Patient-focused Approach Research Articles

Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease: a population-based cohort study

ObjectiveA patient-focused approach is advocated to embody risk of non-adherence to medication and subsequent adverse clinical outcomes following ischaemic heart disease (IHD). This study aimed to explore how patient perceived...

A new model for a palliative approach to care in Australia

There is an inconsistent provision of palliative and end-of-life (palliative) care across Australia, particularly in regional, rural and remote areas. Systematic solutions can help to address identified gaps and improve access to and quality of care and support for patients, their families and carers at the end of life. The Far West New South Wales (NSW) Palliative and End of Life Model of Care is a systematic solution for a rural and remote palliative approach to care. The model enables a consistent and contextually adaptable, patient-focused palliative approach to care so that everyone receives the care they need from appropriately skilled and informed clinicians, in a timely manner, and as close to home as possible. A narrative report used literature and internal documents as well as the perspective and experience of key informants involved in establishing the Far West NSW Palliative and End of Life Model of Care. This narrative report aims to describe the design, development and function of the model, and to identify the essential elements to implement or maintain the model elsewhere. The model was developed by the Specialist Palliative Care Service in the remotely situated Far West Local Health District of NSW. The Far West NSW Palliative and End of Life Model of Care was designed to guide a palliative approach to care in the last year of life, through death and into bereavement, regardless of age, diagnosis, culture, location or provider. The model functionally provides the scaffolding for locally and contextually relevant components of a quality palliative approach to care in consideration of a person's wishes. There are three essential elements to the development, maintenance and further implementation of the model and a palliative approach elsewhere. Until recently, the model relied on paper-based documents and resources; it is now available online. It has the potential to enable a consistent, yet contextually adaptable, patient-focused palliative approach to care.

A Health Literate Patient-focused Approach to the Redesign of the Raltegravir (ISENTRESS) Pediatric Kit and Instructions for Use.

Background:Limited data exist regarding how medications for pediatric use can be developed to minimize medication errors. The integrase inhibitor raltegravir was developed for use in neonates (≥2 kg). Anticipating that neonatal administration would be performed primarily by mothers with varying degrees of health literacy, a health literate, patient-focused, iterative process was conducted to update/redesign the raltegravir granules for oral suspension pediatric kit and instructions for use (IFU) for neonatal use to be ready for regulatory submission.Methods:Prototypes of an updated/redesigned raltegravir IFU were systematically assessed through multi-stage, iterative testing and evaluation involving untrained lay individuals with varying levels of health literacy, healthcare professionals and health literacy experts.Results:This iterative process resulted in numerous refinements to the IFU and kit, including wording, layout, presentation, colored syringes and additional instructional steps. The revised raltegravir pediatric kit and IFU (to include neonatal dosing) were approved by the US Food and Drug Administration in 2017 and the European Union in 2018. No reported medication errors related to IFU utilization had been reported as of March 2021, reflecting >3 years of commercial use worldwide.Conclusions:This patient-focused process produced health literate instructions for preparing and administering an antiretroviral for neonatal use with complex dosing requirements. Testing demonstrated that lay users with a range of health literacy levels were able to accurately mix, measure and administer the product. This process demonstrates how a neonatal medication can be optimized for use through collaboration between the infectious disease expert community and a manufacturer.

Role of the nurse in patient blood management and treating anaemia.

Patient blood management has been defined as a patient-focused and evidence-based approach to optimising the management of patients during the transfusion of blood components. This article explores the complex factors that can influence clinical decisions and enhance patient safety in the administration of blood components, particularly red blood cell transfusions in patients with anaemia. The article also explores the nurse's role in acting as a patient advocate and considering alternatives to the use of blood components. While this article focuses on anaemia-related transfusions, the author relates the principles of patient blood management to all transfusion care.

Patient blood management and blood conservation – Complimentary concepts and solutions for blood establishments and clinical services in South Africa and beyond

Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade.

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade.

Resident Sensitive Quality Measures for General Pediatrics: Alignment With Existing Care Recommendations.

Resident sensitive quality measures (RSQMs) are a new patient-focused approach to performance assessment. Their alignment with existing performance constructs is underexplored. Develop and prioritize RSQMs for outpatient general pediatrics in the areas of well visits (0-2 months, 1, and 5 years) and compare to the existing framework of the Bright Futures recommendations. Categorical pediatric residents, general academic pediatric fellows, and general pediatric faculty participated in nominal group technique (NGT) and Delphi processes to generate and prioritize RSQMs for 3 different well-child visits of interest. The author team then compared the content of the final RSQMs to the American Academy of Pediatrics Bright Futures recommendations. From the list of 143 potential measures from the NGT groups, 15 RSQMs were prioritized for each well-child visit. RSQMs prioritized vaccine administration, documentation of screening, and medication management. Overall, RSQMs mapped well to Bright Futures recommendations. The alignment of the RSQMs with Bright Futures frameworks supports their contribution as process measures for informing resident performance. RSQMs created from this study should be used for future investigations into resident performance assessment and to drive personal improvement efforts.

The influence of migration of the exeter V40 stem on patient reported outcome measures: a 2-year follow-up of 112 total hip arthroplasties using radiostereometric analysis

The cemented Exeter V40 stem is known to migrate distally. Several previous studies have reported on the extent of stem migration and its influence on clinical outcome. However, no studies have investigated the influence of stem migration on Patient Reported Outcome Measures (PROM). One hundred and twelve total hip arthroplasties (THA) were included in a 2-year follow-up using Radiostereometric Analysis (RSA). Patients were evaluated using the Oxford Hip Score (OHS) and EQ-5D-3L PROMs. The purpose of this study was to assess the influence of stem migration, measured by Maximum Total Point Motion (MTPM), on the 2-year postoperative score (OHS and EQ-5D). Furthermore, the influence of pre-operative PROM, age, gender, acetabular component and BMI was associated with the 2-year postoperative OHS and EQ-5D scores. MTPM was a non-significant predictor of the 2-year postoperative OHS (regression coefficient (B) = − 2.38 (CI − 5.44; .69)) and of the 2-year postoperative EQ-5D (B = − .01 (CI − .04; .02)). The only significant predictor of the 2-year postoperative OHS and 2-year postoperative EQ-5D was gender (B = 8.71 (CI 3.52; 13.90)) and (B = .13 (CI .07; .18)), respectively. Stem migration did not significantly influence PROMs at 2 years post-operatively. Using a patient-focused approach, our results seem to corroborate results reported by previous studies, showing that slow migration of the Exeter V40 stem does not seem to influence the clinical outcome.

Therapeutic Futility in Terminal Cancer Patients: A Retrospective and Observational Study.

IntroductionAdvanced cancer patients often need therapy for symptomatic control, in addition to cancer and other disease treatments. As the cancer disease progresses and life expectancy decreases, there should be a change in the goal of care. If this change is not accompanied by therapeutic adjustments, there is a risk of maintaining useless and ineffective treatments, as well as potential harmful drug interactions. This study analyzed the prevalence of therapeutic futility in patients with advanced cancer disease.Materials and methodsThis was a retrospective and observational single-center study, that included advanced cancer patients who died during the hospital stay, at a University Hospital in Lisbon, Portugal. Demographic and clinical data were collected. A Palliative Prognostic Score (PaP) was used to stratify patients according to their prognosis group. An analysis of the prescribed therapy was performed to quantify the “potentially inappropriate medications” (PIMs) and “inappropriate medications” (IMs), at admission and 24 hours prior to the patient’s death.ResultsOver 140 patients were included. On the first day of hospitalization, 119 patients (85%) were exposed to at least one IM or PIM and 100 patients (71%) were still exposed to at least one IM or PIM in the last 24 hours of life. Regarding chemotherapy, 66 patients (47%) had treatment in the last two months of life, 38 (27%) in the last month, and 17 (12%) in the last two weeks prior to death.Therapeutic simplification (suspension of IMs and reduction of at least 50% of PIMs during hospitalization) was performed in 43% of the overall population and was higher in PaP score group C, but not statistically significant (p=0.09). The patient's inclusion in PaP score group C and inpatient consultation by the palliative care team were independent predictors of therapeutic simplification.DiscussionThere is an effort to achieve greater therapeutic suitability in palliative patients. However, many patients maintain futile and disproportionate therapy at the end of life (EoL). In many cases, systemic cancer treatment is performed until quite late in the course of the disease. The prescription of PIMs was significantly higher than that of IMs, which could be expected given their definition. A shorter life expectancy at admission led to a greater therapeutic simplification, as well as an intervention by the Palliative Care Team, which can be explained by the more focused approach towards quality-of-life improvement and symptomatic control. Different than expected the prescription of supportive therapies at hospital admission was not a predictor of therapeutic simplification. Although there was a reduction in IMs and PIMs in the studied population, and therapeutic simplification occurred in one fraction of the patients, the fact is that more than half of the patients evaluated did not undergo therapeutic simplification as defined in this work.ConclusionIt appears that there is an effort to achieve greater therapeutic suitability in palliative patients, however, many patients maintain futile therapy at the EoL. It is of paramount importance to change the standard of care in this setting, to privilege a more patient-focused approach and tailored therapy, and to prioritize symptomatic control and quality-of-life improvement.

Unmet Information Needs Among Hispanic Women with Thyroid Cancer.

Thyroid cancer is the second most common cancer in Hispanic women. To determine the relationship between acculturation level and unmet information needs among Hispanic women with thyroid cancer. Population-based survey study. Hispanic women from Los Angeles Surveillance Epidemiology and End Results registry with thyroid cancer diagnosed in 2014-2015 who had previously completed our thyroid cancer survey in 2017-2018 (N = 273; 80% response rate). Patients were asked about 3 outcome measures of unmet information needs: (1) internet access, (2) thyroid cancer information resources used, and (3) ability to access information. Acculturation was assessed with the Short Acculturation Scale for Hispanics (SASH). Health literacy was measured with a validated single-item question. Participants' median age at diagnosis was 47 years (range 20-79) and 48.7% were low-acculturated. Hispanic women were more likely to report the ability to access information "all of the time" if they preferred thyroid cancer information in mostly English compared to mostly Spanish (88.5% vs 37.0%, P < 0.001). Low-acculturated (vs high-acculturated) Hispanic women were more likely to have low health literacy (47.2% vs 5.0%, P < 0.001) and report use of in-person support groups (42.0% vs 23.1%, P = 0.006). Depending on their level of acculturation, Hispanic women accessed the internet differently (P < 0.001) such that low-acculturated women were more likely to report use of only a smartphone (34.0% vs 14.3%) or no internet access (26.2% vs 1.4%). Low-acculturated (vs high-acculturated) Hispanic women with thyroid cancer have greater unmet information needs, emphasizing the importance of patient-focused approaches to providing medical information.

Subcutaneous Delivery of High-Dose/Volume Biologics: Current Status and Prospect for Future Advancements.

Subcutaneous (SC) delivery of biologics has traditionally been limited to fluid volumes of 1–2 mL, with recent increases to volumes of about 3 mL. This injection volume limitation poses challenges for high-dose biologics, as these formulations may also require increased solution concentration in many cases, resulting in high viscosities which can affect the stability, manufacturability, and delivery/administration of therapeutic drugs. Currently, there are technologies that can help to overcome these challenges and facilitate the delivery of larger amounts of drug through the SC route. This can be achieved either by enabling biologic molecules to be formulated or delivered as high-concentration injectables (>100 mg/mL for antibodies) or through facilitating the delivery of larger volumes of fluid (>3 mL). The SC Drug Delivery and Development Consortium, which was established in 2018, aims to identify and address critical gaps and issues in the SC delivery of high-dose/volume products to help expand this delivery landscape. Identified as a high priority out of the Consortium’s eight problem statements, it highlights the need to shift perceptions of the capabilities of technologies that enable the SC delivery of large-volume (>3 mL) and/or high-dose biologics. The Consortium emphasizes a patient-focused approach towards the adoption of SC delivery of large-volume/high-concentration dosing products to facilitate the continued expansion of the capabilities of novel SC technologies. To raise awareness of the critical issues and gaps in high-dose/volume SC drug development, this review article provides a generalized overview of currently available and emerging technologies and devices that could facilitate SC delivery of high-dose/volume drug formulations. In addition, it discusses the challenges, gaps, and future outlook in high-dose/volume SC delivery as well as potential solutions to exploit the full value of the SC route of administration.

An Introduction to CPESN

Have you ever wondered which pharmacy networks are the largest? CVS and Walgreens might be at the top of your list, but there is a relatively unknown network of over 3,000 community-based pharmacies that have quickly moved into the top five. That is over 3000 local community pharmacies across that nation in a newly created network called CPESN® USA. CPESN® USA is not an ordinary network but rather the country’s first and only Accountable Pharmacy Organization – a group of forward-thinking community pharmacy owners focused on both providing critical clinical services to the patients they serve and on working directly with payers who value the benefits of a patient-focused approach. In other words, CPESN® USA is focused on creating opportunities to provide value-based care in community pharmacies.This original network was able to create local opportunities where pharmacies/pharmacists would contract with employer groups and bill for clinical services rendered under the medical benefits of health plans. This is revolutionary as most reimbursement for pharmacies is tied to a product, despite the many other clinical tasks that are performed by pharmacists including but not limited to extensive counseling, blood pressure screenings, monitoring of lab values and ensuring patient adherence to medications with a variety of adherence tools. However, pharmacists are typically not able to charge pharmacy benefits managers for these services and although medication therapy management programs have propelled pharmacists to showcase our significant impact on managing chronic disease the reimbursement is low and related to dispensing adherence not outcomes. Those are the key tenets of every new CPESN network in operation today or every new CPESN network going forward.With this shared mindset, pharmacists across the nation recognize the role local, community-based pharmacies have in keeping patients healthy. This has led to an explosion of CPESN networks being established, the creation of minimum service standards that are shared across the networks, and importantly, education, training, and best practices sharing centered around working directly with health plans and other medical side payers who are focused on improving the overall health of their patients (members).As we go into 2021, CPESN® USA is positioned to excel in three areas.First, CPESN® USA is a federal vaccine partner helping independent pharmacies prepare to deliver the COVID 19 vaccinations to their communities. They want to help getting America back to normal, especially in the underserved rural and inner city areas where CPESN pharmacies have a strong presence.Second, CPESN® USA has educated and trained pharmacists in each network to have the skill set to approach health plans and other medical side payer to confidently share the CPESN model and its documented success in improving outcomes and surpassing performance metrics.Third, CPESN® USA is actively recruiting new pharmacies, partners, and payors to expand the reach local networks have to serve communities in need.If you are interested in learning more about CPESN networks or how to join your local a network in your area, email info@cpesn.com or visit cpesn.com/pharmacies to gain more information.

"Often Relatives are the Key […]" -Family Involvement in Treatment Decision Making in Patients with Advanced Cancer Near the End of Life.

BackgroundFamily communication has been increasingly recognized as an important factor in decision making near the end of life. However, the role of the family in decision making is less studied in oncology settings, where most patients are conscious and able to communicate almost until dying. The aim of this study was to explore oncologists’ and nurses’ perceptions of family involvement in decision making about forgoing cancer‐specific treatment in patients with advanced cancer.Materials and MethodsQualitative semistructured interviews with 22 oncologists and 7 oncology nurses were analyzed according to the grounded theory approach. The results were discussed against the background of the clinical and ethical debate on family role near the end of life.ResultsWe could identify two approaches shared by both oncologists and nurses toward family involvement. These approaches could be partly explained by different perception and definition of the concept of patients' autonomy: (a) a patient‐focused approach in which a patient's independence in decision making was the highest priority for oncologists and (b) a mediator approach with a family focus in which oncologists and nurses assigned an active role to patients' family in decision making and strived for building consensus and resolving conflicts.ConclusionThe main challenge was to involve family, increasing their positive influences on the patient and avoiding a negative one. Thereby, the task of both oncologists and oncology nurses is to support a patient's family in understanding of a patient's incurable condition and to identify a patient's preference for therapy.Implications for PracticeThis study focused on oncologists’ and oncology nurses’ perceptions of family involvement in decision making about treatment limitation in patients with advanced cancer who are able to communicate in a hospital setting. Oncologists and oncology nurses should be aware of both positive aspects and challenges of family involvement. Positive aspects are patients’ emotional support and support in understanding and managing the information regarding treatment decisions. Challenges are diverging family preferences with regard to treatment goals that might become a barrier to advanced care planning, a possible increased psychological burden for the family. Especially challenging is involving the family of a young patient because increased attention, more time investment, and detailed discussions are needed.

460 - Unmet needs and loneliness perception among elderly people with chronic diseases

Introduction:Unwanted loneliness is a public health issue due to its high prevalence among elderly people (20-40%) and its relation with morbidity and mortality. There is no clear strategy for addressing this problem given the diversity of needs and resources people with feelings of loneliness have.Objective:Identify the needs and resources of elderly people with chronic conditions and feelings of loneliness by comparing the patient’s outlook with that of their primary healthcare professional.Methods:Observational, cross-sectional, descriptive pilot study using theoretical convenience sampling at 5 health facilities in Barcelona (Spain), performed between October and May 2020. Of 159 people selected, 42 were identified to have feelings of loneliness (UCLA &lt; 30) who agreed to participate in the study and their care needs were analysed using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire. A descriptive and comparative analysis (Kappa coefficient and discrepancy percentage) of needs was performed using the outlook of the patients and their healthcare professionals. Data was analysed using SAS assuming a 5% significance level. A qualitative analysis was also performed to understand the relation between the feeling of loneliness and needs across 24 care areas (environmental, social, psychological, and physical). The study was approved by the IDIAP Jordi Gol Healthcare Ethics Committee (19/138-P).Findings:The needs perceived focused on physical health, distress, companionship, and relationships (30% to 41.7%). Professionals showed a severe lack of knowledge regarding housing, home care, relationships, and social services (22% to 48%). The qualitative analysis revealed the relation between the feeling of loneliness and the irreversible losses of those close to the patient, along with insufficient support and understanding during the aging process, and feelings of abandonment and guilt. Meanwhile, other notable aspects include the need of independence and resistance towards starting activities requiring commitment and travel. Caring for others and mobility and sensory restrictions act as extra barriers.Conclusions:This study enables the needs of people with feelings of loneliness to be identified. Discrepancies between them and their healthcare professionals were recorded, in turn providing direction regarding which areas need to be improved when designing patient-focused primary healthcare approaches.

A public health approach for prevention of periodontal disease.

Upwards of 1 in 10 adults worldwide may be affected by severe periodontitis, making the disease more prevalent than cardiovascular disease. Despite its global scope, its impact on pain, oral function, and the wellbeing of individuals, and the disproportionate burden of disease and the socioeconomic impact on communities, the perception that periodontal disease is a public health problem remains low. Although there have been substantial improvements in our understanding of the etiology of periodontal disease and how we can prevent and control it, these advances have been primarily focused on individual, patient-focused approaches. The prevention of periodontal disease depends on improving currently available individual interventions and on determining what public health interventions can be effective and sustainable under real-life conditions. Currently, public health approaches for periodontal disease prevention and control are lacking. This review traces the historical strategies for prevention of periodontal disease in an epidemiologic transition context, using a modified model developed for cardiovascular disease, and presents a possible public health approach. Improving periodontal disease prevention and control will need to take into consideration the core activities of a public health approach: assessment, policy development, and assurance.

Using the Cultural Formulation Interview in Denmark: Acceptability and clinical utility for medical doctors and migrant patients.

Previous studies have shown the importance of focusing on the cultural background of migrant patients in the psychiatric assessment. The Cultural Formulation Interview (CFI) offers a patient-focused approach to foreground the cultural context of the patient in the clinical encounter. Our objective was to explore the acceptability and clinical utility of the CFI for physicians and its acceptability for migrant patients seen at a transcultural mental health clinic in Denmark. In this study, the CFI was used in a second session following the standard clinical assessment to explore what additional information was gained from the CFI. Data on the use of the CFI data were collected immediately after the interview with questionnaires for medical doctors (MDs) (N = 12) and patients (N = 71). The findings showed that the CFI, in addition to standard assessment, was useful to the MDs for planning the treatment (60.0%) and for exploring the patients' view on their cultural and social context (74.7%), but less so for the diagnostic process (9.9%). Patients reported high overall satisfaction with the CFI (93.0%) and viewed it as a welcome opportunity to tell their story. The findings add to existing knowledge on the CFI in terms of acceptability for patients of a primarily Middle Eastern origin and patients using an interpreter during the CFI session. Based on the findings of this study, the CFI is recommended to clinicians for treatment planning purposes and for exploring the cultural and social context of the patient.

Patient Burden and Real-World Management of Chemotherapy-Induced Myelosuppression: Results from an Online Survey of Patients with Solid Tumors.

IntroductionChemotherapy-induced myelosuppression (CIM) is one of the most common dose-limiting complications of cancer treatment, and is associated with a range of debilitating symptoms that can significantly impact patients’ quality of life. The purpose of this study was to understand patients’ perspectives on how the side effects of CIM are managed in routine clinical practice.MethodsAn online survey was conducted of participants with breast, lung, or colorectal cancer who had received chemotherapy treatment within the past 12 months, and had experienced at least one episode of myelosuppression in the past year. The survey was administered with predominantly close-ended questions, and lay definitions of key terms were provided to aid response selection.ResultsOf 301 participants who completed the online survey, 153 (51%) had breast cancer, 100 (33%) had lung cancer, and 48 (16%) had colorectal cancer. Anemia, neutropenia, lymphopenia, and thrombocytopenia were reported by 61%, 59%, 37%, and 34% of participants, respectively. Most participants (79%) reported having received treatment for CIM, and 64% of participants recalled chemotherapy dose modifications as a result of CIM. Although most participants believed their oncologist was aware of the side effects of CIM, and treated them quickly, 30% of participants felt their oncologists did not understand how uncomfortable they were due to the side effects of CIM. Overall, 88% of participants considered CIM to have a moderate or major impact on their lives.ConclusionThe data highlight that despite the various methods used to address CIM, and the patient-focused approach of oncologists, the real-world impact of CIM on patients is substantial. Improving communication between patients and health care providers may help improve patients’ understanding of CIM, and foster shared decision-making in terms of treatment. Additional insights from patients should be obtained to further elucidate the totality of life burden associated with CIM.

Staff's Perception of the Intensive Care Outreach Nurse Role: A Multisite Cross-sectional Study.

Rapid Response Systems are emerging internationally to provide a patient-focused approach to prevent potentially avoidable deaths and serious adverse events. This study focused on ward nurses in the United Arab Emirates (UAE) government hospitals who were perceived to lack the confidence and knowledge to detect and/or respond to deteriorating patients. A cross-sectional study design was used to evaluate the Intensive Care Outreach Nurse (ICON) role from the perspectives of the ICONs, their managers/educators, and ward-based physicians and nurses. ICONs are intensive care experienced nurses with additional education in the role of rapid responder to the deteriorating patient. An ICON role was implemented across 4 hospitals to respond to and support clinicians in the recognition and management of the deteriorating patient on general inpatient wards. ICON skills perceived as most beneficial by respondents included staff education, respiratory therapy, medication administration, and intravenous access. The ICON role is able to support recognition and management of the deteriorating patients.

Implementation of a patient-focused approach in the work of primary care pediatric nurses of medical organizations of the Trans-Baikal Territory

In modern health care, the principles underlying patient-orientated healthcare, aimed at preserving the health of the patient, as well as the productive cooperation between the medical caregivers and the patient, are becoming increasingly important. The article presents the results of the timely improvement of the professional activities of nurses in the Trans-Baikal Territory. It considers the use of operational management tools to improve the work of the front desk (registry), pre-physician examination rooms. Particular attention is paid to the implementation of the «Health Coordinators» project in the Trans-Baikal Territory.

A pilot study on assessing the gap between nurses’ task performances and knowledge pertaining the same with reference to “ I COUGH” initiative- a call for promoting patient ‘care bundle’ assignments in low-income nations

Background: The health sector in low-income nations has been crippled owing to low resources, lack of trained staff and a scarcity of effective health-related reforms. Amidst such a scenario, implementation of patient-centered care bundle approaches could help reprise the autonomy and standards of care for healthcare providers as well as safeguard patient safety. Methods: We sought to determine the gap between task performance and the underlying knowledge pertaining the same among nurses from intensive and high dependency neurosurgical units within three hospitals in Nepal through a questionnaire-based approach focusing on task assignments to prevent pulmonary complications among their patients and scoring them with references to the variables of ‘I COUGH’, a similar patient care bundle initiative. Results: There is a gross discrepancy between the patterns of task performance and the knowledge regarding the rationale behind the same tasks among nurses working in critical care neurosurgical units. In reference to I COUGH, nurses had below 50% knowledge on interventions aimed to prevent pulmonary complications among their patients, irrespective of the level of experience attained in the units. Furthermore, none of them had complete knowledge regarding all components of effective chest physiotherapy. Conclusion: There is the utmost need for the implementation of patient-focused care bundle approaches in upraising the health delivery standards, especially in low-income nations. Such initiatives can promote autonomy amongst healthcare professionals on patient care as well as assuring better patient outcomes by minimizing complications.