(1) Background: Mobile health (mHealth) solutions can become means of improving functional recovery and reducing the peri-operative burden and costs associated with arthroplasty procedures. Aim of this study is to explore the objectives, functionalities, and outcomes of a platform designed to provide personalized surgical experiences to qualified patients, along with the associated problems and opportunities. (2) Methods: A survey-based analysis was conducted on patients who were prescribed the use of a specific care management platform and underwent primary Robotic total knee arthroplasty (rTKA) between January 2021 and February 2023. (3) Results: Patients registered on the platform who have undergone primary Robotic TKA (rTKA) were considered. The mean age of registered patients is 68,6 years. The male (M) / female (F) ratio is 45.1% / 54.9%. The patients interviewed were at an average distance of 485 days from the intervention, with a standard deviation of 187.5. The survey highlighted appreciation for the App and its features but limits in its use and in its perception from the patients. All these data were evaluated according to the Wald principles and strategies to improve patient recruitment, enhance adherence, and create a comprehensive patient journey for optimized surgical experiences were analyzed. (4) Conclusions: This patient care platform may have the potential to impact surgical experiences by increasing patient engagement, facilitating remote monitoring, and providing personalized care. There is the need to emphasizes the importance of integrating the recruiting process, improving adherence strategies, and creating a comprehensive patient journey within the platform

The intelligent elderly care model places new demands on the skills of aging caregivers. The identification and development of forward-thinking, high-potential nursing talent is essential for advancing the intelligent elderly care sector. Multi-benchmarking selection and competitive analysis is used to evaluate and identify nursing personnel in the rehabilitation treatment center of a hospital in Hefei City. Using proxy evaluation and democratic evaluation model, three types of benchmarks such as single item benchmark, individual benchmark and group benchmark were identified and selected, and the professional nursing team was constructed based on the evaluation results. Different from the traditional other-directed evaluation, multi-benchmarking selection and competitive analysis is self-directed evaluation, this method is more conducive to the identification of high-potential and digital nursing talents by intelligent elderly service organizations, and facilitates the formation of professional nursing teams with complementary strengths and cross-fertilization, so as to satisfy the diversified and multi-level needs of the elderly for intelligent elderly services.

Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

This study examines the current functioning of Health Care Bioethics Committees (HBCs) in Chile, with the objective of providing recommendations for improving public health care management. Through a comprehensive literature review and a case analysis of the ‘Hospital Clínico de la Universidad de Chile’, the structure, functions and challenges of the CEA are explored. The research reveals the importance of the multidisciplinary composition of the committees, the need for continuing education in bioethics, and the relevance of the consultative role in ethical decision making. The results suggest that the effectiveness of CABs does not necessarily depend on the number of members or the length of their terms of office, but on the quality of their training and experience. It is concluded that for adequate health care management, it is essential to strengthen the role of the CEA in the ethical education of health care personnel and in the development of institutional regulations, as well as to improve their visibility and accessibility within the Chilean health care system.

BackgroundGood management behavior in patients with diabetes mellitus can reduce disease complications and improve quality of life. This philosophical problem is very important for nurses who are able to provide management care for diabetic patients. The purpose of this literature review is to describe the concept, model or theory that can be used in improving the management of diabetes mellitus patients.MethodsThe method used is by searching several studies published through the Scopus database, PubMed, CINAHL, SpingerLink, and web of science (WOS). The search strategy uses a combination of the terms MeSH Terms. The research questions were designed using the principles of the PICOS framework. Selected studies were published from 2017-2022.ResultsA total of 15 studies were included, with 12 using quantitative methodology and 3 were qualitative. The studies were conducted across various countries. The majority of articles used the concept of self-management intervention based on digital-based development and e-health (n=6), Dorothea Orem's self-care deficit nursing theory n=2) and the transtheoretical model (n=2). These concepts, models and theories are able to improve good self-management through lifestyle changes, psychosocial, cultural acculturation and increase in spiritual values (n=6).ConclusionTransitional change focuses on changing the modifiable factors found in the concepts, models and theories of the articles obtained. Future research can be developed to assess the existence of elaborations and modifications based on the philosophy that people with diabetes are responsible for their own health.

A new intervention model for promoting healthy ageing grounded on integrated value-based care was developed and tested in the city of Valencia (Spain). Its implementation raised relevant barriers for older adults in their access to health, health promotion, and health self-management linked with their health and digital literacy. This new intervention model included several aspects. On the one hand, researchers together with older adults and their informal caregivers participating in the study, designed personalised care plans, based on older adults’ specific needs, to be implemented with the support of a digital solution. On the other hand, researchers and health and social professionals implemented a series of six workshops in different locations of the city to encourage the sense of community among participants, reinforcing their trust in the new care model and increasing their adherence. Social activities were at the core of the workshops to understand older people’s interaction with the health and social services provided in the neighbourhood. Qualitative and quantitative methods were combined to extract information from older participants on how to engage them as active actors of their own health and understanding their values and preferences. Qualitative results show that after a post-pandemic situation, they were more concerned about social isolation and desired face-to-face contact with their professional care team; however, feelings of loneliness and/or sadness were not considered amongst the reasons to visit health professionals. Some of the conclusions reveal that the use of technology as a supportive tool is well received but with a stress on its role as “supportive”, and not replacing the close contact with healthcare professionals. Professionals recognised the benefits of this new approach but required more time and incentives to dedicate the effort needed.

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stay and amputation. We suggest a remote-monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, wound characteristics, and clinical parameters, such as cognitive function, were integrated, contributing to a comprehensive risk factor profile. We evaluated the feasibility of this platform with 124 DFU patients over 12 weeks; 39% experienced unfavorable outcomes such as dropout, adverse events, or non-healing. Digital biomarkers were benchmarked (0-10), categorized into low, medium, and high risk for unfavorable outcomes, and visually represented using color-coded radar plots. The initial results of case reports illustrate the value of this holistic visualization to pinpoint the underlying risk factors for unfavorable outcomes, including a high number of steps, poor adherence, and cognitive impairment. Although future studies are needed to validate the effectiveness of this visualization in personalizing care and improving wound outcomes, early results in identifying risk factors for unfavorable outcomes are promising.

Stroke is a global leading cause of death and disability. Knowledge of related guidelines is crucial for Emergency Department (ED) staff, influencing early diagnosis and timely treatment. We investigated Greek-Cypriot ED healthcare professionals' (nurses and physicians) knowledge in recognizing and managing stroke. A descriptive cross-sectional study spanned November 2019 to April 2020, encompassing four private and seven public EDs in the Republic of Cyprus. The data were collected through a self-reported questionnaire developed by the research team, consisting of 37 questions. Eight questions focused on sociodemographic and employment characteristics, 28 assessed knowledge in stroke recognition and management (each item was equally weighted without deliberate prioritization), and one question addressed self-assessment of knowledge in stroke care. 255 nurses [Response Rate (RR): 74.1%] and 26 physicians (RR: 47.3%) completed the questionnaire. The average correct response rate was 12.9 out of 28 statements (SD: 4.2), with nurses and physicians scoring 12.6 (SD: 4.1) and 15.7 (SD: 4), respectively. Work experience significantly influenced stroke knowledge, with all groups demonstrating superiority over those with less than one year of experience. Participants with previous training scored an average of 1.45 additional correct answers while educational attainment did not significantly influence stroke knowledge. Investigating stroke knowledge among Emergency Department nurses and physicians in the Republic of Cyprus revealed significant deficits. The study stresses targeted interventions, including, education, yearly examinations, workshops with hands-on training, and repeated training, to address these gaps and enhance the overall stroke care capabilities of the healthcare professionals.

The quadruple burden of diseases, early discharge from hospital and hospital at home have resulted in home-based care services becoming a requirement in South Africa. The home-based care services generate a significant amount of health care risk waste that is mismanaged. However, more attention is given to the health care risk waste generated in hospitals and clinics than to health care risk waste generated by home-based caregivers. Therefore, this study investigates the health care risk waste management practices by home-based caregivers. The study adopted a mixed research approach, qualitative and quantitative methods, using a literature review, interviews, and questionnaires as means of data collection. Results show that there are different types of health care risk waste generated as a result of different activities performed by home-based caregivers, but that the waste was found to be managed in an unsafe manner. The majority of households receiving home-based care did not have basic sanitation facilities such as toilets, running water and waste removal services, aggravating the issue of health care risk waste mismanagement. The study recommends a new policy framework that will lead to safe management practices of generated health care risk waste to be adopted by home-based caregivers.

Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. A rich and diverse body of literature describing and evaluating case management work in NZ (n=148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analysed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centred and integrated health care.

Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the Veterans Administration has encouraged the development of geriatric evaluation and management programs. Evolution of geriatric evaluation and management has occurred over time and many VA medical centers have transferred inpatient geriatric evaluation programs to long-term care Community Living Centers (CLC) and outpatient settings. Availability of resources and trained personnel across the continuum of care as well as administrative facilitation of collaboration between care components are critical to the efficient utilization of geriatric services. Facilities may need to prioritize their resources and utilize the most effective and relevant elements of geriatric evaluation and management according to patient population needs, available space, resources, and institutional priorities.

Introduction: Lower respiratory tract infections, including pneumonia, are one of the leading causes of child mortality, especially in low-resource settings. Current guidelines rely on clinical signs for diagnosis, leading to over-prescription of antibiotics, which in turn contribute to antimicrobial resistance. Lung point of care ultrasound (L-POCUS) offers potential to improve diagnostic accuracy and reduce unnecessary antibiotic use, but lacks standardized guidelines for diagnosis and management of paediatric pneumonia. Methods and Analysis: This study utilizes a modified Delphi process to develop expert consensus guidelines for L-POCUS interpretation in paediatric pneumonia that would constitute a framework for effective guidelines for judicious antibiotic prescribing. The 5-stage iterative process includes: i) creation of a literature summary and conceptual framework, ii) first round of online surveys for expert feedback, iii) virtual meetings to discuss survey results and refine guidelines, iv) second round of online surveys, v) final analysis and development of consensus guidelines. A panel of 12-15 experts, chosen for their paediatric POCUS experience, geographic diversity, and gender balance, will participate. Consensus will be defined as ≥75% agreement. Ethics and Dissemination: Participation is voluntary, with consent obtained at the start and the option to withdraw at any time. The protocol was approved by the Ethics Commission of Bern, Switzerland. Findings will be disseminated through open access publication.

: Background. Delivering bad news is a sensitive and challenging aspect of nursing healthcare, requiring a holistic approach that respects patients' preferences, cultural values, and religious beliefs to promote adaptation to the state's health. Aim: map the evidence of the dimensions present in the communication and management of bad news by nurses, with the person in a palliative situation, their caregivers, and family members. Methods: Based on Joanna Briggs Institute methodology, the search was conducted through MEDLINE Complete (EBSCOhost), CINAHL Complete (EBSCOhost), SciELO, and Open Access Scientific Repository in Portugal. From a total of 756 articles, 14 were included, published between 2018 and 2023. Results: Structure components in bad news are influenced by the characteristics of the palliative patients, their caregivers, family members; nurses; and the organizational environment. Promoting the quality of the communication process is desirable through continuous and advanced training in end-of-life; training in bad news; religiously and culturally sensitive nursing interventions centered on hope and maintaining faith; emotional management; and utilization of a checklist protocol. Conclusions: Honest communication allows people to actively participate in the decision-making process and in the trajectory of the care plan that is focused on themselves and their preferences, which has outcomes in functional capacity and readaptation.

Background: in 2016 an IT system was developed at MUL for the documentation of nursing practice. Preparing nursing students for the implementation of eHealth solutions under simulated conditions is crucially important for achieving digital competencies necessary for the health care systems in the future. Scientific evidence demonstrates that the use of an IT system in clinical practice shortens the time required for preparation of documentation, increases the safety of clinical decisions and provides data for analysis and for creation of predictive models for the purposes of HB HTA. Methods: The system was created by cooperation of an interprofessional team at the Medical University of Łódź. The ADPIECare system was implemented in 2016 at 3 universities in Poland, and in 2017 a study of its usability was conducted using a questionnaire made available by Healthcare Information and Management Systems Society “Defining and Testing EMR Usability MASTER V2 Final” on 78 nurses — students of MA in Nursing at Medical University of Łódź. Findings: Over 50% of the surveyed nurses have indicated the usability of the system for the “effectiveness of documentation” variable. The same group of respondents have confirmed that a positive attitude towards patient care planning with the use of the assessed system. In the opinions of the examined parties positive opinions predominated, such as e.g.: “the system is intuitive,” “the system facilitates work,” “all patient assessments are in one place,” “the time needed for data entry would be shortened.”

Managing severe bleeding, particularly in soft tissues and visceral injuries, remains a significant challenge in trauma and surgical care. Traditional hemostatic methods often fall short in wet and dynamic environments. This study addresses the critical issue of severe bleeding in soft tissues, proposing an innovative solution using a Polyethylene Glycol (PEG)-based hydrogel combined with zinc oxide (ZnO). The developed hydrogel forms a dual-network structure through amide bonds and metal ion chelation, resulting in enhanced mechanical properties and adhesion strength. The hydrogel, exhibiting excellent biocompatibility, is designed to release zinc ions, promoting coagulation and accelerating hemostasis. Comprehensive characterization, including gelation time, rheological properties, microstructure analysis, and swelling behavior, demon-strates the superior performance of the PEG/ZnO hydrogel compared to traditional PEG hydro-gels. Mechanical tests confirm increased compression strength and adhesive properties, crucial for withstanding tissue dynamics. In vitro assessments reveal excellent biocompatibility and en-hanced procoagulant ability attributed to ZnO. Moreover, in vivo experiments using rat liver and tail bleeding models demonstrate the remarkable hemostatic performance of the PEG/ZnO hy-drogel, showcasing its potential for acute bleeding treatment in both visceral and peripheral sce-narios.

(1) Background: With continuous globalization and modernization of people's lives, lifestyle has changed dramatically, with decreased physical activity and increased unhealthy eating patterns in many nations throughout the world. With the COVID-19 pandemic and changes taking place in people’s health and lifestyles around the world, the need for rehabilitation is expected to rise in the coming years.(2)Methods: This paper analyzes the integration model of sports and health care using theoretical analysis, literature reviews, logical reasoning, and other methods.(3)Results: The integration of sports and health care in China has entered the stage of practical implementation after many years of development, forming a few representative integration patterns. Governments, communities, community hospitals, hospitals, and third-party institutions are the main participants, with the community playing an important role in the integration. Pharmacies, sports venues, and schools with sufficient staff have a relatively low participation rate.(4)Conclusion: The grading treatment has been applied in health management and sports rehabilitation, based on the development of digital medicine, a government-led grading treatment model of "health management center" can promote the participation of multiple subjects in the integration of sports and health care, solving the problems existing in the current integration process to a certain extent.

Introduction: Despite its high prevalence and impact on health, metabolic dysfunction-associated steatotic liver disease (MASLD) is inadequately addressed in European primary care (PC), with a large proportion of cases going undiagnosed or diagnosed too late. A multi-country European re-search consortium led a project to design and evaluate a patient-centered, integrated model for MASLD screening, diagnosis and linkage to specialty care for European PC settings. Aim: Based on the lessons from this project, the latest research evidence and existing guidelines for the management of MASLD, we sought to develop a set of practice recommendations for screening, referral and management of MASLD in PC. Methods: The Rand/UCLA modified Delphi panel method, with two rounds, was used to reach consensus on practice recommendations. The international panel consisted of experts from six countries, representing family medicine, gastroenterology, hepatology, cardiology and public health. Initially, fifteen statements were drafted based on a synthesis of evidence from the literature and earlier findings from our consortium. Prior to the consensus meeting, the statements were rated by the experts in a first round. Then, in a hybrid meeting, the experts discussed findings of round one, adjusted the statements and reassessed the updated recommendations in a second round. Results: In round one, there was already a high level of consensus on 10 out of 15 statements. After round 2, there were fourteen statements with a high agreement (>90%). One statement was not endorsed. The approved recommendations addressed the following practice areas: risk screening and diagnosis, management of MASLD – Lifestyle interventions, pharmacological treatment of MASLD/MASH, pharmacological treatment for co-morbidity, integrated care, surgical management and other referrals to specialists. Conclusion: The final set of 14 recommendations focuses on increasing comprehensive care for MASLD in PC. The recommendations provide practical evidence-based guidance tailored to PC practitioners. We expect that these recommendations will contribute to the ongoing discussion on systematic approaches to tackle MASLD and support European PC providers by integrating the latest evidence into practice.

Type 1 diabetes (T1D) has shown an increase in the incidence rate of about 3% per year over the last two decades. Continuous Insulin Subcutaneous Therapy (CSII) is widely used in the paediatric population with diabetes; however, it requires more preparation by the treating team and careful selection of potential users. Prescriptive provisions vary from Region to Region and the perspective of health workers still remains an unexplored area. The aim of the research project is to explore the representations of a group of diabetologists and psychologists working in pediatric diabetology on the national territory, regarding roles, functions and activities as part of a multidisciplinary team; their views on the potential benefits of CSII and the types of individuals applying for the use of technology. A socio-anagraphic data sheet was administered and two homogeneous focus groups were conducted by profession; they were audio recorded. The transcripts produced were analysed using the Emotional Text Mining (ETM) methodology. Each of the two corpus generated three clusters and two factors: for diabetologists, a focus on the patient in different levels of care emerged, collaborating both with other health professionals and with the territory, through the proposal of an intervention where the medical aspect is often represented by technology; also for psychologists there was a representation of interdisciplinary networking, with a greater focus on the processes inherent the management of pathology, from acceptance to the elaboration and integration of diabetes in the family narrative. The understanding of the representations of health professionals working in pediatric diabetes about new technologies can contribute to the consolidation of a network of professionals through a targeted work on possible critical issues emerged.

Aim: The aim of the study is to analyze quantitatively the scientific literature covering nursing studies on patient safety. Method: The Web of Science database is queried in this retrospective bibliometric analysis to identify relevant publications. The study themes, contributing journals, countries, institutions, and authors were evaluated quantitatively. Thus, a total of 5470 publications concerning patient safety in nursing were included and analyzed. Findings: The number of studies conducted increased every year from 1992 to 2023. While the country whose articles receive the most citations (31072) is the United States of America (USA), Turkey is ranked as last with the lowest number of citations (581). Journal of Clinical Nursing, with 338 articles, appeared to have the highest number of publications, Chaboyer W. appeared to have the highest number of citations with a total of 1426 and 45 publications. The countries that have the strongest international cooperation for research in this field are the USA, England, Australia and China. Results: After examining the literature in the field of patient safety in nursing through bibliometric analysis, it is seen that themes such as patient safety, medication errors, nursing care, nursing, education, systematic review, quality care and leadership were emphasized as important considerations.

This article takes an approach to explaining the behavioral manifestations of the decision making in US companies’ offer of health insurance that is grounded not only on their cost minimizing behavior, but also in a humanness dimension based on the African concept of Ubuntu. In this way, we define an Ubuntu based Random Utility modeling framework, describing the choice process as a tripartite decision making, and implemented using a nationally representative random sample of 1,061 American companies from the Dunn and Bradstreet Business data, supplied by Survey Sampling International to the Associated Press-NORC Center for Public Affairs Research. The results from the three sequentially implemented specifications showed that the relationship between management culture and health plan offering strategy is dependent on other relevant co-variates, which when left out, leads to the problem of omitted variables bias. However, when all variables are included but assumed to enter the relationship exogenously, this results in management culture not having any statistically significant effect on companies' decisions about scope of health plan offering. When the exogeneity assumption is relaxed through a recursively Bivariate Probit model, the system of two equations produces a highly significant management culture effect. In fact, in this later case we see that companies with groups and formal committee management culture are 1.58 times less likely to choose a multiple plan strategy over a single plan strategy, hence failing to show the more wholesome plan offering that would theoretically prevail under Ubuntu style management.

Heart failure (HF) affects about 60 million people worldwide, making it one of the chronic conditions with the greatest health and economic impact. The primary objective was to assess the efficacy of lung ultrasound (LUS) in the management of HF in order to intervene early and reduce the rate of hospital readmissions. A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, including clinical trials, meta-analysis, systematic reviews, and original articles from 2019/1/1-2023/12/31, about LUS for the assessment of HF, on an outpatient basis, for HF diagnosis or/and decompensation. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 873 articles were identified of which 33 articles were selected: [n=19] focused on prognostic assessment of HF, [n=11] centred on multimodal diagnostic assessments, and [n=2] addressing therapeutic guidance for HF diagnosis. LUS exhibits advantages in the detection of sub-clinical congestion linked to prognostic significance in re-admission and mortality during out-patient follow-up, after hospital discharge, and in complex scenarios as the patients' homes or institutional long-term care facilities. However, there are considerable uncertainties in their interpretation and monitoring changes due to its lack of standardization. The need for an updated international consensus on the use of LUS seems obvious.

High-flow Nasal Cannula (HFNC) oxygen therapy is gaining traction globally as a treatment for respiratory failure. There are several physiological benefits and there may be a growing patient preference for HFNC. In this narrative review, we aim to outline the basic mechanisms of HFNC, who can use it and review the literature regarding its utility both in the critical care setting, as well as in the home setting for chronic hypercapnic respiratory failure with an emphasis on Chronic Obstructive Pulmonary Disease (COPD). The role of non-pharmacological interventions like non-invasive ventilation (NIV) and HFNC in the prevention of hospital readmissions following acute exacerbations of COPD (AECOPD) is an area of increasing importance because randomised controlled trials and systematic reviews have found measures like nurse-led predischarge bundles to be clinically ineffective and to have a high cost per quality adjusted life year. This review therefore considers the evidence of NIV vs HFNC in the context of AECOPD and the application of HFNC at home in the prevention of AECOPD. We also look at applications of HFNC in specific settings, such as in the peri-operative period, emergency department, acute (mainly Critical Care) setting including in immunocompromised patients and palliative care.

The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies recommend against population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. In order to assess patterns of physician management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Results from seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining light on physician practices in the face of uncertainty. Future research is needed is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

Emphasis on primary health care (PHC) is the most efficient and economical approach to achieving universal health coverage. The aim of the study is to examine PHC publications from 2011 to 2023 in the Asian Pacific region (APR) using the Web of Science (WoS) database. Academic papers in the WoS PHC subject category published in the APR from 2011 to 2023 were retrieved and analyzed. A total of 4,283 papers were published in the WoS PHC category from APR onwards. The annual number of published papers and their citations increased from 2011 to 2023. Australia led PHC publications in APR with 3,049 publications (71.19% of APR regional output). New Zealand had the highest number of citations per paper (13.76) and the highest mean impact factor (3.23±1.80). Publications in the WoS PHC category also covered a wide range of topics, including Medicine General Internal (64.77%), Health Care Sciences Services (21.88%), Health Policy Services and Public Environmental Occupational Health (21.36%), demonstrating the breadth of PHC research. Australia dominates the output of PHC publications in the APR. Australian Family Physician and Australian Journal of Primary Health are the leading journals publishing PHC papers in the APR.

Worldwide, one of the main causes of death among young adults is multiple trauma. In these pa-tients hemorrhagic shock represents the leading cause for worsening of the clinical status and for increased morbidity and mortality. This is due to a multifactorial complex involving cellular, bi-ological, and biophysical mechanisms. The most important mechanisms affecting clinical out-come are oxidative stress, the augmentation of pro-inflammatory status, immune deficiency, dis-ruptions in the coagulation cascade, imbalances in electrolyte and acid-base homeostasis. Poly-trauma patients in hemorrhagic shock need adequate fluid management to ensure hemodynamic stability that must consider not only the maintenance of adequate blood pressure, but also the ad-equate oxygenation of tissues for optimal cellular function. In the current clinical practice, fluid resuscitation in polytrauma patients uses a variety of widely studied pharmacological products, such as crystalloids, colloids, blood transfusions, and the infusion of other blood products. Alt-hough these products exist, an agreement was not reached on a standard administration protocol that could be generally applied for all patients. Moreover, numerous studies have reported a se-ries of adverse events related to fluid resuscitation and to the inadequate use of these products. This review aims at describing the impact the administration of all the solutions used in fluid re-suscitation might have on the cellular and pathophysiological mechanisms in the case of poly-trauma patients suffering from hemorrhagic shock.

Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD, did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, we analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.

Traumatic Brain Injury (TBI) is one of the leading causes of death and disability worldwide. Patient treatment and management pose a challenge for healthcare systems. The prognosis of these patients may be influenced by factors such as sex. This study aims to describe the clinical parameters of patients hospitalized in the Intensive Care Unit (ICU) of a Spanish hospital due to Trauma Brain Injury and to establish differences based on sex. Methodology: An observational, cross-sectional, and analytical study was conducted from March 2015 to December 2019. All patients admitted to the ICU during this period who presented isolated significant Traumatic Brain Injury, defined as an abbreviated injury scale (AIS) ≥ 3, were included. Data on baseline characteristics, mechanism of injury, substance use, and acute management in the prehospital and hospital stages (including the need for hospitalization) were recorded. A descriptive and in-ferential analysis was conducted using the chi-square test. Results: A total of 950 patients were ultimately included. The majority of the patients were men (723) with a mean age of 45.16 (± 17.55). There were statistically significant differences in terms of the mechanism of injury (p

Individualized nursing care allows a systematic assessment and intervention, considers the patient's preferences, values, and context, and contributes to a positive care trajectory. However, its operationalization has proven to be challenging. This research aims to determine which items of nursing care individualization are most integrated into nurses' clinical practice, and those that are less included. A cross-sectional study was conducted on 122 eligible and registered nurses at a Hospital Center, in Ophthalmology (operating room and inpatient ward), Cardiology Service, Internal Medicine, and Medical Emergency Unit, in Portugal. The Indi-vidualized Care Scale nursing version (ICS-Nurse) was used for the assessment, including three sub-dimensions: clinical situation, personal life situation, and decisional control over care-related decisions. Analyses were performed using Cronbach's Alpha and Principal Component Analysis to confirm the relationships between the variables, suggested by the literature and previous studies. In the results, no statistically significant differences were identified between the sociodemographic profile and the sub-dimensions of individualization. Nurses overall have a good perception of the importance of individualized care (4.06 ± 0.46 ICS-A-NURSE), but face difficulties in its implementation during the last shift worked (3.97 ± 0.49 ICS-B-NURSE). The sub-dimensions more integrated into the care environment were clinical situations and decisional control, and the less integrated were the personal lives of patients. This study identifies key aspects of the individualization of nursing care in acute and perioperative settings, as its omission represents a failure to address the multidimensional health needs of patients, families, and caregivers. We suggest the development of training programs that promote a holistic approach, as well as future studies that consider patient outcomes related to the individualization of nursing care.

Introduction Older people with complex, chronic conditions often receive insufficient or inefficient care provision. And few instruments are able to measure their perception on care provision. The "User Reported Measure of Care Coordination" instrument has been satisfactorily used to evaluate chronic care provision and integration. The aim of this study is to validate this instrument into Spanish. Methods The questionnaire was adapted and validate in two phases: translation and cultural adaptation of the questionnaire, and psychometric property measurement. Study population were chronic care conditions patients. Results A total of 332 participants completed test re-test as part of the questionnaire validation process. The final version of the questionnaire had 6 domains: Health and Well-being (D1), Health day to day (D2), Social Services (D3), Planned Care (D4), Urgent Care (D5) and Hospital Care (D6). Cronbach's alpha for the overall questionnaire was 0.86, indicating good internal consistency. When analysing each domain, only Planned Care (D4) and Urgent Care (D5) had Cronbach’s Alphas slightly lower than 0.7, although this could be related to the low number of items in each domain. A good temporal stability was observed for the distinct subscales and items, with intraclass correlation coefficients varying from 0.412 to 0.929 (p < 0.05). Conclusion The adapted version of the “User Reported Measure of Care Coordination” into Spanish proved to be a practical tool for use in our daily practice and an efficient instrument for assessment of care coordination in chronic, complex conditions in older people across services and levels of care.

Background: Skin and soft tissue infections (SSTI) are common presentations to the emergency department. However, this is less common after contact with contaminated water, both salt or fresh. This review presents the diagnosis and the management of water-related soft tissue sepsis in this vulnerable and difficult to treat subgroup of necrotizing soft tissue sepsis. Methods: A summative literature overview regarding bacterial and fungal SSTI after contact with contaminated water, with practical diagnostic and management aspects addressed. Results: The literature indicates that these remain difficult to treat wounds and organisms. An approach using appropriate diagnostic tools with both medical and surgical management strategies is provided. Conclusion: SSTI due to water contamination of wounds involve unusual organisms with unusual resistance patterns and require a nuanced and directed diagnostic approach with adaptation of the normal antibiotic or antifungal selection to achieve cure, along with aggressive debridement and wound care.

Watching the international COVID-19 epidemics unfold during February and early March 2020, we began to highlight how outbreaks in care homes were inevitable, given the vulnerable patients in close proximity, and pressures on social care to help relieve pressure on the NHS. We suggested public health measures would significantly impact on care homes. Specifically we felt all homes would have multiple individuals isolated within days of introduction of guidance requiring isolation of new cough (or fever), and that a clear definition of an outbreak would be needed that differentiated COVID19 from influenza. We share the experiences of a GP practice looking after 900 nursing or dual registration care homes in the London Borough of Ealing in the early stages of the COVID19 Pandemic 2020. We believe that the altered presentation of cases of COVID19 in care homes contributed to the size of outbreaks, and that keeping COVID19 out of homes is the only way to manage this disease, with early isolation and complete segregation of positive and negative cases. We have seen over 300 suspected cases resulting in four fold (n=175) average monthly death rates, three fold usual issue of anticipatory medications, and approximately 32% mortality rate (up to 43% in over 90’s). Discharge pathways from hospital and admissions to care homes must be clear and robust. COVID19 naïve patients should not be admitted to units with outbreaks and COVID19 positive patients should not be admitted to anything other than a designated “hot” home until risk of contagion is passed. Some patients are testing positive at over 30 days since initial mild symptoms.

The livestock sector can be a major contributor to the mitigation of greenhouse (GHG) emissions. Within the sector, beef production produces the largest proportion of the livestock sector’s direct emissions. The objective of this study was to assess the on-farm GHG emissions in semi-arid rangelands in Argentina and to identify the relationships between emissions and current farm management practices. A survey recorded detailed information on farm management and characteristics. Assessments of GHG emissions were based on the IPCC Tier 2 protocols [1]. The relationships between farm management and GHG emissions were identified using General Linear Models. Cluster analysis was used to identify groups of farms that differed from others in emissions and farm characteristics. Emissions per product sold were low on farms that had improved livestock care management, rotational grazing, received technical advice, and had high animal and land productivities. Emissions per hectare of farmland were low on farms that had low stocking rates, low number of grazing paddocks, little or no land dedicated to improved pastures and forage crops, and low land productivity. Our results suggest that the implementation of realistic, relatively easy-to-adopt farming management practices has considerable potential for mitigating GHG emissions in semi-arid rangelands of central Argentina.

Long-term care (LTC) settings are increasingly used for palliative care in Japan. This study aimed to assess the proportion of LTC settings that provide palliative care services for older clients with advanced dementia in Japan and the trends across the types of settings. A nationwide questionnaire survey was conducted between November 2022 and January 2023, targeting 1,000 geriatric hospitals (GHs), 1,000 geriatric health services facilities (GHSFs), and 1,000 home nursing care stations (HNCSs). The palliative care practices for older patients with advanced dementia and their families in the agencies were assessed. Less than half of the GHs supported family participation or the spiritual needs of their older clients with dementia, while many had access to pain and symptom assessments and analgesic prescriptions by physicians. Less than half the GHSFs used pain assessment tools, assessed and supported family caregivers' pain and distress, and supported family participation in palliative care. More than 80% of the HNCSs practiced most of the listed palliative care. Current palliative care practices for older adults with dementia vary among GHs, GHSFs, and HNCSs. This emphasizes the need for targeted approaches to improve the provision of palliative care for patients with dementia across LTC settings in Japan.

Chest trauma is one of the most serious and difficult injuries, with various complications that can lead to ventilation - perfusion (V/Q) mismatch and systemic hypoxia. We are presenting a case of 53 – year - old male with no comorbidities or chronic therapy, who was admitted to the Intensive Care Unit due to severe respiratory failure after chest trauma. He developed right - sided pneumothorax and then thoracic drain was placed. On admission, the patient was hemodynamically unstable and tachypneic. The patient was intubated and mechanically ventilated, febrile (38.9°C) and unconscious. A lung CT showed massive non-ventilated areas predominantly in the right lung. He was ventilated with PEEP of 10 cmH2O with a FiO2 of 0.6 – 0.8. Empirical broad-spectrum antimicrobial therapy was immediately initiated. Both high FiO2 and moderate PEEP were maintained and adjusted according to the current blood gas values and oxygen saturation. After Stenotrophomonas maltophilia was identified and treated with sulfamethoxazole/trimethoprim his general condition gradually improved, and he was weaned from mechanical ventilation. In conclusion, both ventilatory and antibiotic therapy were needed to improve oxygenation and outcome of the patient with pneumonia due to the resistant S. maltophilia with V/Q mismatch.

Holistic care in the nursing care consists of physical, psychological, socio-cultural, developmental and spiritual aspects. However, the spiritual has received less attention than the other four aspects. The aim of this study was to review paper related to spiritual care in nursing care practices. The method in this study is a review using the CINAHL database. CINAHL was used because the articles focus on nursing topics. The keywords used were "Spirituality" OR "Spiritual care" OR "Spiritual" AND "Nurse". The inclusion criteria for the article were English language and published from 2019-2021, for adult range between 18-44 years old. Exclusion criteria were article not in English language, not full paper article, not in Human and not psychometric study also master thesis. This study recorded 64 articles, screened according to the topic, then the final results recorded 19 articles. This article focuses on the use of spiritual care in patients, nurses and caregivers, as well as both of patients and caregivers. The results of the review showed that spiritual care was important for mental health, physical health, and well-being, quality of life, increasing expectations for patients, nurses or caregivers. The significance of the study was spiritual care should be addressed in nursing care practices and it must include in the nursing curriculum, because spiritual care has many benefits for patients and nurses.

Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were most commonly placed in nursing homes, while patients with heart failure and breast cancer were more frequently hospitalized. Breast cancer and heart failure patients had a higher likelihood of dying at home. The presence of general practitioners increased the probability of home-based end-of-life care for cancer patients, while non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusion: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care.

Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence and characteristics of residents with dementia in nursing homes in Flanders, and their palliative care service use and comfort in the last week of life. We used two retrospective epidemiological studies, including 198 residents in 2010 and 183 in 2015, who died with dementia in representative samples of nursing homes in Flanders. We found a 23%-point increase in dementia prevalence (P-value<0.001), with a total of 11%-point decrease in severe to very severe cognitive impairment (P=0.04). Controlling for this difference in resident characteristics, in the last week of life, there were increases in the use of pain assessment (+20%-point; P<0.001) and assistance with eating and drinking (+10%-point; P=0.02) but no change in total comfort. The higher prevalence of dementia in nursing homes with no improvement in residents’ total comfort while dying emphasize an urgent need to better support nursing homes in improving their capacities to provide timely and high-quality palliative care services to more residents dying with dementia.

Although cancer care is often contextualized in terms of survival, there are other important cancer care outcomes, such as quality of life and cost of care. The ASCO Value Framework assesses the value of cancer therapies not only in terms of survival but with consideration of quality of life and financial cost. Early palliative care for patients with advanced cancer is associated with improved quality of life, mood, symptoms, overall survival, and cost savings. While palliative care has been shown to have numerous benefits, the impact of real-world implementation of outpatient embedded palliative care on value-based metrics is not fully understood. We sought to describe the association of outpatient embedded palliative care in a multidisciplinary thoracic oncology clinic on inpatient value-based metrics. We performed a retrospective cohort study of 215 patients being treated for advanced thoracic malignancies with non-curative intent. We evaluated the association of outpatient embedded palliative care with inpatient clinical outcomes including emergency room visits, hospitalizations, intensive care unit admissions, hospital charges, as well as hospital quality metrics including 30-day readmissions, admissions within 30 days of death, inpatient mortality, and inpatient hospital charges. Outpatient embedded palliative care was associated with lower hospital charges per day ($3,807 versus $4,695, p=0.024). Furthermore, patients who received outpatient embedded palliative care had decreased hospital admissions within 30 days of death (O.R. 0.50; 95% CI 0.34, 0.74; P<0.001) and decreased inpatient mortality (O.R. 0.46; 95%CI 0.23, 0.94; p=0.032). Our study further supports that outpatient palliative care is a high-value intervention and alternative models of palliative care, including one embedded into a multidisciplinary thoracic oncology clinic, is associated with improved value-based metrics.

An increasingly frail population in nursing homes accentuates the need for high quality care at the end of life and better access to palliative care in this context. Implementation of palliative care and its outcomes can be monitored by using quality indicators. Therefore, we developed a quality indicator set for palliative care in nursing homes and a tailored measurement procedure using a mixed-methods design. We developed the instrument in three phases: 1) literature search, 2) interviews with experts and 3) indicator and measurement selection by expert consensus (RAND/UCLA). Second, we pilot tested and evaluated the instrument in nine nursing homes in Flanders, Belgium. After identifying 26 indicators in the literature and expert interviews, 19 of them were selected through expert consensus. Setting-specific themes were advance care planning, autonomy and communication with family. The quantitative and qualitative analyses showed the indicators were measurable, had good preliminary face validity and discriminative power and were considered useful in terms of quality monitoring according to the caregivers. The quality indicators can be used in a large implementation study and process evaluation in order to achieve continuous monitoring of the access to palliative care for all residents in nursing homes.

Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, doctors, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for Legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint, and 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but stated that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.

This study demonstrated that antibiotic residue in milk can be reduced when dairy farmers use Ethno-veterinary Practices (EVP) based on herbal alternatives to prevent and cure common clinical conditions in cattle instead of antibiotics. Of the 220 farmers selected for the study, 140 were trained and motivated to use validated herbal formulations, 80 were kept as control. Milk samples from the selected farmers (except Thirukanurpatti milk society) tested positive for antibiotic residue in the baseline survey. One year after interventions, the milk from 123 (87.86%) farmers out of 140, were without any detectable antibiotic residue, while samples from 11 farmers (7.85%) were low positive for either Beta-lactams or sulphonamides and 6 (4.29%) were positive for Beta lactams and/or sulphonamides. These 17 (11 + 6) farmers had used antibiotics along with herbal formulations. The milk samples from the control groups were positive for beta lactam and sulphonamide. There was suggestive significance of change in knowledge, attitude and practice of EVP among the farmers from Kerala and Tamil Nadu. A progressive reduction in the incidence of mastitis, enteritis, repeat breeding and cowpox were observed from 2016 to 2019 among the cows treated with EVP. Use of herbal alternative also resulted in a significant reduction in health care expenditure of cattle.

Care coordination (CC) for children with special healthcare needs and medical complexity (CSHCN-CMC) is challenging, and medication management is especially difficult for providers, parents/caregivers, and patients alike. While numerous strategies for CC have been suggested and implemented, barriers to medication optimization remain. The report describes the creation of a pediatric clinical pharmacotherapy practice, related standard operating procedures to assure consistent application of screening tools and care provision through comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy delegation, monitoring, and modification. The methodology of a prospective case series is also presented to highlight drug therapy problems and their resolution in CSHCN-CMC. Future opportunities to expand the practice for engagement in population health management as well as prior authorization activities on behalf of physicians will be discussed.

Growing evidence suggests that healthcare provider advice may increase tobacco cessation, reduce alcohol use, and improve the adoption of desirable lifestyle behaviors among patients. However, how brief interventions and other provider-patient interactions can shape cumulative adoption of multiple modifiable behaviors is less well studied for diabetes prevention and control. Using weighted internet panel survey data from a large socio-demographically diverse urban population in the United States (n=1,003), the present study describes differences in group characteristics among those who had been “ever diagnosed” with prediabetes/diabetes versus those who had not. It also examines the associations between the cumulative adoption of lifestyle behaviors and each of the following: a) lifetime prediabetes/diabetes diagnosis; b) brief lifestyle intervention exposure (i.e., received provider advice/encouragement); and c) recent provider-patient communication about diabetes. There were several group differences in “ever diagnosed” prediabetes/diabetes status by age, employment status, health status, nutrition knowledge, blood pressure/hypertension diagnosis, and diabetes-related health behaviors (p<0.05). Each of the three provider-patient interactions of interest were positively associated with a higher cumulative sum of adopted modifiable lifestyle behaviors for diabetes prevention and management. Results suggest that provider advice/provider-patient interactions of any type can have a salutary impact on whether individuals with prediabetes or type 2 diabetes will engage in recommended lifestyle behavior modifications.

Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in pediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented (RP). This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (PICU or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP which was documented within the last 48 hours of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration (particularly involving PICU and PPC services) in developing protocols of how to manage this difficult but inevitable clinical scenario.

Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centered care at a practical level, a methodological study was carried out to assess the face validity of the model. Particularly, a Delphi method involving a group of 15 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a Content Validity Index-Item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic and HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing of complexity in healthcare practice.

Acute myeloid leukemias (AMLs) are heterogeneous hematologic cancers that occur prevalently in older patients as the result of a complex pathobiology. The clinical outcomes of older patients with AML, often unsuitable for intensive chemotherapy and allogeneic stem cell transplantation, are generally disappointing. However, recent advances in understanding molecular pathogenesis and other biological mechanisms recognized in AML development and progression have changed the treatment approach, especially for this particularly vulnerable category of patients. Indeed, non-intensive biologically tailored approaches, such as combining venetoclax with hypomethylating agents, have changed the therapeutic paradigm in this field. Moreover, other promising compounds and treatment strategies are currently under advanced clinical development. This article delves into the latest biological understanding and therapeutic advances in the clinical management of older AML patients into new conceptual frameworks that progressively transform the clinical practice in this challenging setting.

This study aimed to investigate the prevalence, location, and characteristics of new-onset chronic pain by using a new definition in long-term survivors after discharge from a tertiary emergency center. We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail 2-2.5 years since their discharge from a tertiary emergency center. We used the Brief Pain Inventory to investigate chronic pain parameters, and the painDETECT questionnaire to investigate neuropathic pain. Patient information during hospitalization was collected retrospectively from medical records. The survey was sent to 78 patients, 63 (81%) of whom responded and were included in the analysis. Nine of the 63 patients (14%) had new-onset chronic pain. Of these, six (67%) had chronic pain of moderate or severe intensity which interfered with daily life. The most frequent location of chronic pain was the ankle/foot (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. New-onset chronic pain may occur for up to 2-2.5 years after discharge from a tertiary emergency center, and this may interfere with daily life. Therefore, a follow-up system for chronic pain is warranted.

Neonatal palliative care (NPC) is an integrated and holistic approach that is an integral part of the contemporary neonatal treatment delivery paradigm. It is the highest fulfillment of the notion of beneficence (doing or creating 'good') that has otherwise been neglected/underestimated by the focus of modern medicine on technology and instrumental treatments by its commitment to alleviating patient pain and quality of life. For decades, the Double-Effect Doctrine (DDE) has been used to consider and address a range of ethically questionable circumstances, often at the end of life, including euthanasia, termination of pregnancy to save maternal life, and morally justified warfare. The theory has continued to be mired in controversy as ethicists, legal scholars, theologians, and philosophers discuss the abstract concepts of moral reasoning, purpose, foresight, and other underlying moral theories. In this paper, the moral theory of DDE is discussed in its clinical application to the ethical decision-making process in neonatal palliative and end-of-life treatment, specifically 1) the administration of opioids as required for symptom control and 2) the use of palliative sedation for intractable symptom care.

The current article examined stoma self-care and health-related quality of life in patients with drainage enterostomy, describe clinical and sociodemographic variables and analyze the relations between all of them. Trained interviewers collected data using a standardized form that queried sociodemographic and clinical variables, collected from the electronic medical record, in addition to the Specific Self-Care for Ostomized Patients Questionnaire (CAESPO) and Stoma Quality of life (S-QoL) from January 2016 to January 2017. This was a multicenter, cross sectional study conducted in four hospitals of the province of Castellon (Spain) where 120 participants were studied. Significant differences were found in Self Care according to sex (p = .043); married participants show higher score (p < .01); also, significant differences according to work activity were observed (p < .01). Regarding the clinical variables, differences were observed according to the autonomy of care, the presence of complications in the stoma, the use of irrigation and the type of effluent (p < .01). We can highlight the importance of the skills related to self-care by ostomized patients has for a good level of quality of life related to health. In this learning process, the figure of the stoma therapist plays a very important role.

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

Knowing the symbolizations constructed in people's consciousness, based on lived experiences, is crucial to understanding how they structure their lives. Palliative Sedation (PS) integrates treatment in terminal palliative care, with the purpose of offering support and relief of refractory symptoms that may occur at the end of life. This study aimed at interpreting psychic fantasies that permeate thoughts, as reported by a sample of nurses when administering palliative sedation to patients in the final stage of life. This is a clinical-qualitative study conducted in a large hospital in the city of São Paulo (state of São Paulo, Brazil), a national reference in oncology. The study included 11 nurses working in the care of cancer patients. For data collection, we used the technique of SDIOQD – Semi-Directed Interview with Open-ended Questions in-Depth. The treatment by CQCA - Clinical-Qualitative Content Analysis is grounded on psychodynamic concepts. The interpretation of the meaning cores found in the interviews, complemented by observation of the para-verbal and nonverbal manifestations of the interviewees, led to the construction of three categories: (1) to symbolically serve death on a tray; (2) the act of sedation and its unfortunate coincidences; (3) palliative sedation as an agent of mercy death. This study suggests that nurses face dilemmatic situations, going through periods of self-questioning and moments of the ambivalence of feelings of beneficence and maleficence. When sedating a patient, the nurses envision to be offering dignity in death. Euthanasia fantasies in the process of administering sedation are latent in consciousness.

The supply of mental health processes in primary care has gaps. This study aims to analyze the association of agreement criteria and flows between primary care teams and the Family Health Support Center (NASF) for mental health collaborative care, considering the difference between capital and non-capital cities in Brazil. This cross-sectional study was conducted based on secondary data from the Primary Care Access and Quality Improvement Program. Agreement criteria and flows were obtained from 3883 NASF teams of the matrix support or collaborative care. The Chi-square test and multiple Poisson regression were used; p &lt; 0.05 was considered statistically significant. Prevalence ratios of negative associations demonstrated protective factors for support actions: follow-up at Psychosocial Care Center, management of psychopharmacotherapy, offer of other therapeutic actions, care process for users of psychoactive substances, and offer of activities to prevent the use of psychoactive substances. Collaborative care in primary care was effective, and capital cities were a protective factor compared with non-capital cities.

Aim: Aim of our study was to evaluate incidence and causative factors for acute kidney injury in hepatopancreaticobiliary (HPB) surgeries. Material and Methods: All the HPB surgeries performed between April 2018 to March 2020, in our institution have been analysed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi square test and fisher t test wherever approptiate and continuous variables by Mann Whitney U test. Statistical analysis was done using SPSS version 23. P< 0.05 was considered significant. Results: We performed 195 HPB surgeries between April 2018 to March 2020, Which included 114 biliary surgeries, 57 liver surgeries and 23 pancreas surgeries. 10 patients developed Acute Kidney Injuries. (AKI) On Univariate analysis AKI was associated with open surgeries, intra operative hypotension and liver surgeries, higher ASA grade, increase operative time, more blood products used, higher CDC grade of surgery and more hospital stay before diagnosis of AKI. However on multivariate analysis only higher ASA score independently predicted Acute Kidney Injury. (p=0.003, odds ratio 15.659, 95% confidence interval 2.54-93.36). AKI was also significantly associated with mortality. (p <0.0001). Conclusion: Pre operative higher ASA grade independently predicted post operative acute kidney injury. Post operative AKI is significantly associated with mortality.

Objectives: The aim of this study is to understand the rationale for the lack of interest to perform regular opportunistic oral cancer screening (OCS) by primary care providers (PCPs) and the challenges they have in incorporating OCS into their annual examination protocol. Method: Sequential exploratory mixed methods were used. Both qualitative and quantitative data from PCPs working at Nebraska Medicine were obtained. One-on-one in-depth interviews were performed to identify PCP's perceptions and challenges in performing OCS. The themes identified in the qualitative study were used as a guide in the development of survey questionnaires. The survey was emailed to all the PCPs (N=100), whose information was available on the Nebraska Medicine publicly accessible website. Results: The response rate was 34%. Approximately 60% of the participants mentioned that they currently perform oral cancer screening, but only 3.8% of the providers answered that they were performing comprehensive oral cancer screening every time. Forty-eight percent of the providers identified time as the biggest challenge. Over 35.3% of the providers answered that they perform screenings for patients with a history of tobacco (i.e., smoking) or alcohol use. Conclusion: Around half of the participants identified lack of time as their primary challenge in performing OCS and lack of knowledge as their second main obstacle. Very few provided comprehensive OCS and visual examination of the oral cavity is the only step performed often.

Introduction: Identifying the complexity of palliative care needs is a key aspect of referral to specialised multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains, developed in 2018 and validated in 2023, to identify the level of complexity in patients with advanced cancer. Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. Method: An observational, prospective, multicentre study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were: a) instability ratio (IR), defined as the probability of level change or death; b) emergency department visits; c) days of hospitalisation; d) hospital death; e) survival. All variables were analysed monthly according to the level of complexity assigned at the baseline visit. Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group (p

Background: Parents of preterm infants face major mental health challenges in the Neonatal Intensive Care Unit (NICU). Family-centered music therapy actively integrates and empowers parents in their infant’s care. With the aim to better understand and address parental needs separately from their babies’, a music therapy (MT) self-care group was implemented as part of clinical practice at the hospital Clínica de la Mujer in Bogotá, Colombia. Methods: The group is provided for both parents twice a week in the NICU. Music guided relaxations, breathing techniques, and self-expression are at the center of the MT group sessions. Parents complete a pre/post self-administered Numeric Rating Scale (NRS) including anxiety levels, stress levels, mood and motivation. Results: Parents highly value the MT self-care group at the NICU. On average there is a 37% improvement in anxiety levels, 28% in stress levels, and 12% in mood, restfulness and motivation. Being able to relax, to distract themselves from their worries and having time for themselves are amongst the most frequently mentioned benefits. Conclusions: Addressing parents’ needs separately form their babies’ treatment with culturally sensitive interventions aimed to improve parental mental health, is essential for continuing the development of family-centered music therapy interventions in the NICU.

Collaborative action between families and health professionals, in this case nurses, doctors, nutritionists, pharmacies in forming harmonious support is the philosophy of family centered nursing care which aims to involve families as the main focus in care. The aim of this literature review is to identify family-centered family member care: a literatu review. This language method uses literature reviews which are summaries of 10 articles in the publication years of 2020-2021 on search 4 databased electronic searches containing namely Scopus, ProQuest, Pubmed, and Scient Direct. This review used prisms. The eligibility of these studies were from its title, abstract, research methodology, results and discussion. The results of the review were presented in narrative form. The results of a review of 10 articles found that the form family centered care Conclusion: The family is considered a partner in the care of other family members. The concept of family centered care is a philosophy in nursing where the role of the family is very important in caring for family members who are sick.

The aim of this study is to describe a research protocol of a multi-country randomized controlled trial to investigate the effect of a smartphone CBT stress management program on improving depression and other health- and work-related outcomes among hospital nurses in Vietnam and Thailand during the COVID-19 epidemic as a part of the COCONATS project. The study is a two-arm, parallel randomized control trial. Hospital nurses (N = 1,500) will be recruited in Vietnam and Thailand, and those who meet the criteria will be randomly allocated to the intervention or control (treatment as usual) group. A seven-week, seven-module smartphone-based stress management program will be developed to teach CBT skills. The intervention group will participate in the program for 10 weeks. Depression as the primary outcome will be measured using the DASS21 at baseline and in 3- and 6-month follow-up surveys. A mixed model repeated measures analysis will be used to test the intervention effect in the total combined sample, on an intention-to-treat basis. This is the first study to investigate the effectiveness of a self-guided smartphone CBT program on improving depression among hospital nurses using a RCT design in South-East Asian middle-income countries during the COVID-19 pandemic.

Complexity of care, adequate staffing levels, and workflow are key factors affecting nurses’ workloads. Clinical complexity classification and related staffing adjustment remain notable gaps in the current evidence limiting the capacity for optimal staffing practices. This study aimed to adapt and validate the WANNNT-SC to the Italian context to allow the assessment of newborns admitted to the NICUs. To evaluate the reliability of the tool among different profes-sionals, a correlation test was performed using Pearson’s correlation, which resulted in a strong correlation (r = 0.967, p = 0.01). In the test-retest phase, there was a significant correlation (r = 0.910 and p = 0.01). Using an analysis of variance, we found that the higher the I-WANNNT-SC score, the higher the predicted death rate (F = 13.05 and p < 0.001). The Italian Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool represents the first tool available for the Italian context that aims to measure the nursing workload in neonatal intensive care. It could allow adjustments in nursing staffing based on NICU activities and patient needs. This study was prospectively approved by the local Ethics Committee “Palermo 1” (Protocol CI-NICU-00).

Objectives: Imaging exams are requested in intensive care units as a diagnostic, evaluation, and clinical monitoring method. While Chest Computed Tomography is the gold standard, Chest X-ray is the exam usually performed in routine care. Lung ultrasound has been gaining ground as it is a reliable exam performed at the bedside without exposure to radiation and at a low cost. This study aimed to evaluate the accuracy of bedside lung ultrasounds performed by pediatric intensivists as a diagnostic method. Methods: A prospective, diagnostic test-type study comparing bedside lung ultrasound performed by a pediatric intensivist with the evaluation of chest X-ray and lung ultrasound performed by a radiologist. Result: 48 patients on mechanical ventilation, aged from 1 month to 14 years, were analyzed, corresponding to 95 chest X-ray exams and 95 lung ultrasound exams. The Kappa agreement coefficients between the pediatric intensivist and the radiologist, both analyzing the lung ultrasound, were: normal report (1.0), atelectasis (1.0), pneumothorax (1.0), consolidation (0.97), pleural effusion (0.95), and pulmonary edema (0.90). Sensitivity, specificity, and accuracy of lung ultrasound were, respectively, normal report (50%; 91.8%; 82.1%), consolidation (88.3%; 57.1%; 76.8%), atelectasis (11.1%; 90.7%; 83.2%), edema (0; 70.2%; 70.5%), pneumothorax (83.3%; 94.4%; 93.7%), and pleural effusion (71.4%; 73%; 72.6%). Conclusion: The pediatric intensivist was skilled in examining and diagnosing lung injuries. Lung ultrasound showed good sensitivity, specificity, and accuracy when the pediatric intensivist performed when diagnosing consolidation, pleural effusion, and pneumothorax. Furthermore, lung ultrasound demonstrated better accuracy in evaluating pulmonary edema when compared with chest X-ray.

Over the past few decades, digitalisation has pushed patient care towards a new era, inducing the evolution of health care delivery and enhancing the overall sustainability of health systems worldwide. Despite the ever-evolving technology leading to a change in health care provision, the uptake of these novel technologies by medical professionals is slow, largely because of concerns about the potential impact on patient care and patient safety, and medico-legal implications. Hence, this research aimed to understand doctors’ perceptions of the adoption of digital virtual consultations in the practice setting.In this survey, an online questionnaire, adapted from the construct by Venkatesh and Bala and based on the Technology Acceptance Model by Davis, was distributed to 886 hospital doctors. Altogether 133 responses were obtained.Results suggest that the respondents perceived digital virtual consultations as adjuncts to face-to-face consultations and as able to diminish time and place barriers. Doctors were willing in principle to utilise these alternatives to traditional methods if the appropriate infrastructure and technology were in place. Feasibility and cost-effectiveness studies are recommended to establish the technology-fit factor and the impact of the technology on the workforce, coupled with a stakeholder analysis to include all the actors involved in such a strategy.

In this paper, we propose a novel approach named EmbedHDP to enhance the evaluation models used to assess sentence suggestions within nursing care record applications. The key focus is determining whether these suggestions garner assessments that align with caregivers as human evaluators. It is crucial due to the direct relevance of the information provided to the health or condition of the elderly. The motivation behind this proposal stems from challenges observed in previous models, such as BERTScore, which encountered difficulties in effectively evaluating the nurse care record domain, consistently providing quality assessments of generated sentence suggestions above 60%. Additionally, while widely used, cosine similarity exhibits limitations concerning word order, leading to potential misjudgments of semantical differences within similar word sets. Similarly, relying on lexical overlap, ROUGE tends to overlook semantic accuracy. Furthermore, despite its utility, BLEU neglects semantic coherence in its evaluations. EmbedHDP excels in evaluating nurse care records by effectively handling a variety of sentence structures and medical terminology and providing differentiated and contextually relevant assessments. We used a dataset comprising 320 pairs of sentences with correspondingly equivalent lengths. The results revealed that EmbedHDP outperformed other evaluation models, achieving a coefficient score of 61%, followed by cosine similarity with a score of 59%, and BERTScore with 58%. This shows the effectiveness of our proposed approach in improving the evaluation of sentence suggestions in nursing care record applications.

Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.

Introduction. The outbreak of the COVID pandemic was a period of uncer-tainty and tension for healthcare managers, resulting from the lack of knowledge, i.e. about the transmission of the virus, but also from the lack of uniform organisational and treatment procedures. It was the period where the ability to prepare to a crisis situation, to adapt to the existing conditions and to draw conclusion from the situa-tion were critical to keep ICUs operating. The aim of this study was to show the prep-aration of an ICU in Poland to ensure resilience, and also the methods of reacting dur-ing the COVID-19 pandemic on both central and local level. Methods. Based on the EC and WHO guidelines on resilience a matrix of 6 elements and 13 standards as-signed to them was created, with a series of questions from a survey questionnaire. Results. Good management in resilient systems is free access to any resource. A free and transparent flow of information and also well motivated human resources in an appropriate number. Conclusion. Appropriate preparation, adaptation to the existing situation and effective management of crisis situations is an important element of ICU resilience.

The different waves of the COVID-19 pandemic caused dramatic issues regarding the organiza-tion of care. In this context innovative solutions have to be developed in a timely manner to adapted the organization of the care. The establishment of middle care (MC) units is a bright example of such an adaptation. A multidisciplinary MC team, including expert and non-expert respiratory nurses, physicians, physiotherapists, psychologists, nutritionists and social workers, was built and trained to work in the COVID-19 MC unit. Important educational resources were set up to ensure rapid and effective training of the MC team, limiting the admission or delaying transfers to ICU and ensuring optimal management of palliative care. We conducted a retrospec-tive analysis of patient data in the MC unit during the second COVID-19 wave. Fifty-two COVID-19 ‘step-up’ patients admitted to the MC unit were included in the study. Thirty-four (65%) patients worsened, of which 12 (23%) were not eligible for ICU access. In total, 42% of the ICU-eligible patients were managed in the MC unit to avoid the ICU. Among the 22 patients transferred to the ICU, 15 were intubated. The establishment of an MC unit during a pandemic, mixing expert and non-expert respiratory team members, is feasible and needed. MC units possi-bly relieve the pressure exerted on ICUs. A highly trained multidisciplinary team is key to ensur-ing the success of an MC unit during a pandemic.

The utilization of person centered care is highlighted as essential for health promotion, yet implementation has been inconsistent and multiple issues remain. There is a dearth of applied re-search exploring the facets of successful implementation. In this paper, a person centered wellbeing program spanning various groups is discussed outlining the central principles that have allowed for successful outcomes. The main data emerges from 10 years of pragmatic pre-post service evaluation. Measures of functional capacity and wellbeing were captured using validated measures. The method for this paper is a narrative exploration of the theory and practices that can explain the continual improvement the clinics have achieved over 10 years. Core principles relate to connecting with people, connecting through groups, and connecting with self. The operationalization and theoretical explanation of these principles is outlined alongside 10 years of data which shows sustained improvement in a range of outcomes. The discussion of these principles posits essential factors to prioritize to advance the implementation of person centered care in health promotion for long term conditions.

While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low resource countries. In Kenya, a large body of research studies or has studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HWCs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identify four areas connected to the delivery of disrespectful care including poor infrastructure, understaffing, service users’ socio–cultural beliefs, and health care workers’ attitudes toward marginalized women. Investments are needed to address health systems influences on DMC including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing stigma and discrimination of pregnant women due to socio-economic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women’s poor experiences of facility based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socio-economic inequities as well as the structural and policy features that contribute and determine peoples’ behaviors and choices.

(1) Background: Nursing homes’ preparedness in managing a public health crisis has been fragile, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in Southern Portugal, including personnel’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey to personnel was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the personnel survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were fragile areas among nursing homes’ contingency plans. We identified compliance with procedures and nonpunitive response to mistakes as fragile areas of safety culture, and teamwork as a strong safety area. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.

A new model for international bed numbers is applied to local area populations for English Clinical Commissioning Groups (CCGs) where the Age Standardized Mortality Rate (ASMR) is used as a measure of population health and hence for total occupied hospital bed demand (elective plus emergency admission types, including acute, rehabilitation, mental health, and maternity), rather than simple bed availability. A 100-unit increase in ASMR (European Standard population) leads to a 15.3 – 30.7 (feasible range) unit increase in occupied beds per 1,000 deaths. ASMR shows why the Australian states of the Northern Territory and Tasmania have an intrinsic higher bed demand than the other states – although in both cases the bed planning methodologies failed to indicate this need and both states show a large bed deficit. Due to the high volatility in bed demand the average bed demand for 2019 was determined by a linear trend using data for 2014/15 to 2019/20 — as the pre-COVID-19 baseline. The slope of the relationship between occupied beds per 1,000 deaths and deaths per 1,000 population shows a power law function. As is to be expected there is scatter around the trend line which will partly arise from uncertainty in the expected occupied beds in 2019, fluctuations in both ASMR and deaths per 1,000 population from one year to another, changes in the number of persons on the elective, outpatient and diagnostic waiting lists, and local area variation in births and consequently upon maternity, neonatal and pediatric bed demand. Additional variation in bed demand will arise from differences in the level of funding for social care, especially elderly care, and to a lesser extent upon patients using private health care, and charitable hospices for palliative care. However, after including the change in bed demand arising from ASMR the model is sufficiently accurate to identify gross differences in bed demand as a prelude to further investigation. The model requires further extension to cover specialty-level demand, and perhaps segregation between elective and emergency types of inpatient demand. A method for benchmarking the whole hospital’s average bed occupancy is given which enables them to run at optimum efficiency and safety. Using this method English hospitals can be shown to operate at highly disruptive and unsafe levels of bed occupancy leading to deleterious ‘turn-away’. Turn-away implies bed unavailability for the next arriving patient. The problems associated with crafting effective bed planning are illustrated using the English NHS as an example.

Digital weight-loss services (DWLSs) that supplement continuous lifestyle coaching with Semaglutide therapy have shown promise in delivering continuous and effective obesity care. However, the extent to which lifestyle coaching approach and Semaglutide brand influences patient engagement and program effectiveness is unknown. This study retrospectively analyzed several engagement markers and weight loss percentage over 16 weeks in a large Semaglutide-supported DWLS in the UK. The comparative analysis found that patients who received lifestyle coaching that was proactive and personalized sent a statistically higher number of messages to their health coach (M=19.37 vs M=8.55) and opened the program app more frequently (M = 49.31 days vs M = 40.06 days) than patients whose coaching was reactive and standardized. Mean 16-week weight-loss was 10.1% in the proactive group compared to 8.9% in the reactive group, but the difference was not statistically significant. A two-sample t-test found that female patients (M = 9.76) tended to lose more weight than male patients (M = 6.88), (t(152) = 1.89 , p = 0.04). The findings add vital layers of nuance to the emerging literature on Semaglutide-supported DWLSs, indicating that a proactive, personalized coaching approach leads to better patient engagement with DWLS health coaches and that Wegovy has a comparable effect to Ozempic as a supplement to DWLS coaching. Future research should seek to conduct comparable investigations of other obesity services and over a longer period.

The present study examines the long-term care service awareness, needs, and usage intention of elderly male homosexuals in Taiwan and their ideal long-term care service model. This study of five elderly male homosexual subjects aged 66 to 73 years was intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects had high awareness of long-term care services, as they had actual experience of long-term care services or even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and experienced problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to use home care services if they required long-term care services. Due to their personal experiences, the subjects had negative awareness of long-term care services and worried that long-term care service staff had poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects’ sexual orientation or stereotypes, and they were concerned above all about the “friendly attitude” of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, and they felt that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against . With regard to ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, the situation and care needs of homosexuals, and care techniques for homosexuals.

Artificial intelligence (AI) has grown in healthcare in recent years. The UK government recognises AI’s potential to enhance NHS services, yet research on AI in primary care (PC) has received limited attention. AI acceptance presents unique challenges in PC, characterised by fragmented structures, heterogeneous data sources, and multiple government departments. The organisational levels within PC are categorised as macro, meso, and micro levels. Existing research has predominantly focused on micro-level stakeholders. Our online survey addressed this research gap by encom-passing stakeholder perspectives at all levels. The results demonstrate the critical role of me-so-level stakeholders in facilitating AI acceptance. Importantly, a lack of understanding of AI terminology and concepts, concerns over potential job displacement, and the importance of em-pathy in patient care are highlighted as key challenges. Stakeholders also express the need for standardised AI terminology, comprehensive training, and regulatory standards to ensure equi-table and effective AI utilisation. This study lays the foundation for future in-depth interviews and further exploration of AI's role in PC. Observations in secondary care indicate that practitioners have substantial concerns about AI, how it works, and its limitations. Explainable AI can help technologists address such concerns, but first, we need to understand primary care's information needs.

Mood and anxiety disorders affect pregnant people and their families at increased rates throughout the perinatal period. Geographic, financial, and social barriers persist in identification and access to care that preclude adequate diagnosis and treatment of anxiety and mood disorders. These challenges have been exacerbated by the COVID-19 pandemic, particularly for Black and Indigenous People and People of Color (BIPOC) who already experience increased risk for adverse mental health outcomes and faced structural barriers to accessing perinatal mental health care at baseline. The literature shows that integrated care can improve mental health outcomes and save billions of dollars in annual healthcare costs. This study evaluated a novel statewide integrated care effort designed to facilitate access to perinatal mental health care for OB/GYN patients. In addition to enrollment data, variables studied were maternal program satisfaction, retention rates, and preliminary maternal mental health outcomes. 285 patients were ever referred for care. Of this, we contacted 259 patients (91%) and enrolled 209 (72%). Of the 209, 48 were lost to follow up, while 107 remained enrolled at the time of data analysis. 54 patients met their treatment goals. 97% of individuals asserted they were satisfied with the services they received. Black race and public insurance predicted faster attrition from treatment; risk for interpersonal violence exposure and substance use were not related to attrition. Preliminary mental health outcomes showed significant decreases in anxiety and depression, with the most dramatic decreases in the first month of treatment. The MC3 Perinatal care program is a viable, patient-endorsed collaborative care model that increases access to perinatal mental health and facilitate access to outside resources.

Background: The importance of community health psychology in providing complex bio-psycho-social care is well-documented. We present a mixed-method study monitoring the efficacy of health psychology services in the Public Health Focused Model Program for Primary Care Development (2012-2017) in four disadvantaged micro-regions in North-East Hungary. Methods: Study 1 assessed the availability of the services using a sample of 17003 respondents. Study 2 applied a follow-up design to measure the efficacy of the health psychology services in a sample of 132 clients. In Study 3, we conducted focus group interviews to assess clients’ lived experiences. Results: More mental health issues and higher education predicted a higher probability of service use. Follow-up showed that individual and group-based psychological interventions resulted in lower depression and (marginally) higher well-being. Thematic analysis of the focus group interviews indicated that participants deemed topics like psychoeducation, a greater acceptance of psychological support, and heightened awareness of individual and community support important. Conclusions: The results of the monitoring studies demonstrate the important role health psychology services can play in primary health care in disadvantaged regions. Community health psychology can improve well-being, reduce inequality, support the population’s health awareness, and address unmet social needs in disadvantaged regions in Hungary.

AIM: Aim of our study was to evaluate incidence and causative factors for acute kidney injury in gastrointestinal and hepatobiliary surgeries. Material and methods: All the gastrointestinal surgeries performed between April 2018 to March 2020, in our institution have been analysed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi square test and continuous variables by Mann Whitney U test. Statistical analysis was done using SPSS version 23. P< 0.05 was considered significant Results: We performed 331 gastrointestinal and hepatobiliary surgery from April 2018 to March 2020. After exclusion 317 patients were included in study population.14 patients (4.4%) were defined as having acute kidney injury according to acute kidney injury network classifications. On univariate analysis acute kidney injury was associated with open surgery (p= 0.002, Intra operative hypotension (p=0.006), CDC grade of surgery (p<0.001), increased used to blood products (p=0.004), higher ASA grade (p<0.0001), increased operative time(p<0.0001). On multivariate logistic regression analysis higher ASA grade (p=0.001) and increased operative time (0.015) independently predicted acute kidney injury. Acute kidney injury was also significantly associated with 90 days mortality. ( p= <0.0001) Conclusion:Post-operative acute kidney injury was associated with significant mortality in gastrointestinal and hepatobiliary surgery. Open surgery, higher CDC grade surgery, more blood products, higher ASA grades, increase operative time predicted acute kidney injury in post operative periods. Higher ASA grades and increased operative time predicted acute kidney injury.

We consider the financial planning problem of a retiree wishing to enter a retirement village at a future uncertain date. The date of entry is determined by the retiree's utility and bequest maximisation problem within the context of uncertain future health states. In addition, the retiree must choose optimal consumption, investment, bequest and purchase of insurance products prior to her full annuitisation on entry to the retirement village. A hyperbolic absolute risk-aversion (HARA) utility function is used to allow necessary consumption for basic living and medical costs. The retirement village will typically require an initial deposit upon entry. This threshold wealth requirement leads to exercising the replication of an American put option at the uncertain stopping time. From our numerical results, active insurance and annuity markets are shown to be a critical aspect in retirement planning.

The intensive care units in North West London are part of one of the oldest critical carenetworks in the UK, forming a mature and established strategic alliance to shareresources, experience and knowledge for the benefit of its patients. North WestLondon saw an early surge in COVID-19 admissions, which urgently threatened thecapacity of some of its intensive care units even before the UK government announcedlockdown. The pre-existing relationships and culture within the network allowed itsmembers to unite and work rapidly to develop agile and innovative solutions, protectingany individual unit from becoming overwhelmed, and ultimately protecting its patients.Within a short 50-day period 223 patients were transferred within the network todistribute pressures. This unprecedented number of critical care transfers, combinedwith the creation of extra capacity and new pathways, allowed the region to continue tooffer timely and unrationed access to critical care for all patients who would benefitfrom admission. This extraordinary response is a testament to the power and benefitsof a regionally networked approach to critical care, and the lessons learned maybenefit other healthcare providers, managers and policy makers, especially in regionscurrently facing new outbreaks of COVID-19.

For Attention Deficit/Hyperactivity Disorder (ADHD) youth transitioning from child to adult services, protocols that guide the transition process are necessary. While some guidelines are available, they do not always consider effective workload and scarce resources. In Italy, there are currently very few guidelines available, and they do not adhere to common standards, possibly leading to a non-uniform use. The present study analyzes 6 protocols collected from different services for ADHD patients that took part in the TransiDEA (Transitioning in Diabetes, Epilepsy, and ADHD patients) Project. Their content is described in parallel to the National Institute for Clinical Health and Excellence (NICE) guidelines. While there are some strong points and several common core elements, a need emerges to standardize practices and to make them more adherent to patients’ needs and to the resources available to clinicians.

The Dutch PET@home Toolkit was developed to mitigate challenges and foster conversations and planning concerning pets in long-term care at home. This process evaluation study aimed to evaluate the practical application of the toolkit on four topics: 1) satisfaction; 2) relevance; 3) feasibility; and 4) integration of the PET@home Toolkit materials in home care. Outcomes may be used to improve the toolkit materials to better align with the long-term care at home setting. Accounting for data saturation, professional caregivers (N=6), clients (N=2), and family caregivers (N=2) who used toolkit materials participated in semi-structured interviews. Interviews were analysed by two researchers in ATLAS.ti using an inductive-iterative approach. The researchers reached consensus on themes and clustering within interview topics. This led to the identification of the following topics and (themes): satisfaction (general impression, suggestions for improvement), relevance (awareness, planning, pet-related aspects in practice, impact on healthcare quality), feasibility (healthcare practice, competence, quantity), and implementation (digitalisation, task owner, piloting, timing). Several improvements were made to toolkit materials, such as providing clearer instructions for clients in the information booklet. Participants acknowledged the toolkit could lead to better planning while mitigating potential challenges concerning pets which may lead to longer-lasting relationships between clients and their pets.

Background/Objectives: Home and community care (HCC) nurses experienced increased occupational challenges during the COVID-19 pandemic including increased workloads, job stressors and occupational risks like virus exposure. The objective was to elucidate what factors influenced nurses’ decisions to stay in their role, take a temporary leave, or exit HCC during the COVID-19 pandemic. Methods: A secondary analysis of data collected using a cross-sectional online open survey distributed among HCC Registered Practical Nurses across Ontario between June and September 2022 was conducted. The factors contributing to nurses’ decision to remain in HCC, temporarily leave, or exit the sector were evaluated using multinomial logistic regression (p < 0.05). Results: Of the 664 participants, 54% (n=357) stayed in the HCC sector, 30% (n=199) temporarily left, and 16% (n=108) exited the sector. Nurses with greater years of experience working in HCC and those who avoided infection were more likely to stay in their role in HCC, which may reflect strong relationships with long-term clients, opportunity and accumulated experience to increase income, and maintained good health. Nurses with higher levels of emotional intelligence were more likely to take leaves and exit HCC, suggesting that stepping away may have been a strategy to safeguard themselves. Conclusions: HCC leadership should prioritize the development of solutions to support nurses in the HCC workforce, including those with fewer years’ experience. This may promote nurses’ participation in the sector, particularly during times of heightened occupational challenges and crises like COVID-19.

Introduction: Rural Americans face significant health disparities due to limited access to healthcare services. Telehealth has emerged as a promising solution to mitigate these disparities by facilitating remote access to medical care. This paper comprehensively reviews the advantages, challenges, and implementation strategies of telehealth in rural areas.Method: A narrative review methodology was employed to synthesize existing literature and case studies on telehealth in rural settings. Databases such as PubMed, Google Scholar, and JSTOR were searched for relevant studies published in the last three decades. Keywords such as "telehealth," "rural health," and "healthcare disparities" guided the search process. The review focused on studies assessing the impact of telehealth on healthcare access, cost-effectiveness, and quality of care in rural areas.Results: The review findings indicate that telehealth significantly enhances healthcare access by reducing travel distances, increasing availability of specialist consultations, and promoting patient engagement. It improves chronic disease management and patient satisfaction by enabling convenient access to healthcare services at home. Despite initial setup costs and challenges such as broadband access and regulatory issues, telehealth demonstrates long-term cost savings through reduced travel expenses and improved healthcare efficiency. Quality of care is enhanced through improved communication between healthcare providers and patients, leading to better treatment adherence and health outcomes.Conclusion: Telehealth represents a transformative approach to address healthcare disparities in rural areas. It offers a cost-effective solution to improve access to healthcare services, enhance patient outcomes, and reduce healthcare costs in the long run. However, successful implementation requires addressing infrastructure challenges, refining reimbursement policies, and ensuring regulatory support. Future efforts should focus on expanding broadband infrastructure, refining policy frameworks, and conducting further research to optimize telehealth's impact on rural healthcare delivery.

Background: Virtual care adoption accelerated during the COVID-19 pandemic, highlighting the need for healthcare professionals to develop relevant competencies. However, limited evidence exists on the core competencies required for quality virtual care delivery. Objective: This study aimed to identify the critical competencies physicians, nurses, and other health professionals need for adequate virtual care provision in Saudi Arabia using a Delphi method. Methods: A 3-round Delphi technique was applied with a panel of 42 experts, including policymakers, healthcare professionals, academicians, and telehealth specialists. In round 1, an open-ended questionnaire elicited competencies needed for virtual care. Competencies were distilled and rated for importance in rounds 2 and 3 until consensus was achieved. Results: Consensus emerged on 151 competencies across 33 domains. The most prominent domains were communication (15 competencies), professionalism (13), leadership (12), health informatics (5), digital literacy (5) and clinical expertise (11).

Keywords: renal replacement therapy. Point-of-Care Ultrasound; intensive care; acute kidney injury; nephrologist.Point of care ultrasonography (POCUS) is gaining heightened significance in critical care settings as it allows for quick decision making at the bedside. While computerized to-mography is still considered the standard imaging modality for many diseases, the risks and delays associated with transferring a critically ill patient out of the Intensive Care Unit (ICU) have prompted physicians to explore alternative tools. Ultrasound guidance has increased safety of invasive procedures in the ICU, such as the placement of vascular catheters and drainage of collections. Ultrasonography is now seen as an extension of the clinical examination, providing quick answers for rapidly deteriorating patients in the ICU. The field of nephrology is increasingly acknowledging the value of diagnostic Point-of-Care Ultrasound (POCUS). By employing multi-organ POCUS, nephrologists can address specific queries arising during the diagnosis and treatment of patients with acute kidney injury. This approach aids in ruling out hydronephrosis and offering immediate information on hemodynamics, thereby consolidating patient data and facilitating the development of personalized treatment strategies.

The oral health of older individuals can be negatively impacted by various systemic health factors, leading to rapid oral health deterioration. Older people are at risk of experiencing adverse reactions to medications due to multimorbidity, polypharmacy, and changes in pharmacokinetics and pharmacodynamics. Hyposalivation, a significant side effect of some medications, can be induced by both the type and number of medications used. Frailty, disability, sarcopenia, care dependency, and limited access to professional oral healthcare can also compromise the oral health of older people. To prevent rapid oral health deterioration, a comprehensive approach is required that involves effective communication between oral healthcare providers, other healthcare providers, and informal carers. Regardless of their health status, it is crucial to prioritize the well-being of older people. Oral healthcare providers have a responsibility to advocate for the importance of maintaining adequate oral health and to raise awareness of the serious consequences of weakened oral health. By doing so, we can prevent weakened oral health from becoming a geriatric syndrome.

Abstract The aim of this research is to conduct a systematic review analysing the role of the physiotherapy interventions in palliative care. PRISMA as a critical appraisal tool was utilised for the selection of the research articles. The inclusion criteria were based on the year of publication, ease of availability, language, geographical location, and study type. To ensure the credibility, databases such as Elsevier, Proquest, and EBSCO Host were used to filter the grey content. Data published in the past ten years (2009-onwards) was only included to ensure the selection of the most recent interventions used by the physiotherapists. A total of 11 articles were selected which determined that physiotherapy interventions involving breathing exercises, aerobic exercises, manual therapies, and educational awareness were critical to promoting the functional capability and empower the patients.

Objectives: The purpose of this systematic review was to ascertain critical care nurses’ understanding and experiences of patient advocacy in adult critical care settings. The specific objectives were to identify how critical care nurses define patient advocacy, to explore the understanding and experiences of critical care nurses regarding patient advocacy, to explore critical care nurses’ role in patient advocacy, and to ascertain the barriers to encouraging advocacy in the critical care setting. Research design: Systematic literature search of CINAHL and Medline databases, Google Scholar, and Cochrane Database of Systematic Reviews, as well as grey literature search, was conducted. Search dates were restricted from January 2005 to 2015 in both CINAHL and Medline. Findings: 62 studies were identified, of which 6 qualitative research papers were included. Nurses gave varied definitions of patient advocacy, which were categorized into three themes: communication, protection, and doing. Nurses perceive advocacy as truly listening to patients and their families. Conclusion: For critical care nurses to be effective advocates, there must be support, collaboration, and improved working relationship between professional groups. Moreover, nurses must be empowered to be able to give power to patients and family.

This paper investigates the effects of Inter-generational co-residence on health care market, and labor market outcomes, to see whether or not living under the same roof with at least one parent matters in health care market, and labor market behaviors in post-Affordable-Care Act (ACA) USA. The adopted analytical strategy involves not only looking at the gender differences in co-residence, and its effects on outcomes in the two markets, but also accounting for co-residence endogeneity following the recent literature. Unlike the recent literature that relies on instrumental variables methods, this study adopts a switching regression approach, defining inter-generational co-residence as an endogenous selection process using a binary probit equation, and modeled jointly with the extensive margins and intensive margins in the two markets. This novel approach results in a recursive trivariate probit model for each market, and estimated using penalized maximum likelihood methods. The results suggest that ACA by reorganizing the US health care market, seems to have reduced significantly disparities in health care access among males and females based on race, region of residence, place of birth, and citizenship. However not only do we observe significant differences in inter-generational co-residence status between males and females, we also find significant inequalities in the effects of co-residence on health care market, and labor market outcomes. In fact, co-residence is found to increase health care expenditure by 56.7% among females, while this figure increases to 74.2% among males. In addition co-residing individuals, while spending 69.7% more on health care annually are 1.22 times more likely to access health care, but 31% less likely to use health care intensively during the year. In the labor market, co-residence is found to reduce significantly hours of weekly labor supplied by 41% for females, and 55.6% for males. Furthermore co-residing individuals, while not significantly different in their likelihood of labor force participation, are 1.52 times less likely to work full time once they decide to participate, and also spend about 55.4% less time working in the labor market in post-ACA USA.

The West Pomeranian Anti-Crisis Package was an effective tool of the Voivodeship Executive Board of West Pomeranian self-government, which was used to combat and counteract and counteract the social and economic effects of the COVID-19 pandemic. The Anti-Crisis Package was prepared with a view to undertaking systemic, but also point-based measures in order to save and protect regional health care, entrepreneurs, the labour market, but also to use the existing social capital of non-governmental organizations involved in measures reducing the effects of the COVID-19 pandemic. The West Pomeranian Anti-Crisis Package, as evidenced not only by the financial outlays incurred, but also by the outcome of implementing measures achieved in 2020 and their continuation in 2021.

Improving the quality and access to healthcare services in rural areas is fundamental to develop sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary care units that lack direct hospital or hospital-health center access. The research was conducted specifically in the rural islands of Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, unstable working environment, educational and organizational aspects, and insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.

Cystic Fibrosis is a chronic disease affecting multiple systems including the GI tract. Clinical manifestation in patients can start as early as infancy and vary across different age groups. With the advent of new highly effective modulators, the life expectancy of PwCF has improved significantly. Various GI aspects of CF care such as nutrition are linked to the overall improvement in morbidity, lung function, and quality of life of PwCF. The variable clinical presentations and management of GI diseases in pediatrics and adults CF should be recognized. Therefore, it is necessary to ensure efficient transfer of information between pediatric and adult providers for proper continuity of management and coordination of care at the time of transition. The transition of care is a challenging process for both patients and providers and currently, there are no specific tools for GI providers to help ensure smooth transition. In this review, we aim to highlight the crucial features of GI care at the time of transition and provide a checklist that can assist in ensuring an effective transition and ease the challenges associated with it.

The term dehumanisation refers to the ways in which a person is perceived to be less than human or treated as if they are less than human. It involves treating a person as if they are a child or infant, like an animal or non-living object, or as if they are dead, or any other way in which someone fails to be treated like a human being with an adult identity. Dehumanisation is widespread in dementia care; it is a major obstacle to person-centred care and has poor outcomes for people with dementia. This article proposes a new model of dehumanisation. The New Model presents a new way of describing dehumanisation that has been synthesised from current understanding about the phenomenon and reflects what is presently known about the subject. The model aims to summarise existing theories and models of dehumanisation and make dehumanisation theory accessible to students and trainees in healthcare. This article describes the new model, discusses existing models and theories in the literature, and explores the potential role of the new model in solutions for reducing dehumanisation in dementia care.

Background and Objectives: The Ventilatory Workload Kinetic Index (VWKI) has been proposed as a clinical instrument to evaluate ventilatory balance-imbalance. On the other hand, the regulated application of scales that allow an integral evaluation of the object of study and their subsequent reliability evaluation should be a continuous. The objective was determined the reliability of the VWKI between two evaluators and its applicability in the clinical field of physiotherapy. Materials and Methods: Methodology was divided into three stages: i) induction period, ii) application of the VWKI, and iii) reliability process. Results: The VWKI total score obtained excellent inter-rater reliability (ICC=0.913, p&lt;0.05). The airway resistance (AR) showed moderate inter-rater reliability (ICC=0.528, p&lt;0.05), while the use of accessory musculature (UAM) showed poor inter-rater reliability (ICC=0.483, p&lt;0.05). The physiotherapy care prioritization system, for both evaluator A (EA) and evaluator B (EB), the total VWKI score was significantly higher in priority 1 (p=0.001; p&lt;0.05, respectively). The Total VWKI score by services, it was observed that both EA and EB rated the VWKI significantly higher in the intensive care unit (ICU) than in Medicine and the other services (p=0.001, p=0.0001 and p&lt;0.05, p&lt;0.05, respectively). Conclusions: VWKI have of excellent reliability your the total score. Also, have consistency with the system of prioritization of physiotherapy care, and the ability to determine the severity of respiratory clinical pictures.

The combined use of lasmiditan and triptan is unexplored in medical literature. This study aimed to investigate whether the intake of lasmiditan following triptan improves migraine pain. Following triptan intake, if headache relief was less than 50% at 1 hour, patients took 50 mg lasmiditan within 2 hours of migraine onset. Patients recorded headache intensity and adverse events(AEs) caused by lasmiditan at 1, 2, and 4 hours after intake of additional 50 mg of lasmiditan. A significant reduction in pain scale was observed post 50 mg lasmiditan intake (p &lt; 0.001, t-test). Pain relief was reported for 32 migraine attacks (80%) at 1 hour after additional lasmiditan intake. Although AEs were observed in 63% of the patients who took an additional lasmiditan, most were mild and resolved 1 hour after lasmiditan intake. Our study revealed the significant headache reliefs provided by an additional lasmiditan for patients who did not achieve satisfactory results following initial triptan intake for treating migraine. The AEs associated with this treatment strategy were mild and lasted for a short term. This study suggested that the combination of triptan and lasmiditan is promising for the treatment of migraine and should be studied in a randomized placebo-controlled trial.

AbstractBackground: In digitalization era, health care system was conditioned with the health worker’s ability to adapt media of digital technology. Digital technology media was used to strengthening and fasted the health care for patient and community. Aims: This study aimed to explore the accurate information of health professional utilization digital technology during doing the job at the health facilities in Timor-Leste. Methods: This study was used correctional study with 56 respondents was participated in the study. Was collected the data from 1 to 30 February 2023. Was used questioner of google form based for data collection. Data collection was distributed via online with google form to social media as WhatsApp’s, email and face book and twitter to completed by respondents. The inclusive Criteria are: health professional living in Timor-Leste, to able response the questioner. Was used descriptive analysis in this study. Finding: This study was indicated that majority of health professional was participated in the study as 54,2% man then women have 45,8%. About 100% health professional used hand phone to facilitate their daily activities including related with their work activities. Other side indicated in digital technology tools use are able to use Microsoft word is 78,3%, able to use Microsoft Excel is 76,7% and able to use Power Point is 81,7%. E-mail use about 89,2%, WhatsApp’s use 81,7%, About 74,2% was used zoom/webinars/Google meet application, about 72,5% sad that they were used computer in the work place until now. Around 96.4% need to improve or deepen their knowledge and skills in using ICT in the future to facilitate they are activity. Conclusion: Majority of health professional in Timor-Leste was used the computer, internet, hand phone in daily activities. Majority need to gate the training to improve their knowledge, attitude and psychomotor in the future.

Primary Health Care is crucial in the healthcare system, being the first level of contact with health services for users and patients to take action using the available resources. Patient care units are created to facilitate direct user participation through the circuit of complaints, grievances, and suggestions, allowing the analysis of the population's unmet expectations and needs. To study complaints and grievances regarding the treatment and information received by users in the Santiago and Barbanza healthcare area during the year 2022. A descriptive cross-sectional study was conducted, in which complaints filed by patients in the year 2022 in the Santiago and Barbanza healthcare area were analyzed. A total of 326 users who filed a total of 512 complaints were studied in the year 2022, with 358 (70.0%) related to treatment/information. The mean age was 33.5±16.2 years. 72.4% were women (n=236). A Pearson correlation was performed to establish whether there was a dependence between the number of healthcare visits in both primary care and hospital settings in 2022 and the number of complaints filed in the same year. Pearson correlation coefficient was 0.14; 95% CI (0.02 - 0.27), p=0.012. There is a correlation between the number of consultations and the number of complaints filed. Frequent users are more likely to file a complaint. However, there is no correlation between the number of consultations and the likelihood of filing a complaint regarding treatment/information. Therefore, there seems to be a good relationship between healthcare personnel and users, which impacts patient satisfaction.

Introduction: Family-centered care (FCC) is currently taking a greater role in health care, due to the increasing empowerment of the parental experience. This literature aims to find out the study of the philosophy of child nursing services based on Family Centered CareMethode: The study of this literature through the search of scientific publications ranges from 201 7-2022. The databases used are Pubmed, Science Direct, and Proquest. The literature search was conducted according to the topic with four keyword groups based on Medical Subject Heading (MeSH) and combined with Boolean operators AND, OR and NOT, keywords Child AND Family AND Centered AND Care. Result: The study of the philosophy of child nursing services based on Family Centered Care is conducted based on the study of ontology, epistomotogi and axiology. Family-centered care (FCC) is a philosophy that emphasizes partnerships between parents and health care staff. The FCC's basic principles in neonatal intensive care units (NICs) are unlimited parental presence and parental participation, shared responsibility and decision-making about infant hospital care, and open communication between parents and staff. A family-centered treatment approach has benefits such as maintaining a bond between the child and the family, allowing the family to engage in child care, and minimizing the negative effects of hospitalization on the child and family.Conclusion: FCC is beneficial for nurses in terms of efficiency and effectiveness of time in the care process and increases professional satisfaction. Therefore, the implementation of the FCC is more effective and the satisfaction of clients and families is more increased.

Abstract: Appetite loss is common in older patients and an independent risk factor for sarcopenia, which is associated with high mortality. However, few studies have explored the phenomenon of appetite loss after discharge from the intensive care unit (ICU). Therefore, we aimed to describe the prevalence of appetite loss and the relationship between appetite loss and depression in patients living at home 12 months after intensive care. We conducted a post hoc analysis, which was a published ambidirectional study examining post-intensive care syndrome at 12 months after discharge. We included patients aged > 65 years. The Short Nutritional Assessment Questionnaire (SNAQ) and Hospital Anxiety Depression Scale (HADS) were used for the analysis. Descriptive statistics and a multilevel generalized linear model were used to clarify the relationship between appetite loss and depression. Data from 468 patients were analyzed. The defined appetite loss was 25.4% (95%CI, 21.5–29.4). High severity of depression was an independent factor for high probability of appetite loss (OR, 1.2; 95%CI, 1.14–1.28; p=0.00). Poor appetite is common 12 months after intensive care and is associated with the severity of depression.

Background: Nursing services provided by nurses are based on knowledge and competence in the field of nursing science developed in accordance with Client needs, scientific developments, and the demands of globalization. These health services include nursing services that are carried out responsibly, accountably, with quality, and safely by nurses who have obtained registration and permission to practice. Nursepreneur is innovation and courage to take risks and is ready to work hard to achieve goals with optimism. Which has important components namely: 1) quality, 2) role, 3) option and success. The post-pandemic new world, especially in the health care system, continues to grapple with the demands of costs to provide patient care and safety. By using the application of the nursing theory model. Purpose :. Assessing scientific studies on the application of evidence-based intervention in wound care using nursing theory, identifying the important role of telenursing in improving nursing services in Nerspreneurship, Method: literature study Conclusion: Telenursing in nursing focuses on providing nursing care through information technology, such as telephone, computers, and the Internet that can be used to improve treatment outcomes among older people, especially those with low literacy skills and low financial status (Esmaeilpour-BandBoni et al., 2020). The statement from the results of the study refutes that Telenursing is intended for patients who have higher education and middle and upper economic states.

Background: Accreditation is a qualitative assessment aimed at technical-professional quality, but above all, at organizational and measurable aspects through process and outcome checks. Method: There are few references in the literature relating to the accreditation and improvement of the quality and safety of care and treatment in the field of primary care. Clinical Governance must also be applied and certified in the field of primary care. Results: An accreditation system for general medicine is proposed based on a new dynamic model and implement that meets different requirements and assessed on the basis of indicators. Discussion: In the current Italian health system, accreditation of health structures is addressed only to public hospitals and private structures and to providers of services and services, however primary care. GPs / PLS do not have quality and safety guarantee systems or models or systems or public or private accreditation certifications with the SSR and SSN. Conclusion: Given the fundamental importance in the NHS of primary care of MG / PLS as the main and fundamental provider of services to the patient in all his socio-welfare and clinical needs, it is considered essential to think and implement an accreditation system extended to the territorial general practice as already present and in place for all affiliated and provider structures on behalf of the NHS.

Objective: To map the literature pertaining to adult Person-Centered Rehabilitation (PCR).Data Sources: Following our previously published scoping review protocol, data were identified through: three major databases, snowball searches and expert consultation.Study Selection: Two independent reviewers identified English-language papers which addressed adult physical rehabilitation and met one or more of the six pre-defined inclusion categories for PCR content. Data Extraction: Two independent reviewers extracted key characteristics of included papers (e.g. aims, methods, participants). Quantitative methods (descriptive statistics, regression analysis) and qualitative content analyses were used to synthesize the results. Data synthesis: Of 5084 unique records initially screened, 145 papers were included: 111 empirical, including 11 systematic reviews. Empirical papers had data from 13498 clients and 3849 providers, in total. Yearly publications grew exponentially from 2000 to 2017 (r²= 0.65; p<0.01). Publications were unevenly distributed by countries (e.g. United States’ publications per population size was 45 times lower than New Zealand’s). Most papers focused in more than one profession, setting-type or health conditions, respectively 57.2%, 66.2%, and 60.7%. Finally, more than half of the empirical papers (53.2%) studied implementation of PCR approaches, including its effect. Conclusion: This scoping review synthesizes key characteristics and publication trends in the PCR literature, which is mainly empirical and growing exponentially over time. Stakeholders can use the identified trends, gaps, and literature map to guide further PCR research, and both clinical and organizational practices. The high prevalence of papers focused on multiple professions, settings-type, or health conditions reinforces the need for developing a transdisciplinary, trans-service model of PCR, which will be derived from a thematic analysis of this body of literature.