (100%) clinic continuity with decreased use, with the largest effect seen for the most complex patients. Levels of clinic continuity between 1% and 50% were generally associated with slightly higher use, and levels of 51% to 99% with slightly lower use. The best health care outcomes (measured by ED visits and hospitalizations) are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable. The effect of partial clinic continuity appears complex and requires additional research. These results provide some reassurance for part-time and shared practices, and guidance for primary care workforce policy makers.

Transitional Medicine of Intractable Primary Dyslipidemias in Japan.

Transitional medicine refers to the seamless continuity of medical care for patients with childhood-onset diseases as they grow into adulthood. The transition of care must be seamless in medical treatment as the patients grow and in other medical aids such as subsidies for medical expenses in the health care system. Inappropriate transitional care, either medical or social, directly causes poorer prognosis for many early-onset diseases, including primary dyslipidemia caused by genetic abnormalities. Many primary dyslipidemias are designated as intractable diseases in the Japanese health care system for specific medical aids, as having no curative treatment and requiring enormous treatment costs for lipid management and prevention of complications. However, there are problems in transitional medicine for primary dyslipidemia in Japan. As for the medical treatment system, the diagnosis rate remains low due to the shortage of specialists, their insufficient link with generalists and other field specialists, and poor linkage between pediatricians and physicians for adults. In the medical care system, there is a mismatch of diagnostic criteria of primary dyslipidemias between children and adults for medical care expense subsidization, as between The Program for the Specific Pediatric Chronic Diseases and the Program for Designated Adult Intractable Diseases. This could lead some patients subsidized in their childhood to no longer be under the coverage of the aids after transition. This review intends to describe these issues in transitional medicine of primary dyslipidemia in Japan as a part of the efforts to resolve the problems by the Committee on Primary Dyslipidemia under the Research Program on Rare and Intractable Disease of the Ministry of Health, Labour and Welfare of Japan.

Transitioning from hospital to home after a major lower extremity amputation: Interview study on patients' and relatives’ perspectives

IntroductionPatients often feel unprepared and concerned about their new life after a major lower extremity amputation (LEA). Therefore, we implemented an integrated care program, Safe Journey, to optimize the quality and continuity of care for patients with LEA due to vascular disease when transitioning from hospital to home. This study aims to illuminate and explore the experiences of patients with LEA and their relatives with the transition from hospital to home after implementing Safe Journey. Material and methodsThis qualitative, exploratory study individually interviewed six patients with a major LEA and four relatives and jointly interviewed eight patients with their relatives. ResultsThe participants’ experiences transitioning from hospital to home were centered around two major themes: (1) Going home: mixed emotions and confusion, and (2) bridging the gap. The main themes encompassed six subthemes: (1) simultaneously expectant and worried, (2) a lack of knowledge creating uncertainty, (3) an unexpressed but pending need for psychosocial support, (4) reassurance but safety comes at a price, (5) navigating the system, and (6) lack of involvement. ConclusionTransitioning from hospital to home after a major LEA creates mixed emotions. Knowledge, feeling involved, and being prepared and cared for were highlighted as important during the transition. The Safe Journey program made patients and relatives feel physically reassured and safe, but all the home visits strained the families. The program's benefits are consistent with existing knowledge on patients with complex needs benefitting from integrated care models. However, a more individualized and person-centered approach is needed.

Identifying ideal pharmacist‐to‐patient ratios for the successful provision of clinical pharmacy services

AbstractClinical pharmacists add significant value to the health care team and are associated with reduced hospital mortality, drug costs, length of stay, and adverse drug reactions. However, there remains a paucity of evaluative data regarding optimal clinical pharmacy practice models. Identifying optimal patient (or bed)‐to–clinical pharmacist ratios is one mechanism to assess the allocation of resources. The ACCP Task Force on Clinical Pharmacy Services was charged with developing a white paper to examine optimal ratios in different care settings, considering confounders and other factors that affect the interpretation of ratio data. The committee performed an extensive search of the pharmacy, medical, and nursing literature to identify existing data on provider‐to‐patient ratios. Recommendations on ratios are mainly from survey data or statements from various health care organizations. Many factors affect the capacity of clinical pharmacists to achieve patient care and non‐patient care responsibilities. Examples include general differences in baseline expectations; nonstandardized program performance metrics; variable hospital/practice setting types; variable patient acuity and complexity; competing priorities and other resources; industry‐wide rates of and variability in addressing burnout; inconsistent means for justifying numbers and historical corporate structures; and external endorsements and mandates. Although some areas of practice such as critical care pharmacy have more robust evidence for specific ratios, others such as pediatrics are far less clear. A clinical pharmacist ratio must be established as a starting point. This will allow for better allocation today and serve as a springboard for future determinations. Furthermore, clinical pharmacist ratios should be preserved to offer reliable patient care 365 days per year. As clinical pharmacist services shift from beneficial to essential, continuous daily patient care services must be the practice model moving forward.

Improving Care Continuity in Oncology Settings: A Lean Management Approach to Minimize Discharges Without Follow-Up Appointments.

This study aimed to reduce the number of patients discharged without scheduled follow-up appointments by implementing lean management principles. Conducted at the Sultan Qaboos Comprehensive Cancer Center in Muscat, Oman, the research utilized a one-group pretest-posttest quasi-experimental design to evaluate the impact of lean management interventions on the rate of patient discharges without follow-up appointments. Strategies such as the Kaizen principle, Gemba Walks, cross-functional collaboration, standard work procedures, and waste reduction were employed to enhance operational efficiency. Spanning from Quarter 3 of 2022 to Quarter 2 of 2023, the study demonstrated a significant decrease in the percentage of patients discharged without planned follow-up appointments. The rate dropped from 9% in September 2022 to 0% in March 2023, with statistically significant differences observed (X2= 65.05, p value=<.0001). By effectively implementing lean management principles, this research successfully enhanced care continuity for oncology patients after being discharged.

Research progress of continuous care of patients after percutaneous coronary intervention

Research progress of continuous care of patients after percutaneous coronary intervention

Abstract 2427: The development of a tissue-agnostic genome-wide methylome enrichment MRD assay for applications across the cancer care continuum for head and neck malignancies

Abstract Background: Plasma-based tests to quantify circulating cell-free DNA cancer signal have emerged as viable applications across the cancer continuum, from early detection to optimal disease management. Here we demonstrate the feasibility of a tissue-agnostic, genome-wide methylome enrichment platform based on cell-free methylated DNA immunoprecipitation and high throughput sequencing (cfMEDIP-seq) for cancer detection, cancer signal quantification, and prognostication in head and neck cancer (HNC). Methods: Pre-treatment plasma samples from individuals with newly diagnosed stage I-IV HPV+ or HPV- HNC were analyzed with a bisulfite-free, non-degradative, genome-wide methylome enrichment platform using 5-10 ng of cell-free DNA. For cancer detection, a machine learning classifier used differentially methylated regions to distinguish cancers from non-cancer controls. The area under the receiver operating characteristic curve (AUC) and 95% confidence intervals were calculated. Cancer signals were quantified from average normalized counts across informative methylated regions and a 95% specificity threshold. For prognostication, events were defined as recurrence, progression, or death due to HNC, whichever occurred earliest. Time to event was compared for samples with cancer signal quantities above versus below the threshold. Post-treatment and longitudinal plasma samples from individuals with Stage I-IVB HNC (HPV+ and HPV- included) will be analyzed for recurrence prediction and detection of relapse. More than 100 patients and 300 samples will be analyzed. Results: For cancer detection, 92 pre-treatment plasma samples from HNC cases were distinguished from 674 controls with an AUC of 0.96 (0.94, 0.98). The AUC was 0.93 (0.86, 1.0) for Stage I, 0.93 (0.83, 1.0) for Stage II, 0.96 (0.94, 0.99) for Stage III, and 0.97 (0.96, 0.99) for Stage IV. For prognostication, 91 pre-treatment samples were included (7 stage I, 16 stage II, 23 stage III, 45 stage IV). Median follow-up time was 50.6 months with 27 events. Likelihood of recurrence or progression was significantly higher in samples with cancer signal above the threshold [hazard ratio 5.4 (95% CI 2.25, 12.95), log-rank P&amp;lt;0.001]. In the upcoming analysis, data will be reported on the ability to predict recurrence and relapse in post-treatment samples. Conclusions: The cfMeDIP-seq approach demonstrated robust detection of HNC, across all stages and subtypes, and the ability to predict recurrence and progression from pre-treatment samples. We will report training data with cross validation to predict recurrence and relapse using post-treatment and longitudinal sampling. Collectively, data from these studies indicate that genome wide methylome enrichment has multiple use cases across the care continuum for patients with HNC. Citation Format: Geoffrey Liu, Jun Min, Yarong Wang, Justin Burgener, Ben Brown, Karen Budhraja, Junjun Zhang, Owen Hall, Shu Yi Shen, Martha Pienkowski, Shao Hui Huang, Laurie Ailles, Katrina Rey-McIntyre, Jeremy B. Provance, Eduardo Sosa, Cynthia Frye, Scott Bratman, Brian Allen, Joshua T. Jones, Abel Licon, Jing Zhang, Anne-Renee Hartman, Daniel D. De Carvalho. The development of a tissue-agnostic genome-wide methylome enrichment MRD assay for applications across the cancer care continuum for head and neck malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2427.

Improving the Quality and Completeness of Discharge Summaries at a Tertiary Care Hospital in Pakistan: A Quality Improvement Project.

Introduction Discharge summaries (DS) allow continued patient care after being discharged from the hospital. Only a few quality improvement projects (QIPs) focused on assessing and improving the quality and completeness of DS at tertiary care hospitals have been undertaken in Pakistan. This QIPaimed to evaluate and enhance the quality and completeness of DS at a tertiary care hospital in Pakistan to facilitate seamless healthcare transitions. Methods A QIP was conducted in the medical unit of a tertiary care hospital in Rawalpindi, Pakistan. The DS were assessed using the e-discharge summary self-assessment checklist devised by the Royal College of Physicians (RCP). This QIP was done by the plan, do, study, act (PDSA) cycle. The PDSA cycle comprised two audit cycles and an intervention in between them. The first audit cycle (AC) was conducted on 150 DS. Its duration was from March 2023 to June 2023. An educational workshop was conducted before the re-audit cycle (RAC) to address deficiencies and reinforce the implementation of the guidelines provided by the RCP. The RAC was conductedfrom June 2023 to August 2023. 100 DS were studied and analyzed to assess for improvement in the completeness of DS. Frequencies and percentages were calculated in each audit cycle. The Chi-squared test was applied to compare the statistical difference between the results of both audit cycles. Results A total of 150 DS were analyzed in the first AC and 100 DS in the RAC. The results of the first AC show that the details of any allergies were recorded only in 3% of the DS; this percentage significantly improved to 51% after the RAC (p-value <0.05). Relevant past medical history was included in 52% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). Secondary diagnoses were written in 54% and 71% of the DS during the firstAC and RAC, respectively (p-value <0.05). Details of relevant investigations were included in 60% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). The post-discharge management plan was written in 90% and 98% of the DS during the first AC and RAC, respectively (p-value <0.05).The follow-up plan was written clearly in 65% and 93% of the DS during the first AC and RAC, respectively (p-value <0.05). Conclusion The DS was found to be incomplete after analyzing the results of the first AC. The details related to allergies, medications, operations, and procedures were found to be missing in the majority of the cases. No mention of the patient's concerns or expectations was made in the DS. The results of the RAC showed improvement in the level of completeness of DS. The majority of the weak points observed after the first AC seemed to haveimproved after the RAC, which shows that intervention proved to be quite effective in improving the completeness and quality of DS. The RAC showed significant improvement in the completeness of the details relating toinvestigations, allergies, past medical history, secondary diagnoses, and the post-discharge follow-up plan. QIP must be routinely carried out to assess and improve the completeness and quality of DS at hospitals.

Measuring the quality of transitional care based on elderly patients’ experiences with the partners at care transitions measure: a cross-sectional survey

BackgroundThe quality of transitional care is closely related to the health outcomes of patients, and understanding the status of transitional care for patients is crucial to improving the health outcomes of patients. Therefore, this study aims to investigate the quality of transitional care in elderly patients with chronic diseases and analyze its influencing factors, to provide a basis for improving transitional care services.MethodsThis is a cross-sectional study. We used the Chinese version of the Partners at Care Transitions Measure (PACT-M) to survey patients with chronic diseases aged 60 years and older who were about to be discharged from five tertiary hospitals in Henan and Shanxi provinces. We used the mean ± standard deviation to describe the quality of transitional care, t-test or one-way ANOVA, and regression analysis to explore the factors affecting the quality of transitional care for patients.Results182 elderly patients with chronic diseases aged ≥ 60 years completed the PACT-M survey. The scores of PACT-M1 and PACT-M2 were (30.69 ± 7.87) and (25.59 ± 7.14) points, respectively. The results of the t-test or one-way ANOVA showed that the patient’s marital status, ethnicity, religion, educational level, preretirement occupation, residence, household income per month, and living situation had an impact on the quality of transitional care for elderly patients with chronic diseases (P < 0.05). The results of regression analyses showed that patients’ preretirement occupation, social support, and health status were the main influences on the quality of transitional care for elderly patients with chronic diseases (P < 0.05), and they explained 63.1% of the total variance.ConclusionsThe quality of transitional care for older patients with chronic illnesses during the transition from hospital to home needs further improvement. Factors affecting the quality of transitional care included patients’ pre-retirement occupation, social support, and health status. We can improve the hospital-community-family tertiary linkage service to provide coordinated and continuous transitional care for patients based on their occupation, health status, and social support to enhance the quality of transitional care and the patient’s health.

Policies for type 2 diabetes and non-communicable disease management during the COVID-19 pandemic in Kenya and Tanzania: a desk review and views of decision-makers

BackgroundThe COVID-19 pandemic caused disruptions in care that adversely affected the management of non-communicable diseases (NCDs) globally. Countries have responded in various ways to support people with NCDs during the...

Characteristics for Low, High and Very High Emergency Department Use for Mental Health Diagnoses from Health Records and Structured Interviews.

Patients with mental health diagnoses (MHD) are among the most frequent emergency department (ED) users, suggesting the importance of identifying additional factors associated with their ED use frequency. In this study we assessed various patient sociodemographic and clinical characteristics, and service use associated with low ED users (1-3 visits/year), compared to high (4-7) and very high (8+) ED users with MHD. Our study was conducted in four large Quebec (Canada) ED networks. A total of 299 patients with MHD were randomly recruited from these ED in 2021-2022. Structured interviews complemented data from network health records, providing extensive data on participant profiles and their quality of care. We used multivariable multinomial logistic regression to compare low ED use to high and very high ED use. Over a 12-month period, 39% of patients were low ED users, 37% high, and 24% very high ED users. Compared with low ED users, those at greater probability for high or very high ED use exhibited more violent/disturbed behaviors or social problems, chronic physical illnesses, and barriers to unmet needs. Patients previously hospitalized 1-2 times had lower risk of high or very high ED use than those not previously hospitalized. Compared with low ED users, high and very high ED users showed higher prevalence of personality disorders and suicidal behaviors, respectively. Women had greater probability of high ED use than men. Patients living in rental housing had greater probability of being very high ED users than those living in private housing. Using at least 5+ primary care services and being recurrent ED users two years prior to the last year of ED use had increased probability of very high ED use. Frequency of ED use was associated with complex issues and higher perceived barriers to unmet needs among patients. Very high ED users had more severe recurrent conditions, such as isolation and suicidal behaviors, despite using more primary care services. Results suggested substantial reduction of barriers to care and improvement on both access and continuity of care for these vulnerable patients, integrating crisis resolution and supported housing services. Limited hospitalizations may sometimes be indicated, protecting against ED use.

Pearls for Caring for the Boarding Psychiatric Patient in the Emergency Department

BackgroundEmergency Department (ED) boarding of psychiatric patients is a national issue that continues to worsen at a disturbing rate. Implementing strategies in the ED to provide continuous care for patients can help secure patient safety. ObjectiveThe objective of this review is to discuss the boarding of psychiatric patients and its implications. It will focus on executing best clinical practices in managing boarding psychiatric patients in the ED. It will not focus on the treatment of substance use disorders. DiscussionThis article will address the pearls for management plans that can be implemented in the ED, alongside discussing pregnant and elderly patients. Risk factors, complications, and treatments for boarding psychiatric patients are discussed. ConclusionsPatients with psychiatric disorders boarding in the ED need careful consideration of management plans to mitigate patient safety events.

Tingkat Kepuasan Pasien terhadap Pelayanan Rawat Jalan Poli Penyakit Dalam pada Rsup Dr. Sitanala Tangerang

Outpatient services are an integral component of the health service delivery system in hospitals which provides and plays an important role in continuity of patient care and improving service quality. Patients have a level of satisfaction according to their respective standards for the services they have received. Patient satisfaction is a very important and comprehensive part of the quality of health services provided. Patient satisfaction is a level of patient feeling that arises as a result of the performance of the health services they have obtained after the patient compares it with their expectations. The aim of this research was to determine the satisfaction level of internal medicine outpatients available at RSUP Dr. Sitanala Tangerang using 5 dimensions of quality. The research method is quantitative descriptive research using questionnaire survey techniques. This study used a cross sectional approach because the sampling was carried out simultaneously over the same period of time using a non-random sampling method using convenience sampling of patients who came to receive outpatient services at the internal medicine clinic. With the results of the physical evidence (Tangibles) dimension of 90%, the Responsiveness dimension of 87,9%, the reliability dimension of 89,6%, the Assurance dimension of 93%, and the Attention (Emphaty) dimension of 90,8%.

Analysis of the Nursing Effect of Continuity of Care on Elderly Patients with Coronary Heart Disease Unstable Angina and its Impact on Quality of Life

Objective: To analyze the effect of using continuity of care for elderly patients with coronary heart disease (CHD) with unstable angina pectoris (UAP) and its impact on their quality of life. Methods: 100 cases of elderly patients with CHD with UAP admitted to our hospital from March 2022 to March 2023 were selected and grouped into an observation group and a control group of 50 cases each according to the randomized number table method. The nursing effect and quality of life of the observation group (continuity nursing) and the control group (routine nursing) were compared. Results: The total effective rate of nursing care was 96.00% observation group and 80.00% for the control group, and the differences were significant (χ2 = 6.061, P &lt; 0.05). Patients in the observation group had fewer episodes (1.42 ± 0.21) times/week and a shorter duration (5.46 ± 0.39) min, which were better than the control group (t =3.465, 2.973; P &lt; 0.05). The depression self-rating depression scale (SDS) score (42.16 ± 6.64) and anxiety self-rating scale (SAS) score (32.26 ± 7.35) in the observation group were lower and the quality of life was higher as compared to that of the control group (P &lt; 0.05). Conclusion: Continuous nursing care improved the nursing effect of elderly CHD with UAP patients, promoted the alleviation of UAP symptoms, improved patient mentality, and improved their quality of life. Hence, continuous nursing care possesses significant clinical application value.

Resident perceptions of learning challenges in concussion care education

Background: Resident-focused curricula that support competency acquisition in concussion care are currently lacking. We sought to fill this gap by developing and evaluating Spiral Integrated Curricula (SIC) using the cognitive constructivism paradigm and the Utilization-Focused Evaluation (UFE) framework. The evidence-based curricula consisted of academic half-days (AHDs) and clinics for first- and second-year family medicine residents. Our first pilot evaluation had quantitatively demonstrated effectiveness and acceptability but identified ongoing challenges. Here we aimed to better describe how concussion learning is experienced from the learners’ perspective to understand why learning challenges occurred. Methods: A qualitative interpretative cohort study was utilized to explore resident perceptions of concussion learning challenges. Participants completed six monthly longitudinal case logs to reflect on their concussion experience. Semi-structured interviews were conducted. Results: Residents' beliefs and perceptions of their roles influenced their learning organization and approaches. Challenges were related to knowledge gaps in both declarative knowledge and knowledge interconnections. Through reflection, residents identified their concussion competency acquisition gaps, leading to transformative learning. Conclusion: This Spiral Integrated Design created vigorous processes to interrogate “concussion” competency gaps. We discussed resident mindsets and factors that hindered “concussion” learning and potentially unintentional negative impacts on the continuity of patient care. Future studies could explore how to leverage humanistic adaptive expertise, cross-disciplines for curriculum development, and evaluation to overcome the hidden curriculum and to promote integrated education and patient care.

Machine Learning Applications in Healthcare: Current Trends and Future Prospects

The integration of machine learning (ML) in healthcare has witnessed remarkable advancements, transforming the landscape of medical diagnosis, treatment, and overall patient care. This article provides a comprehensive review of the current trends and future prospects of machine learning applications in the healthcare domain.The current landscape is characterized by the utilization of ML algorithms for disease diagnosis and risk prediction, personalized treatment plans, and efficient healthcare resource management. Notable applications include image recognition for radiology and pathology, predictive analytics for disease prognosis, and the development of precision medicine tailored to individual patient profiles.This review explores the evolving role of ML in improving patient outcomes, enhancing clinical decision-making, and optimizing healthcare workflows. It delves into the challenges faced in integrating ML into existing healthcare systems, such as data privacy concerns, interpretability of complex models, and the need for robust validation processes.Additionally, the article discusses future prospects and emerging trends in ML healthcare applications, including the potential for predictive analytics to preemptively identify health issues, the integration of wearable devices and remote monitoring for continuous patient care, and the intersection of ML with genomics for personalized medicine.The overarching goal of this article is to provide healthcare professionals, researchers, and policymakers with insights into the current state of ML applications in healthcare, along with an outlook on the transformative potential that machine learning holds for the future of healthcare delivery and patient outcomes.

Factors disrupting the continuity of care for patients with chronic disease during the pandemics: A systematic review.

Continuous routine care is necessary to prevent long-term complications of chronic diseases and improve patients' health conditions. This review study was conducted to determine the factors disrupting continuity of care for patients with chronic diseases during the pandemic. All original articles published on factors disrupting continuity of care for patients with chronic disease during a pandemic between December 2019 and June 28, 2023, in PubMed, Web of Science, Scopus, and ProQuest databases were searched. Selection of articles, data extraction, and qualitative evaluation of articles (through STROBE and COREQ checklist) were done by two researchers separately. Data graphing form was used to extract the data of each study and then the data were classified by thematic analysis method. Out of 1708 articles reviewed from the databases, 22 were included. The factors disrupting the continuity of care for patients with chronic diseases during the epidemics were classified into two main categories: patient-side factors and health system-side factors. Patient-side factors including psychological, individual and social, disease-related, and health system-side factors including provider access, health system institutional, and infrastructural and financial problems were among the subcategories disrupting the continuity of care for patients with chronic diseases during the pandemic. Based on the studies, psychological factors and access to the provider were among the most frequent factors affecting the continuity of care for patients with chronic diseases in the pandemic. Considering the factors disrupting the continuity of care and applying appropriate interventions based on them, can guarantee the continuity of providing services to chronic patients in health crises.