Care Planning Research Articles

Applications of Artificial Intelligence in Psychiatric Nursing: A Scope Review.

Rapid advances in artificial intelligence (AI) have reshaped healthcare, including psychiatric nursing, to address the limitations of traditional approaches and meet escalating mental health challenges. A scoping review analyzed 48 articles examining the application of AI in psychiatric nursing across different technologies and topics, noting trends in publications and countries involved. The articles covered different aspects of mental health using AI technologies such as machine learning and robotics, and primarily explored AI applications in mental health, specifically dementia, autism and schizophrenia. These studies highlighted the role of AI in personalized care plans, symptom monitoring and risk assessment. AI is promising, but faces challenges such as data bias and ethical concerns. Future research needs to focus on long-term studies, diverse populations, patient interaction and personalized treatments for practical integration into psychiatric nursing.

Oral health in obese children common findings, prevention, treatment, and outcome

Childhood obesity is a significant global public health issue, closely linked to various oral health challenges, including dental caries, periodontal disease, and malocclusion. Obese children are more prone to these dental problems due to dietary habits that include high sugar and carbohydrate intake, poor oral hygiene practices, and systemic inflammation. This review explores the common oral health issues faced by obese children and emphasizes the importance of preventive strategies and tailored treatment approaches. Preventive measures include promoting healthy dietary habits, improving oral hygiene practices, and ensuring regular dental check-ups. Dietary modifications, such as reducing the intake of sugary snacks and beverages, play a crucial role in preventing tooth decay and other dental problems. Educating children and caregivers about proper brushing and flossing techniques and the use of fluoride toothpaste and dental sealants further supports oral health. Regular dental visits allow for early detection and management of dental issues, with professional cleanings, fluoride treatments, and appropriate restorative and periodontal therapies being integral components of care. The outcomes of these comprehensive treatment strategies are generally positive, leading to improved oral health and overall quality of life for obese children. Multidisciplinary collaboration among healthcare providers, including dentists, pediatricians, and nutritionists, is essential to develop effective care plans that address both obesity and oral health. This integrated approach ensures that obese children receive holistic care that promotes lifelong healthy habits, reducing the risk of future dental and systemic health problems. The review underscores the necessity of a concerted effort to address the intertwined issues of obesity and oral health in children, highlighting the potential for significant health improvements through targeted prevention and treatment strategies.

Advancements in health informatics for monitoring perioperative patient data

Advancements in health informatics are revolutionizing perioperative care by enhancing patient monitoring, improving clinical decision-making, and promoting patient safety. The integration of electronic health records (EHR) facilitates seamless information flow across all perioperative stages, ensuring up-to-date patient data is accessible to the entire healthcare team. This accessibility reduces errors, improves coordination, and enhances overall patient outcomes. EHR systems also support standardized documentation, reducing variability in record-keeping and ensuring comprehensive patient information is consistently captured. Real-time data analytics and predictive modeling are powerful tools in perioperative settings, enabling clinicians to anticipate and manage potential complications proactively. By analyzing vast datasets, predictive models identify patterns and risk factors associated with adverse outcomes, allowing for targeted interventions and personalized care plans. Real-time analytics provide continuous monitoring of patient status during surgery, offering immediate feedback and enabling prompt adjustments to ensure patient stability. Wearable devices and remote monitoring systems further augment real-time data analytics by continuously tracking physiological parameters throughout the surgical process and into the postoperative period. This continuous data stream allows for ongoing assessment of patient status and early detection of complications, enhancing patient safety and outcomes. Health informatics solutions, including automated alerts and decision support tools, minimize human error and ensure adherence to clinical guidelines. Automated reminders for critical actions, such as timely antibiotic administration, significantly reduce the incidence of surgical site infections. Decision support tools provide real-time, evidence-based recommendations at the point of care, supporting clinicians in making informed decisions and improving patient outcomes. Additionally, health informatics facilitates continuous quality improvement by enabling the collection and analysis of performance data, informing targeted interventions and process improvements. Overall, advancements in health informatics are transforming perioperative care, offering numerous benefits in terms of efficiency, accuracy, and patient safety, ultimately leading to better patient outcomes and higher quality of care. Continued innovation in this field will be essential for maintaining and improving the standards of perioperative care.

Using digital communication tools to improve interprofessional collaboration and satisfaction in a student-run free clinic.

Interprofessional collaboration can improve the quality of care in complex health conditions often seen in underserved populations. Communication is key to effective collaboration, and digital communication tools can enhance information sharing, collaboration, and satisfaction between professionals, especially when teams are distanced. In a semirural student-run free clinic that provides care to uninsured and underinsured patients with multifaceted health issues, there is a gap in communication and collaboration across interprofessional teams because of the frequent rotation of various staff, part-time hours, and electronic health record (EHR) function and interoperability limitations. The aim of this nurse practitioner-led quality improvement project was to determine whether implementing digital communication tools could enhance communication and improve provider collaboration and satisfaction during clinical decision-making among the several interprofessional teams at the student-run free clinic. Digital communication tools were implemented in a two-part intervention: (1) virtual case conferences to discuss patient care plans and (2) an EHR-linked tool to document the care plans. Survey evaluation across six virtual case conferences found above-average ratings for collaboration, satisfaction, and usability of the EHR-linked tool. There was a 15.78% improvement in global collaboration from the first to third conference, with a sustained improvement of 11.49%. Satisfaction improved by 4.62% from the first to the fourth conference. Digital communication tools can facilitate efficient communication and collaboration among staff while providing a more streamlined approach to patient care. These technologies can be useful in similar settings, especially when teams are distanced.

Cross-disciplinary advance care planning in oncology and palliative care amidst a pandemic: a best practice implementation project.

Advance care planning (ACP) ensures that patients receive medical care aligned with their values, goals, and preferences, especially regarding end-of-life decisions in serious chronic illnesses. This project aimed to introduce and promote evidence-based ACP in oncology and palliative care at a midsized hospital near Berlin, Germany, during the COVID-19 pandemic. This project was guided by the JBI Evidence Implementation Framework and used a mixed methods audit cycle. A baseline audit was conducted using qualitative interviews and workshops with representatives from all the health care disciplines involved in oncology and palliative care at the hospital. The findings were compared with eight best practice recommendations. Targeted strategies aimed at the key stakeholders involved in ACP practice were then implemented. Finally, a semi-quantitative questionnaire was used in a follow-up audit with the same participants as in the baseline audit. The baseline audit revealed a high level of familiarity with the concept of ACP. However, there was a lack of a uniformly accepted definition and understanding of ACP among the health care professionals, leading to a lack of coordination in task distribution. The follow-up audit revealed improvements with regard to education and training in ACP (Criterion 1: 50% to 100%) and organizational support to facilitate ACP conversations (Criterion 3: 87.5% to 100%). Other audit criteria compliance rates remained unchanged. Clinical education and team-based process analysis can facilitate ACP implementation across disciplines in oncology and palliative care facilities. However, the project did not succeed in implementing lasting changes in clinical processes and best practice ACP due to the COVID-19 pandemic. Such an endeavor would demand considerable resources and time, both of which were constrained during the pandemic. http://links.lww.com/IJEBH/A236.

Possible care protocols for patients undergoing road transfer on a biocontainment stretcher model N 36 (36 m<sup>3</sup> air ˃60 ACH)

The practice of transporting a patient affected by a Highly Transmissible Disease (HTD) with a high risk of fatal evolution using biocontainment isolators requires careful planning and preparation. To date, there is only limited literature regarding aeromedical transport, most of which is military-derived, and it does not address patient transfer by road vehicles. To standardize these practices, or at least some of their most critical aspects, we tried to schematize a few of the improvements each author implemented during their practices as a scaffold, which could eventually be based on operative protocols. In particular, we focused on the series of actions that needed to be performed and planned to guarantee the safety of both the patient and operators during the entire duration of the operations.

Examining the Relationship Between Rural and Urban Clinicians' Familiarity With Patients and Families and Their Comfort With Palliative and End-of-Life Care Communication.

Background: Effective healthcare clinician communication is a key component of quality palliative and end-of-life (PEOL) care. However, communication may be hampered when clinicians are not comfortable initiating these conversations with patients and their families. Clinicians working in rural areas report several barriers to providing palliative care. This study examined the relationship between rural and urban clinicians' reported familiarity with their patients and families end-of-life, their reported comfort in initiating PEOL conversations, and their PEOL care knowledge. Method: This study used a cross-sectional design to examine the relationships between rural and urban clinicians' familiarity, their comfort in PEOL communication, and their PEOL care knowledge. Results: N = 548 rural and urban clinicians participated. Rural clinicians reported greater familiarity, more PEOL knowledge, and more comfort with PEOL communication. Multiple regression analyses of PEOL knowledge showed significant associations in knowledge with older clinicians (P < 0.01) and additional palliative care training (P < 0.01); comfort in PEOL communication had significant associations with more palliative care training (P < 0.01) and opportunities to provide palliative care (P < 0.01). Conclusion: The concept of familiarity is highly complex and poorly understood in relation to PEOL care in both rural and urban settings. Future research is needed to explore how additional training in PEOL care and clinician reported familiarity positively impact patient outcomes by increasing the number of advance directives completed and followed and improved documentation of advance care planning.

Influential Factors Affecting the Intention to Utilize Advance Care Plans (ACPs) in Thailand and Indonesia

Demographic shifts resulting from population aging are evident globally, including in Southeast Asia, Thailand, and Indonesia. The relevance of advance care plans is becoming increasingly apparent as the worldwide demographic transforms due to aging. This study sought to investigate the factors influencing the use and implementation of advance care plans (ACPs) using the health belief model (HBM) and technology acceptance model (TAM). This study selected a sample of individuals aged 30–60 in Indonesia and Thailand based on established inclusion and exclusion criteria. The study utilized the purposive random sampling method, integrating aspects of purposive and random selection. A total of 532 questionnaires were distributed via an online form, and 472 were obtained after data cleaning. Most respondents to this survey came from Indonesia, comprising 238 out of 472 respondents (50.4%), and from Thailand, comprising 49.5%; most respondents were women who were between 36 and 40 years old, and most reported graduating with a bachelor’s degree. A significant construct influences the use of advance care plans, i.e., perceived barriers. The perceived barrier (PBA) construct included data security, accessibility, and language barriers. In summary, overcoming existing barriers can indirectly increase the benefits of advance care plans. The results show that perceived usefulness (β = 0.189, p &lt; 0.001), perceived ease of use (β = 0.150, p &lt; 0.01), perceived susceptibility (β = 0.153, p &lt; 0.01), perceived severity (β = 0.105, p &lt; 0.05), and perceived benefits (β = 0.241, p &lt; 0.001) all had significant positive effects on behavioral intention. In contrast, health motivation (β = 0.073, p = 0.100) and perceived barriers (β = 0.034, p = 0.134) did not show significant relationships with behavioral intention in Indonesia and Thailand, offering insights into both countries’ development strategies and the promotion of advance care plans with media as the technology.

The Use of Frailty Scores for Screening the Surgical Risk Benefits: A Multidisciplinary Approach.

Our study aims to examine the role of multi-disciplinary surgical pause committees (MDSPC) in perioperative planning to reduce adverse postoperative events and mortality rates. Frail patients could benefit from preoperative MDSPCs when utilizing risk-benefit ratios for the proposed surgical plan. We examined whether MDSPCs improved clinical outcomes by developing individualized care plans and stratifying patients based on their level of frailty and ability to overcome external stressors. We retrospectively collected patient information after MDSPC evaluation, at our medical center for 12 years since 2011. Patient's frailty risk assessment index (RAI) scores were calculated, and survival status was updated. MDSPCs plans were put into the following categories: proceed with the planned surgery (G1), proceed after medical optimization (G2), reduce invasiveness of surgery or anesthesia plan (G3), or adopt a non-surgical approach (G4). Chi-square and independent t-tests were used for categorical and numerical data, respectively. Survival analysis for 30-day (primary endpoint), one-year, and overall mortality rates used Kaplan-Meier. The alpha was set at 0.05. Clinical information was accessed from 12 women and 382 men. The average age was 71±11 years. 87.3% of planned surgical operations were stratified as ASA class III and IV. RAI scores were 36.4±9.6 (G1), similar to 37.4±10.8 (G2) but lower than 41.4±9.3 (G3) and 44.2±9.7 (G4) (P<0.001). Average survival duration was 35 months (G1), 35 months (G2), both significantly longer than 20 months (G3) and 18 months (G4) (P<0.001). Medical optimization improved overall survival and reduced death within 30 days and one year to be comparable to G1. Additionally, reducing the surgical invasiveness only improved survival advantage for six months, after which it was comparable to those in G4 with the worst outcome. RAI scoring is an excellent tool to predict the outcome of surgery, and it was used successfully in critically ill patients.

Characteristics of prenatal care performed by nurses in a city in Rio de Janeiro

Introduction: Prenatal care is essential for obstetric qualification and health promotion for women, newborns and society. The care occurs predominantly in Primary Health Care, in which the nurse represents an important professional in the reception, classification of gestational risk, evaluation and prescription of exams, performance of anamnesis and physical examination, definition of a care plan with guidelines and periodic evaluations. Method: This is a qualitative research of the descriptive type, in consideration of the object of study, since this type of research allows, in a systematized way, the identification, registration, description and analysis of the perspectives of the participants about the relationships and interactions related to prenatal care. To this end, the study had the participation of 15 nurses who work in the Family Health Strategy scenario of the Municipality of Teresópolis, in the Mountain Region of the State of Rio de Janeiro. The results evidenced is that the participants reported that the greatest approximation with women's health care emerged since their academic training and that this is a practice valued by them in the context of primary care. Other results were: extrinsic: insertion of the pregnant woman in the network, referrals of the pregnant woman in the network, adolescent pregnancy and nurses' autonomy in requesting tests and prescribing medications. Final Considerations: From the accomplishment of this study, it was possible to perceive that the professionals of the network provide qualified and systematized prenatal care. The reports show a relationship of identification and satisfaction in prenatal care by the research participants, although they face challenges.

Teachers’ Challenges in Modular Learning Modality

With careful planning, support, and ongoing professional development, teachers can effectively implement modular learning to meet the diverse needs of their students. Along this line, this study aimed to determine the degree of the teachers’ challenges in modular learning modality (MLM) of two secondary schools in Negros Oriental during the School Year 2021-2022. Data needed for this study was collected from 52 respondents using a self-made 30-item survey questionnaire that has passed the rigorous validity and reliability tests. The study’s findings revealed, among others, a significant difference in the challenges teachers encountered in implementing MLM in module preparation, parental involvement, and performance tasks. This study calls for ample budgetary allocation for material and school equipment in the reproductions of modules to all grade levels, related training, and upskilling to teachers who have potential writers of the module and alternative delivery mode (ADM) within the district. Keywords: Education, teachers’ challenges, modular learning modality

Shared Care Planning for a pregnant patient with uveal melanoma treated with interventional radiotherapy (brachytherapy)

Introduction: Uveal melanoma (UM) is the most prevalent primary intraocular tumor in adulthood, with an important risk of metastasis, notably to the liver, rendering standard chemotherapy ineffective. Cases of UM onset during pregnancy are rare but can exhibit accelerated tumor growth. For these cases the best conservative treatment is interventional radiotherapy (IRT) also known as brachytherapy (BT). It is a form of radiotherapy that demonstrates efficacy comparable to the more common enucleation, while mitigating any risks of intrauterine toxicity. Objective: We reported the case of M., a 39-year-old pregnant patient, diagnosed with UM and undergoing brachytherapy treatment. Our aim is to make pertinent ethical considerations about: a. The ethical and clinical approach favouring a treatment strategy that preserves the affected organ and its functionality, b. The advance care planning process conducted within a multidisciplinary team. Case discussion: With the objective of preserving the mother’s health and ensuring the protection of the foetus, the team unanimously agreed, through a collaborative decision-making process, to proceed with the viable brachytherapy intervention. This approach results in a lower burden and maximizes benefits for both the patient and the unborn child. Conclusions: Considering a holistic evaluation, especially considering the patient’s pregnancy, the multidisciplinary approach proves fundamental. Collaboration between bioethicists and health-care professionals facilitated the development of a shared document for healthcare ethics planning, expressing the team’s ethical-clinical considerations.

Rationale and design of a randomized controlled clinical trial of a resilience-building intervention in adults with congenital heart disease

BackgroundAdults with congenital heart disease (ACHD) are at risk for lower quality of life (QOL) and psychological health. Behavioral interventions to meet their psychosocial needs are lacking. The aim of this study is to evaluate the feasibility of implementing the Promoting Resilience in Stress Management (PRISM) intervention in ACHD and its efficacy in increasing resilience in this population. MethodsWe designed a phase II randomized controlled clinical trial of patients with moderate or complex ACHD, physiological stages C or D. Enrolled participants will be randomized to receive PRISM or usual care. PRISM is a manualized, skills-based behavioral intervention comprised of four one-on-one sessions targeting resilience resources (stress-management, goal-setting, cognitive reframing, meaning making), an optional session on advance care planning, and a facilitated family meeting. Participants in both groups will complete study questionnaires at enrollment and 3-months later. The primary aim is to describe feasibility, namely the proportions of patients who a) enroll in the study among those eligible, and b) complete the PRISM intervention among those randomized to that arm. We will also evaluate PRISM's efficacy by using linear regression models to compare changes in mean resilience scores between assigned groups. In exploratory analyses, we will evaluate effects on QOL, psychological distress, perceived competence for health care management, and comfort with advance care planning. DiscussionThis study will provide rigorous evidence to determine the feasibility and efficacy of a brief intervention to promote resilience and psychosocial health in ACHD. Findings may guide the development of a future multi-site effectiveness study.Clinical Trial Registration: NCT04738474.

Measuring Engagement in Provider-Guided Digital Health Interventions With a Conceptual and Analytical Framework Using Nurse WRITE as an Exemplar: Exploratory Study With an Iterative Approach.

Limited guidance exists for analyzing participant engagement in provider-guided digital health interventions (DHIs). System usage is commonly assessed, with acknowledged limitations in measuring socio-affective and cognitive aspects of engagement. Nurse WRITE, an 8-week web-based nurse-guided DHI for managing symptoms among women with recurrent ovarian cancer, offers an opportunity to develop a framework for assessing multidimensional engagement. This study aims to develop a conceptual and analytic framework to measure socio-affective, cognitive, and behavioral engagement with provider-guided DHIs. We then illustrate the framework's ability to describe and categorize engagement using Nurse WRITE as an example. A sample of 68 participants from Nurse WRITE who posted on the message boards were included. We adapted a prior framework for conceptualizing and operationalizing engagement across 3 dimensions and finalized a set of 6 distinct measures. Using patients' posts, we created 2 socio-affective engagement measures-total count of socio-affective engagement classes (eg, sharing personal experience) and total word count-and 2 cognitive engagement measures-total count of cognitive engagement classes (eg, asking information-seeking questions) and average question completion percentage. Additionally, we devised behavioral engagement measures using website data-the total count of symptom care plans and plan reviews. k-Means clustering categorized the participants into distinct groups based on levels of engagement across 3 dimensions. Descriptive statistics and narratives were used to describe engagement in 3 dimensions. On average, participants displayed socio-affective engagement 34.7 times, writing 14,851 words. They showed cognitive engagement 19.4 times, with an average of 78.3% completion of nurses' inquiries. Participants also submitted an average of 1.6 symptom care plans and 0.7 plan reviews. Participants were clustered into high (n=13), moderate (n=17), and low engagers (n=38) based on the 6 measures. High engagers wrote a median of 36,956 (IQR 26,199-46,265) words. They demonstrated socio-affective engagement approximately 81 times and cognitive engagement around 46 times, approximately 6 times that of the low engagers and twice that of the moderate engagers. High engagers had a median of 91.7% (IQR 82.2%-93.7%) completion of the nurses' queries, whereas moderate engagers had 86.4% (IQR 80%-96.4%), and low engagers had 68.3% (IQR 60.1%-79.6%). High engagers completed a median of 3 symptom care plans and 2 reviews, while moderate engagers completed 2 plans and 1 review. Low engagers completed a median of 1 plan with no reviews. This study developed and reported an engagement framework to guide behavioral intervention scientists in understanding and analyzing participants' engagement with provider-guided DHIs. Significant variations in engagement levels across 3 dimensions highlight the importance of measuring engagement with provider-guided DHIs in socio-affective, cognitive, and behavioral dimensions. Future studies should validate the framework with other DHIs, explore the influence of patient and provider factors on engagement, and investigate how engagement influences intervention efficacy.

Effectiveness of initiating advance care planning among older outpatients through intervention by physicians trained in a model discussion video: A randomized controlled trial.

This study aimed to assess the impact of a physician-led intervention on advance care planning (ACP) introduction among older outpatients using a model discussion video. This prospective interventional study included Japanese general practice outpatients aged ≥65 years. All participants received an ACP leaflet. Co-researchers were trained using a model discussion video based on the "Serious Illness Conversation Guide," and provided ACP introduction explanations to the intervention group to ensure intervention content consistency. The control group received the ACP leaflet only, with no standardized explanations. The primary outcome was ACP discussion occurrence. Secondary outcomes included ACP engagement (assessed through the 4-item ACP Engagement Survey), engagement score for advance directives acquisition and score for surrogate decision-maker identification, and anxiety incidence (assessed through Generalized Anxiety Disorder-7). This study included 48 participants: 25 (52.1%) in the intervention group and 23 (47.9%) in the control group. Regarding primary outcome, the intervention group had significantly more ACP discussions compared with the control group (92.0% vs 26.1%, adjusted odds ratio 50.2, P = 0.0012). Regarding secondary outcomes, the intervention group showed greater readiness (mean scores for the 4-item Engagement Survey [P = 0.0001], engagement score for advance directives acquisition [P = 0.01] and score for surrogate decision-maker determination [P = 0.03]) than the control group, without increasing anxiety. This physician-led ACP introduction for older patients in a Japanese general practice setting enhanced ACP readiness and stimulated discussions, without increasing anxiety. The model discussion video for ACP introduction might effectively train physicians in general practice settings. Geriatr Gerontol Int 2024; ••: ••-••.

Symptom Clusters in Children With Leukemia Receiving Chemotherapy: A Scoping Review.

Leukemia represents the most prevalent childhood malignancy. Understanding the symptom clusters (SCs) associated with leukemia may help develop an effective care plan for affected children. The aims of this study were to summarize the methods of identifying SCs; ascertain the types, attributes, and changing patterns of SCs during different chemotherapy phases; and provide a point of reference for the subsequent improvement of symptom management in pediatric leukemia. The methodological framework employed was the Joanna Briggs Institute Scoping Review Guide. A comprehensive search was conducted across various databases, including PubMed, EMBASE, CINAHL, Web of Science, MEDLINE, Scopus, and China National Knowledge Infrastructure from inception until July 15, 2023. A total of 14 articles were included in this review, 6 in English and 8 in Chinese. The Memorial Symptom Assessment Scale 10-18 is the most commonly used instrument, whereas factor analysis is the most common statistical method for SC identification. The SCs were classified into 12 categories. The most severe SCs varied across different phases. Specifically, the emotional cluster dominated the prechemotherapy phase, the gastrointestinal cluster surfaced during postinduction therapy, and the consolidation and maintenance therapy phases revealed the self-image disorder cluster. Various consistent and dynamic SCs manifest among pediatric patients with leukemia undergoing chemotherapy. Future research endeavors should formulate clear criteria to determine the stability and consistency of SCs, validate SC composition and characteristics, and devise precise symptom management protocols based on SC characteristics in the distinct chemotherapy phases.

Outcomes of advanced care management in home-based long-term care: A retrospective population-based observational study

BackgroundIn home-based long-term care, care management aims to facilitate the independence of community-dwelling older adults and mitigate the escalation of their care needs. We examined the association between the types of care management (advanced vs. conventional) and the progression of care needs among recipients with moderate care needs and compared care services offered in care plans between care management types. MethodsA retrospective, population-based observational study was conducted in Tsukuba City in Japan. The individual-level secondary data from the suburban municipal government was collected between May 2015 and March 2019. The primary outcome was the progression of care-need levels certificated in Japanese long-term care insurance. The exposure variable was advanced care management. First, we conducted propensity-score matching to adjust for differences in recipient characteristics. Second, we performed Kaplan–Meier survival analyses and log-rank tests, with the outcome measure being the progression of care-need levels. Third, Pearson's chi-square tests were performed to compare care services for recipients of advanced vs. conventional care management. ResultsOf the 1010 long-term care recipients, we selected 856 propensity score-matched recipients receiving advanced or conventional care management. The proportions of four-year cumulative progression-free survival in the groups receiving advanced and conventional care management were 82.2 % and 78.5 %, respectively (p = .69). The proportions of the groups with advanced and conventional care management were 17.1 % and 23.8 % using home-help services (p < .05), and 4.0 % and 8.2 % using community-based day care services (p < .05), respectively. ConclusionsAdvanced care management in home-based long-term care was not associated with a slowing of the progression of care needs among older adults with moderate care needs compared with conventional care management. There was a notable discrepancy in the use of care services, with the advanced care management group having lower rates of use of home-help services and community-based day care services compared with the conventional care management group.

Process evaluation of the implementation of the assessment of burden of chronic conditions tool in Dutch primary care – lessons from a qualitative implementation study

BackgroundThe Assessment of Burden of Chronic Conditions (ABCC-)tool is developed to facilitate a personalized approach to care in the patient-healthcare provider (HCP) conversation based on shared decision-making and individualized care plans. An effectiveness study highlighted its effect on the perceived quality of care and patient activation. Successful implementation of novel interventions necessitates an understanding of the user’s actual application, user experiences and an evaluation of implementation outcomes. This study aims to evaluate the implementation of the ABCC-tool by HCPs in Dutch primary care.MethodsThis study is the process evaluation of a larger type 1 effectiveness-implementation hybrid trial. Semi-structured interviews with HCPs, who were interventionists in the hybrid trial, were held at three and twelve months after they started using the ABCC-tool. The Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework was used to evaluate implementation outcomes. The Implementation domain was further strengthened with an evaluation of implementation fidelity using Carroll’s framework. Inductive coding and thematic analysis were applied to identify relevant participant experiences and implementation outcomes within the RE-AIM framework.ResultsSeventeen HCPs (1 general practitioner, 16 practice nurses) participated in the study, representing 39% of potentially eligible participants. Most HCPs applied the tool after finishing their own routines instead of how it is intended to be used, namely from the beginning of the consultation. HCPs reached 2–6 patients. The ABCC-tool was initially adopted, but twelve HCPs stopped using the tool due to COVID-19 related cancellation of consultations. High fidelity was found for applying the questionnaire and visualization. Low fidelity was present for applying shared decision-making, formulating care goals and monitoring progress. HCPs indicated that maintaning the ABCC-tool depended on accompanying training and implementation support.ConclusionsHCPs applied the ABCC-tool critically different from intended, potentially diminishing its benefits and ease of use. This evaluation stresses the need for a tailored implementation plan that includes more detailed training and guidance on how and when to use the ABCC-tool.

'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services.

In line with the Australian Government's Vision 2030, this research foregrounds consumer experiences of recovery to inform the (co)design and delivery of mental health services for people living with complex needs and/or a severe and persistent mental health condition. The research takes a specialist focus on the regional setting, with data collected from client experiences within Western NSW, Australia, in the context of the National Disability Insurance Scheme (NDIS) implementation and inclusion of psycho-social disability within the NDIS service environment. Thirty-seven people aged 19-70 years living with complex needs and/or a diagnosis of a severe and persistent mental health condition were recruited from services where they had a care plan or where they were members of a consumer reference group for recovery-oriented services. A tripartite framework integrating recovery oriented, trauma-informed and collective impact approaches for a qualitative, arts-based (photovoice) study. In areas of the mental health service system that had not yet applied a personalised understanding of recovery or embraced trauma-informed practice there were a range of issues and gaps in service delivery relating to authentic relationships, belonging and connection, service cultures, trauma-informed care, and workforce investment. Clinical and non-clinical services need to ensure consistent person-centred and trauma-informed practice is implemented throughout the mental health service system to meet the needs of the consumer. An eight-point checklist serves as the basis for services to reflect on how they are working with consumers and to support the review of systems and clinical governance frameworks.

Antibiotic Use at the End of Life: Current Practice and Ways to Optimize.

Infections are common complications in end of life (EOL). However, clinicians have minimal guidance regarding antibiotic decision-making in EOL care, leading to the overuse of antibiotics. While symptom relief is frequently cited as a major reason for antibiotic use in EOL, antibiotics have not been shown to provide significant improvement in symptoms outside of urinary tract infections. In addition, when prognosis is expected to be in the range of days to weeks, antibiotics have not been shown to provide significant survival benefit. Antibiotics can be beneficial in EOL care in appropriate scenarios, but the current widespread use of antibiotics in EOL requires reevaluation. There needs to be broader efforts to think about antibiotics like other invasive medical procedures in which benefits and risks are weighed, recognizing that not all patients in EOL who receive antibiotics will benefit. In addition, during care planning process, discussing and documenting antibiotic preferences will be beneficial. Non-antibiotic symptom management should be incorporated to plan of care when infection is suspected. Ultimately, the use of antibiotics at EOL should be for the clear benefit for the recipient and should be guided by the type of infection and its clinical course, patients' primary disease and its prognosis, and the preferences of patients or surrogate decision makers.