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Acknowledgments: C. Paixão’s work is supported by Fundação para a Ciência e a Tecnologia (PhD grant SFRH/BD/148741/2019), Programa Operacional de Competitividade e Internacionalização – POCI, through Fundo Europeu de Desenvolvimento Regional - FEDER (POCI-01-0145-FEDER- 007628), and under the project UIDB/04501/2020. J. Cruz acknowledges the support of the Center for Innovative Care and Health Technology (ciTechCare), funded by Portuguese national funds provided by Fundação para a Ciência e Tecnologia (FCT) (UIDB/05704/2020). In this paper, we provide a brief overview of some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2022 European Respiratory Society (ERS) International Congress, which was held in a hybrid format. Early Career Members from Assembly 9 summarised the content of the sessions, with the support of the Officers from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: recent advances in cardiopulmonary exercise and challenge testing; the role and new trends in physiotherapy, exercise and physical activity promotion interventions in chronic respiratory diseases; development of the international curriculum for respiratory nurses and nursing aspects in disease management; and treatment adherence, e-health interventions and post Covid-19 challenges. This Highlights paper targets delegates who attended the Congress sessions, as well as those who were unable to attend, and provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals. info:eu-repo/semantics/publishedVersion

Purpose This study examined the effects of Fil-Rouge Integrated Psycho-Oncological Support (FRIPOS) in a group of women with breast cancer compared with a group receiving treatment as usual (TAU). Methods The research design was a randomized, monocentric, prospective study with three time points of data collection: after the preoperative phase (T0), in the initial phase of treatments (T1), and 3 months after the start of treatments (T2). The FRIPOS group (N = 103) and the TAU group (N = 79) completed a sociodemographic questionnaire, the Symptom Checklist-90-R (SCL-90-R) at T0; the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and EORTC QLQ-BR23 at T1; and SCL-90-R, EORTC QLQ-C30, and EORTC QLQ-BR23 at T2. Results A series of independent and paired t tests showed that patients in the FRIPOS group performed better on all scales related to symptomatic manifestations and on some quality of life scales (fatigue, dyspnea, and sleep disturbances) at T2. In addition, a series of ten multiple regressions were performed to predict each SCL subscale at T2 from the SCL score at T0 and the EORTC QLQ-C30 scores at T2. In nine of ten regression models (all except somatization), both FRIPOS group membership and QoL subscale contributed significantly to prediction. Conclusions This study suggests that patients in the FRIPOS group have more benefits in emotional, psychological, and collateral symptoms than patients in the TAU group and that these improvements are due to integrated psycho-oncology care.

This is the preregistration protocol for a scoping review on mental health diagnoses addressed in pediatric integrated care settings. Integrated behavioral health care has been increasingly implemented in the pediatric population. Up to half of pediatric patients struggle with mental illness and only 20% of that subset receive psychiatric treatment. It’s recommended to have around 47 Child and Adolescent Psychiatrists per 100,000 patients, however the average nationwide is around 10 per 100,000. (Axelson 2020). Furthermore, the timeliness of identifying appropriate interventions for supporting pediatric behavioral healthcare is imperative given the current national emergency declared in child and adolescent mental health (APA 2022). The current psychiatric work-force is underpowered to provide the behavioral health care alone. Despite institutional efforts to increase focus on mental health treatment, many primary care physicians still perceive a lack of training and confidence when treating mental health conditions (Horwitz et al). However, some studies have shown variability in the levels of provider comfort depending on which mental health diagnosis they are treating (Fremont et al; Pidano et al). While integrative care models have increasingly been studied in recent years, there is not yet a consensus on which mental health diagnoses are typically addressed in these models (Schlesinger et al). Given the wide range of pediatric mental health diagnoses it is crucial to understand the scope of integrative care in order to identify systemic gaps and expand services.

The prevalence of complex patients is on the rise. However, little attention has been paid to the process of providing care to complex patients and how this might be taught to residents. The aim of this scoping review is to map the extent and type of evidence for collaborative and integrated care as a means of caring effectively for complex patients, and as training required to equip physicians to care for complex patients.

Severe COVID-19 infection requiring oxygen support is reported to have high mortality. Chest Severity Score evaluated through CT scan has a predictive value about future outcomes in such cases. Score value ∼18 is predicted to have poor outcomes. We are presenting here a case of severe COVID-19 with all predictors suggestive of a bad prognosis including IL-6, D-Dimer, Ferritin and CRP in addition to 18/25 Chest Severity Score. Initially treated under ICU care at a tertiary care COVID hospital for about 14 days, the patient was intervened with Ayurveda on his own insistence seeing the unsatisfactory improvements. Ayurveda intervention for 19 days along with standard ICU care resulted in complete clinical recovery of the patient besides the correction of biomarker levels. Rapid clinical and biochemical correction in this severe COVID-19 case against all odds is highly significant and warrants an urgent search for possibility of instituting the integrative management strategies for all those treated in an allopathic facility. This case also advocates an early institution of Ayurveda interventions in COVID-19 in order to prevent deterioration leading to complications.

Purpose of Review The benefits of arts in improving well-being in end-of- life patients have been stated by the WHO. To inspire clinical practice and future research, we performed a mapping review of the current evidence on the effectiveness of art therapy interventions in stage III and IV cancer patients and their relatives. Recent Findings We identified 14 studies. Benefits reported by the authors were grouped as improved emotional and spiritual condition, symptom relief, perception of well-being, satisfaction, and helpfulness. As a body of evidence, notable limitations were observed: Only 1 study was a randomized controlled trial (RCT), and there was heterogeneity in the interventions and outcome measures. Summary This mapping review highlights the evidence available on the effectiveness of art therapy in advanced cancer, which remains limited and presents specific challenges. It also provides a visual representation of the reported benefits, encouraging further and more rigorous investigation.

Background Young people in secure services present with multiple vulnerabilities; therefore, transition periods are especially challenging for this group. In this study, we followed up young people discharged from adolescent medium secure services to adult and community settings with the aim to explore transition experiences and outcomes. Methods Participants were recruited from 15 child and adult mental health services in England. We conducted qualitative semi-structured interviews with 13 young people, aged 18–19 years, moving from adolescent medium secure units 2–6 months post-transition, and five carers 1–3 months pre-transition. Thematic analysis was performed to identify predetermined or data-driven themes elicited from face-to-face interviews. Results The findings indicated poor transition outcomes for young people with the most severe mental health symptoms and those who committed serious offences. Three overarching themes were identified: (1) unsettling environmental factors within adult services; (2) experiences of transition management and preparation and (3) parental experiences of transition process and engagement with adult services. Conclusion The findings of this study indicate that young people and carers value ongoing involvement in the transition process by well-informed parallel care. They also highlight the need for a national integrative care model that diverges from the traditional ‘one-size-fits-all’ approach.

Çalışma Sağlık Bilimleri Fakültesi’nde öğrenim gören öğrencilerin manevi destek algılarını etkileyen etmenlerin belirlenmesi amacıyla kesitsel ve tanımlayıcı türde yapılmıştır. Çalışmanın evrenini 2018-2019 Eğitim-Öğretim yılında Bursa Uludağ Üniversitesi Sağlık Bilimleri Fakültesi’nde öğrenim gören 802 öğrenci oluşturmuştur. Araştırmanın örneklemini ise 4 Şubat-4 Nisan 2019 tarihleri arasında araştırmaya gönüllü olarak katılan ve araştırma koşullarına uyan öğrenciler oluşturmuştur. Araştırma verileri toplanırken ‘Sosyodemografik Veri Toplama Formu’ ve ‘Manevi Destek Algısı Tespit Ölçeği’ kullanılmıştır ve araştırmadan elde edilen veriler SPSS-23.0 paket programı kullanılarak yapılmıştır. Verilerin değerlendirilmesinde Shapiro-Wilk Testi iki grup karşılaştırmasında Mann-Whitney U Testi ve ikiden fazla grup karşılaştırmasında Kruskal Wallis Testi kullanılmıştır. Öğrencilerin Manevi Destek Algı puan ortalaması 51.36±8.96’dır. Yapılan istatistiksel analiz sonucunda öğrencilerin yaşı, cinsiyeti ve hangi liseden mezun oldukları ile manevi destek algı puanları arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur (p

While the biopsychosocial nature of inflammatory bowel disease (IBD) is now well accepted by clinicians, the need for integrated multidisciplinary care is not always clear to institutional administrators who serve as decision makers regarding resources provided to clinical programs. In this commentary, we draw on our own experience in building successful integrated care models within a division of pediatric gastroenterology (GI) to highlight key considerations in garnering initial approval, as well as methods to maintain institutional support over time. Specifically, we discuss the importance of making a strong case for the inclusion of a psychologist in pediatric IBD care, justifying an integrated model for delivering care, and addressing finances at the program level. Further, we review the benefit of collecting and reporting program data to support the existing literature and/or theoretical projections, demonstrate outcomes, and build alternative value streams recognized by the institution (e.g., academic, reputation) alongside the value to patients. Ultimately, success in garnering and maintaining institutional support necessitates moving from the theoretical to the practical, while continually framing discussion for a nonclinical/administrative audience. While the process can be time-consuming, ultimately it is worth the effort, enhancing the care experience for both patients and clinicians.

Graphical Plain Language Summary Multiple sclerosis (MS) is a chronic disease in which the immune system attacks the central nervous system, causing inflammation and neurodegeneration. People living with MS may experience a variety of symptoms as a consequence of this process, including many “invisible” symptoms that are internally manifested and not seen by others. Of the invisible symptoms of MS, which we have reviewed in a companion article, mood and mental health disorders are of particular concern due to their high prevalence and significant impact on patient quality of life. In this review, we showcase the experiences of patient authors alongside perspectives from healthcare provider authors as we promote awareness of the common mental health conditions faced by those living with MS, such as depression, anxiety, adjustment disorder, bipolar disorder, psychosis, and suicidal ideation. Many of these conditions stem in part from the increased stress levels and the many uncertainties that come with managing life with MS, which have been exacerbated by the environment created by the coronavirus disease 2019 (COVID-19) pandemic. A patient-centered interdisciplinary approach, routine screening for mental health changes, and referral to specialists when needed can normalize discussions of mental health and increase the likelihood that people living with MS will receive the support and care they need. Management techniques such as robust social support, cognitive behavioral therapy, mindfulness-based interventions, and/or pharmacotherapy may be implemented to build resilience and promote healthy coping strategies. Increasingly, patients have access to telehealth options as well as digital apps for mental health management. Taken together, these approaches form an integrative care model in which people living with MS benefit from the care of medical professionals, a variety of support networks/resources, and self-management techniques for optimal mental health care.

Background: Distributive leadership has been proposed as an effective means towards achieving integrated health services. This study draws from the case of Foundry, a network of integrated youth health centres in British Columbia, Canada, and explores the function and impact of distributive leadership in the context of a large-scale effort towards integrated service delivery for youth experiencing mental health and substance use challenges. Methods: Qualitative data was obtained from a developmental evaluation of Foundry using a longitudinal, ethnographic approach. Over 150 participants involved in the development of six Foundry centres were interviewed individually or in focus groups. Purposive and theoretical sampling strategies were used to maximize the diversity of perspectives represented in the data set. Results and Discussion: Distributive leadership was observed to be a facilitator for achieving service and system-level integration. Distributive leadership was effective in promoting streamlined service provision, and coordinating efforts towards optimized access to care. A new culture of leadership emerged through collaboration and relationship-building based on a common value system to prioritize youth needs. Conclusion: As Foundry, and other integrated youth services, continues to expand, distributive leadership shows promise in assuring diverse and coordinated input for integrating services.

Background Flexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models. Methods A multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach’s α coefficient. Results Ten of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability. Conclusions The components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.

This review article proposes a model of integrative care for cardiovascular patients in institutional settings. We review relevant historic and contemporary examples of medical–chiropractic cooperation and a brief review of the literature illustrating the clinical benefits of chiropractic care for patients with cardiovascular disease. The groundwork proposes a distinct research and clinical practice model incorporating the doctor of chiropractic (D.C.) as a synergistic partner with the medical cardiologist coined the Kaleidoscope Model of Integrative Care (KM). While a traditional kaleidoscope does not alter the nature of light itself, the observer does see the ‘raw data’ of colors and shapes, wavelengths, etc. contained within the “potential” of the light itself; left unrecognized, even subtle re-orientations of the instrument changes the perspective. Similarly, the KM is intended as a conduit for slight reorientations to traditional medical–chiropractic–patient hierarchies, thus creating new treatment options and generating robust changes in inter-professional perception of the patient's condition(s) and treatment options. It is hoped that this model will not only serve future patients within hospitals, but that institutions will serve as incubators for better collaboration and research among the majority of free-standing medical and chiropractic practices ultimately benefitting the patient with cardiovascular disease. Keywords: Cardiology, Chiropractic, Heart failure, Integrative care, Translational medicine

Background Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment. Methods We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis. Results Participants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients’ access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5–10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable. Conclusions Participants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures. Trial registration ClinicalTrials.gov identifier: NCT03624829.

Metastatic cancer, especially in the growing population of geriatric patients, presents a big challenge to these patients, as well as to treatment teams and the entire health care system. This article describes some common medical problems faced by patients with metastases to liver and bone, and presents a diagnostic approach, and therapeutic management of various symptoms, relevant to advanced stages of the malignant disease. The article highlights the importance of patient education on various aspects of metastatic cancer, and underscores the unique position of pharmacists practicing pharmaceutical care, which is particularly beneficial in this group of patients with advanced malignancy. Also, this paper emphasizes that achieving a proper balance between managing the malignant disease and maintaining the patients’ quality of life, especially in the elderly population, should involve coordinated efforts of the oncology treatment team, primary care physicians, pharmacists, therapists and nurses, as well as patients, their families and caregivers.

Purpose For some years now, a programme for the use of integrative care in paediatric oncology has been established in a German university hospital and offers patients and parents complementary treatment options. According to their medical condition and wishes. A variety of external applications such as medical wraps, warm oil compresses and rhythmic embrocations are offered. This article analyses how patients and parents perceived and experienced the integrative care program. Methods In this qualitative study, data consists of field notes conducted through participant observation, informal conversations and interviews with parents (n = 25) during the implementation phase of the program. Data was analysed on basis of thematic analysis and organized with the analysis software MAXQDA. Results Parents and families intuitively developed strategies for dealing with crisis situations such as childhood cancer. In addition, many of the families brought with them a wealth of experience in complementary medicine. Parents perceived the integrative care treatments as soothing, relaxing and pain-relieving for their child. Patients could relax and side effects of chemotherapy were alleviated. However, children, who undergoing chemotherapy were not always open for physical touch and thus sometimes also rejected the treatments sometimes. Conclusion The analysed integrative care programme is perceived as a strong patient and family-centred approach of support during the oncological paediatric treatment. From a salutogenetic viewpoint, this program aims to strengthen the dimension of manageability within the concept of sense of coherence. Parents are given supportive means to manage side effects and ease their child’s suffering, through touch and attention that can be very beneficial.

The Republic of Croatia is in the process of establishing a palliative care system in all aspects of the health care system according to The National Program for Palliative Care Development 2017-2020. A curative and palliative treatment should be carried out simultaneously, from the time the diagnosis of life-limiting illnesses was made, as the illnesses progresses with reducing the share of curative treatment and increasing the proportion of palliative care. With the help of a well-organized palliative care system, the patient and family can have dignified care and quality of life. Still, a large number of health professionals are not even aware of the existence and option of palliative care. Therefore, it is essential that the National Program for Palliative Care Development also continues the education of palliative care that should include all health workers. Implementation of palliative care into the health care system is a long-term process, but important steps have been taken so far, especially in urban areas, Zagreb and Rijeka., U Republici Hrvatskoj u tijeku je proces uspostave sustava palijativne skrbi u sve elemente zdravstvenog sustava, prema Nacionalnom programu razvoja palijativne skrbi 2017.-2020. Od trenutka postavljanja dijagnoze bi trebalo paralelno provoditi kurativno i palijativno liječenje, s tim da se, kako bolest napreduje, smanjuje udio kurativnog liječenja, a povećava udio palijativne skrbi. Uz pomoć dobro organiziranog sustava palijativne skrbi bolesnik i obitelj mogu imati zadovoljavajuću skrb i kvalitetu života. Još uvijek velik broj zdravstvenih djelatnika nije upoznat s postojanjem i opcijom palijativne skrbi. Stoga je bitno da se po Nacionalnom programu razvoja palijativne skrbi provede i nastavak edukacije iz palijativne skrbi koja bi trebao uključiti sve zdravstvene radnike. Implementacija palijativne skrbi u sustav zdravstva je dugotrajan proces, ali već do sada su učinjeni značajni koraci, naročito u urbanim sredinama, Zagrebu i Rijeci.

Rationale: This report describes interdisciplinary rehabilitation for a 51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and multiple comorbidities following an automobile accident. Patient concerns: The patient was admitted to a rehabilitation specialty hospital approximately 2 months post SCI and 2 separate surgical fusion procedures (C3–C6). Diagnoses: Clinical presentation at the rehabilitation hospital included moderate to severe motor strength loss in both upper and lower extremities, a percutaneous endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence, dependence on a mechanical lift and tilting wheelchair due to severe orthostatic hypotension, and pre-existing shoulder pain from bilateral joint degeneration. Interventions: The interdisciplinary team formally coordinated rehabilitative care from multiple disciplines. Internal medicine managed medications, determined PEG removal, monitored co-morbid conditions, and overall progress. Chiropractic care focused on alleviating shoulder and thoracic pain and improving spinal and extremity mobility. Physical therapy addressed upright tolerance, transfer, gait, and strength training. Occupational therapy focused on hand coordination and feeding/dressing activities. Psychology assisted with coping strategies. Nursing ensured medication adherence, nutrient intake, wound prevention, and incontinence management, whereas physiatry addressed abnormal muscle tone. Outcomes: Eleven months post-admission the patient's progress allowed discharge to a long-term care facility. At this time he was without dysphagia or need for a PEG. Orthostatic hypotension and bilateral shoulder pain symptoms were also resolved while bowel/bladder incontinence and upper and lower extremity motor strength loss remained. He was largely independent in transferring from bed to wheelchair and in upper body dressing. Lower body dressing/bathing required maximal assistance. Gait with a 2-wheeled walker was possible up to 150 feet with verbal cues and occasional stabilizing assistance. Lessons: Several specialties functioning within an interdisciplinary team fulfilled complementary roles to support rehabilitation for a patient with SCI.

Introduction : The project arises from the need to make healthcare systems more efficient, at the same time respond to the population suffering from complex wounds, through a new integrative care model in complex wounds of interdisciplinary clinical care delivery units. After analysing the existing models to address this kind of problem, of a designed structure that seeks to define an optimized model characterized by patient centralization, integrated care, efficient management practices, multidisciplinary competence team and; the resulting model would be designed with the active involvement of stakeholders and policy makers with the objective of guaranteeing the widest possible applicability. Complex wounds are a relevant problem within the existing population in the different levels of care. It is important to note, that it is a multifactorial problem. The approach of these wounds is a great challenge for healthcare teams. Main Objective : Define an innovative integrative care model in complex wounds by interdisciplinary units and management models. Secondary Objectives : Analyse the efficiency of this model, the approach and management of patients with hard-to-heal wounds. Method : The differential diagnosis is the first key in this process. Complex wound units perform accurate filtering of each case, and can make referrals to the indicated specialist, but controlling patients, from its entry into the system until the resolution of the problem. In this way the possible drawbacks or jamming that could arise in the circuit may be detected. The established care plan is agreed and adapted to the individual needs of each patient, always supported by a skilled professional. The empowerment of patients in their health care is the second key to not abandon the plan of care. The team of specialists includes different disciplines, such as: Plastic and Reconstructive Surgery, Vascular Surgery and Angiology, Internal and Infectious Medicine, Dermatology, Nutritionist and Expert Nursing Team. Results : This Project began in February 2013 closing the year with 325 patient visits (n: 44) data that was exceeded in 2014 with 738 visits (n: 81). In September of the current year, we’ve already reached 900 visits. The average time of evolution of the lesions on arrival to the system (retiring three cases that broke the norm with 15, 9 and 8) were around 12 months, while the average problem resolution time ranged from 2 months. In 2013 we managed to resolve 68% of cases, while 2014 ended with 81% of cases resolved. There were several correlated variables that could be of interest in this part of the study very motivating for future studies DISCUSSION : It's important to have a clinically effective and cost-effective allocation of health resources, decisions on treatment and prevention of wounds as a result. Reduce length of patient hospital stays. Promote preventive measures that allow reducing the prevalence. The scope of the parameters to be considered, favours the development of an archetype with a high transfer potential to other unit types. Streamline demand improving hospital and primary healthcare. Offer support to care centres so that they can become self-sufficient. Reduce queries of specialized patients derived incorrectly. Nursing plays a new role (in Spain): "Advanced Nursing" may require changes in legislation and regulations to eliminate barriers in the practice. This model of integrated care, works in several fields. A horizontal integration between health services, social services and other providers and a vertical integration model, which includes primary care, community, hospital and geriatrics. This experience has been through some obstacles. Economic: It has been implemented in a time of crisis and budget cuts, which has fought with an internal restructuring of the team that has led to a professional and human effort. Resistance to change: The lack of predisposition to the collaboration of other medical equipment has been a problem that has been waning as was demonstrating the efficiency and professionalism. Professional barrier: A nursing coordinator has the need to interact with other leaderships of higher professional range (mostly medical). Has been created close relations between different disciplines. Distrust to a new management model: Has been increased the effort and steady work, which has generated well results and a special interest in its diffusion. Conclusion : There is the need to develop basic lines of work in different fields. It’s necessary to carry out more studies to prove that interdisciplinary wounds units are suitable and a need required by society and expected from the health care system: a low cost, the best possible management and excellent quality of care.

Introduction: In its annual report for 2008, the World Health Organization (WHO) states fragmentation is one of the five most common shortcomings experienced by health systems in health care provision, while an integrated healthcare model can significantly improve efficacy/efficiency, reduce visits to doctors, improve patient satisfaction, and ensure safe and quality healthcare. Aim: The aim of our study is to point out importance of the cooperation between healthcare professionals from different sectors, institutions and levels of care involved in patient treatment and care and to propose measures for integration including criteria for clinical review and audit. Methods: In this paper, feedback and results from three workshops held in Tuzla on October 16th, 2007, Bihac on December 9th, 2013, and Sarajevo on November 24th, 2018, were analyzed. All three workshops used the same methodology: first they have had a lecture on the topic of “Interface theory and protection blocks in the health system” and the second part took the form of six working groups in accordance with participants’ affinities and places of employment. Results: The measures proposed to improve the interface are included: Development and adoption existing of clinical practice guidelines and pathways; Maintain joint working group meetings; Eliminate conflicts between PHC and hospital care and seek consensus through formal cooperation. Criteria for clinical audit of the PHC-hospital interface are: annual analysis of unnecessary or inadequate referrals as well as of any duplication of tests and prescriptions (failure to control costs); joint planning of preventive treatments (including the ministry and public health authorities); and clear responsibilities related to screening programs and patient path analysis. Discussion: Standardized communication protocols should be used to improve communication between health professionals at different levels and to moderate integration processes and protect data. Conclusion: Regular communication between healthcare professionals across the various institutions and levels of health care is a prerequisite for organizational, functional, service and clinical integration.

In the article there are presented: prevalence; pathophysiology; diagnosis; treatment (conventional therapy and complementary and alternative medicine – CAM); integrative therapy

Camphill Medical Practice NHS(CMP) and Camphill Wellbeing Trust (CWT), a Scottish medical charity, have developed an integrative medical-therapeutic approach for patients with complex needs in a primary care setting. This multi-modal approach is both integrative in its nature and integrated in its delivery. The anthrohealth approach [also known as anthroposophic medicine1] is based on the conventional medical system of diagnoses and treatment, but extends this with a specific holistic understanding of the patient in illness and in health. The prescribing spectrum is extended with medicines derived from minerals, plants and animals, and the therapeutic options with specific nursing techniques and therapies. These include therapeutic speech and art, eurythmy therapy, rhythmical massage, riding therapy and counselling /psychotherapy. A shared anthrohealth philosophy and knowledge base amongst doctors, nurses and therapists facilitates effective integration of the therapeutic modalities within patient-centred individualised therapeutic programmes. These aim to help the patient address illness, build resilience and maintain wellbeing. The approach has high patient satisfaction, particularly where conventional treatment has plateaued or has little to offer. Anthrohealth is also integrated in delivery through the joint working of an NHS practice and a third sector organisation. CMP’s core primary care services are extended with CWT’s anthrohealth services, through collaborative planning and sharing of resources, including premises and personnel.

Posljednjih se godina, nemoćnošću medicine da djelotvorno odgovori na sve veći broj smrtonosnih ishoda bolesti, javlja snažna potreba za uspostavom palijativne medicine, pokreta hospicija i terapeutske primjene duhovne skrbi, kako bi se bolesnicima s progresivnim neizlječivim bolestima omogućilo holističko ublažavanje tjelesne boli i psihološke patnje medicinskom i duhovnom skrbi, kojima bi se poboljšala preostala kvaliteta života i omogućilo dostojanstveno umiranje. S tim ciljem, ovaj članak opisuje osnovne značajke, organizacijske oblike, zakonodavne okvire, potrebu uspostave i pristup palijativne medicine uvažavajući medicinske i duhovne potrebe terminalnih bolesnika., According to the powerlessness of medicine to respond effectively to the growing number of lethal outcomes of the diseases, in recent years occurred an intense need for the establishment of palliative medicine, hospice movement and therapeutic applications of spiritual care. The purpose of these was to allow holistic relieve of physical pain and psychological suffering with the medical and spiritual care for the patients with progressive incurable diseases, to enhance the quality of remaining life and the allowance of dignified dying. To achieve that aim, this article describes the basic features, organizational forms, legal framework, the establishment and access to palliative care, while taking into account the medical and spiritual needs of terminal patients.

Background: Globally the use of complementary and alternative medicine (CAM) has dramatically increased in the last few decades. In India CAM is used both as medical treatment and health care methods enhancing wellness. Aim: To explore nurse’s experiences of complementary alternative medical care as care methods in clinical settings in Karnataka, India. Methods: A qualitative interview study with semi-structured interviews was carried out. Four individual interviews were conducted with nurses working in two clinical settings in Karnataka, India. The data was analysed using a content analysis. Results: Two main themes emerged from the content analysis: Caring as a challenge and Dealing with challenges. Discussions: The result is discussed using Travelbee’s’ theory on interactions.

The article disscuses the contribution of LAAIs in the treatment of schizophrenia in comparison with oral equivalents.Given the well-recognized relationship between non-adherence and risk of relapse, patients who are irregular in taking medications are must-offer candidates for LAAIs.

Background: Spiritual care has been shown to be beneficial for patient in the settings of oncology and intensive care [1-5]. We propose that the quality of care given to the aging or to individuals with chronic illness might also improve as a result of the inclusion of spiritual care interventions in the integrative care models which guide the management of such individuals. The research studies to date that point to a positive impact of spirituality on patient outcomes in this patient population, have been criticized for the lack of a strong theoretical framework [6- 11]. The need for spiritual care is recognized, but a theoretical model has not been developed, and testable spiritual interventions have not been defined. In addition, there are also key reasons that have to do with the conceptualization of integrative care itself — the focus on the integration of ‘services’ which have a direct economic component is reflected in the WHO definition of integrated care: “Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency” to the individual [12, p.6]. The person in the WHO scheme is always to be seen as part of an entity and a system of beliefs, culture, religion and a community ecosystem and not to be seen as a "single" person. Similar reports from the IOM (Institute of Medicine) (13, p.20) focus on the essentials of a “systems engineering” approach to fixing an aliening health care system, defining essential and necessary steps best depicted by the following diagram. The individual, labeled as patient, is the white circle with no subscript. Although the word spiritual evokes fears in some people that esoteric concepts undermine the scientific rationality, we would argue that conceptually spiritual care is based on the rational concept of how we define a person in

Objective: A critical review of articles published between 2000 and 2010 on the relation between mental health and primary care in Brazil in view of the practice of matrix support. Method: Review of virtual database in the period in question. The descriptors were “mental health”, “primary care”, “matrix support”, and the analysis categories were constructed from the reading of the articles. Results: We selected 86 articles, divided in three categories: the articulation analyzed from the Mental Health, the Primary Care Health, and experiences of matrix support. This analysis revealed the existence of different ways of describing the collaborative care. Conclusions: The Brazilian experience is in line with global recommendations towards decreasing the gap between the offer and treatment needs care. The construction of the integrated mental health network for Family Health Strategy is a new challenge for the Brazilian Psychiatric Reform. Objetivo: Analizar los artículos publicados entre 2000 y 2010 sobre la relación entre salud mental y atención primaria en el Brasil, desde el punto de vista del apoyo matricial. Método: Revisión de base de datos virtual, en el período en cuestión. Los descriptores fueron: “salud mental”, “atención primaria”, “atención básica!, “apoyo “matricial”. Se determinaron categorías de análisis a partir de la lectura de los artículos. Resultados: Se seleccionaron 86 artículos, divididos en tres categorías: la articulación analizada desde la Salud Mental, desde la Atención Primaria y desde experiencias de apoyo matricial. El análisis reveló la existencia de diferentes maneras de describir el trabajo colaborativo. Conclusiones: la experiencia de Brasil está en concordancia con las recomendaciones internacionales sobre la reducción de la brecha entre la oferta y la atención de las necesidades terapéuticas. La construcción de la Red de Salud Mental integrada a la Estrategia de Salud Failiar es un nuevo reto para la Reforma Psiquiátrica brasileña. Objetivo: Analisar artigos publicados entre 2000 e 2010 que versam sobre a articulação entre saúde mental e Atenção Primária no Brasil, na perspectiva da prática do matriciamento. Método: Revisão em banco de dados virtual, no período referido. Os descritores foram: “saúde mental”, “atenção primária”, “atenção básica”, “apoio matricial” e “matriciamento” e as categorias de análise foram construídas a partir da leitura dos artigos. Resultados: Foram selecionados 86 artigos, divididos em 3 categorias: a articulação analisada a partir da saúde mental, a partir da Atenção Primária e experiências de matriciamento. A análise evidenciou a existência de diferentes formas de descrever o trabalho em colaboração. Conclusões: A experiência brasileira está em consonância com as recomendações mundiais rumo à diminuição da lacuna terapêutica entre a oferta e as necessidades de cuidado. A construção da Rede de Saúde Mental integrada à Estratégia Saúde da Família é um novo desafio para a reforma psiquiátrica brasileira.

Introduction: The Danish Multiple Sclerosis Society has conducted a research project where five conventional and five complementary practitioners as a team have treated people with Multiple Sclerosis (MS). As part of the treatment project’s interdisciplinary framework, the team has worked with negotiated treatment goals. The overall purpose of this paper is to explore how negotiated treatment goals can contribute to an interdisciplinary treatment effort for people with MS. Theory: The study explores 1) How a flexible framework for involving negotiated treatment goals has been handled by the practitioners, 2) What potentials and challenges have been involved in the practitioners’ work with negotiated treatment goals. The analyses are based on theories of epistemic cultures and learning theories, focusing on interdisciplinary development. Methods: The study was conducted as an exploratory case study. The data material consists of patient-owned records, referral schemes, questionnaires and completion reports. Results and conclusions: The flexible frame for the involvement of negotiated treatment goals has been handled in an incohesive way. Lack of time for coordination and trends for mono-professionalism as well as parallel treatment have posed challenges in the process, both for practitioners and patients. Despite these challenges, the team managed to implement successful treatment courses, not least due to a thorough pre-phase of collaboration. Discussions: The research results indicate that there is therapeutic potential in the use of negotiated treatment goals, but that a number of conditions must exist to obtain benefits from such negotiation.

Introduction: More than 50% of the People with Multiple Sclerosis (PwMS) in Denmark have used complementary and alternative medicine (CAM). The majority of these combine CAM and conventional treatment, and from 2004 to 2010 the Danish Multiple Sclerosis Society conducted a research project with the purpose of investigating and testing models for cooperation between conventional and complementary practitioners. Theory: Five health care providers and five CAM practitioners were set up to work together from 2004 to 2010 in developing and offering integrated treatment to 200 PwMS at a Danish MS Hospital. The investigation of the collaborative process between practitioners has been based on theories of epistemic cultures as well as learning theories, focusing on interdisciplinary development. Methods: Empirical material consists of individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish MS Hospital, interviews with patients as well as written responses from the practitioners. Results and conclusions: The six-year cooperation among the practitioners documented mutual inspiration and learning within the team, as well as numerous basic challenges involved in developing interdisciplinary treatment for PwMS. Cooperation between researchers and the treatment team resulted in the development of four interdisciplinary models, which describe the potentials and barriers in relation to various types of collaboration. Discussions: In many cases, integrating CAM and conventional treatment providers is seen as an ideal. This paper points out the importance of not overlooking the opportunities, values and the potential inherent in a pluralistic ideal in terms of the patients’ own active efforts and the dynamism that can arise when the patient becomes a co-informant, co-coordinator and/or co-integrator.

Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM) in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a) professional and research development, b) health human resource planning, c) regulation and legislation and d) practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.

Background: Massage therapy has grown in popularity, yet little is known globally or in New Zealand about massage therapists and their practices. Purpose and Setting: The aims of this study were to describe the practice patterns of trained Massage New Zealand massage therapists in New Zealand private practice, with regard to therapist characteristics; practice modes and settings, and therapy characteristics; referral patterns; and massage therapy as an occupation. Research Design and Participants: A survey questionnaire was mailed to 66 trained massage therapist members of Massage New Zealand who were recruiting massage clients for a concurrent study of massage therapy culture. Results: Most massage therapists were women (83%), NZ European (76%), and holders of a massage diploma qualification (89%). Massage therapy was both a full- (58%) and part-time (42%) occupation, with the practice of massage therapy being the only source of employment for 70% of therapists. Nearly all therapists (94%) practiced massage for more than 40 weeks in the year, providing a median of 16 – 20 hours of direct client care per week. Most massage therapists worked in a “solo practice” (58%) and used a wide and active referral network. Almost all therapists treated musculoskeletal symptoms: the most common client issues or conditions treated were back pain/problem (99%), neck/shoulder pain/problem (99%), headache or migraine (99%), relaxation and stress reduction (96%), and regular recovery or maintenance massage (89%). The most frequent client fee per treatment was NZ$60 per hour in a clinic and NZ$1 per minute at a sports event or in the workplace. Therapeutic massage, relaxation massage, sports massage, and trigger-point therapy were the most common styles of massage therapy offered. Nearly all massage therapists (99%) undertook client assessment; 95% typically provided self-care recommendations; and 32% combined other complementary and alternative medicine therapies with their massage consultations. Conclusions: This study provides new information about the practice of massage therapy by trained massage therapists. It will help to inform the massage industry and other health care providers, potential funders, and policymakers about the provision of massage therapy in the NZ health care system.

Introduction: Translational education takes up the notion of integrating basic research and practice out of a cross-disciplinary perspective given that disciplinary knowledge will no longer be sufficient to account for the complexity of the encountered problem fields. Persons trained in translational education will thus be able to integrate several disciplinary knowledge domains and translate new developments in basic research to their application. Description of care or policy practice: The concept of translational education has become prominent in medical training and it clearly has implications for the training of care givers given the complexity of the diverse problems associated with care. Care and care giving always imply theory and research from different scientific disciplines; there are medical, legal, sociological, and psychological components of care giving, and care giving also increasingly relies on new developments in the domains of technology. In order to keep an integrative view of all these developments and to finally obtain an integrative approach in care, translational education represents an imperative task for training carers in the domains of ageing and disabilities. Conclusion and discussion: Caring for a person—be it formal or informal—always has to rely on a sound basis of knowledge in order to prevent failures as well as feelings of stress and strain. Given that the knowledge base for carers becomes increasingly complex as it is fed by several disciplines as well as societal developments, training and education programmes should realise both a translational approach as well as a lifelong learning perspective. Although much is in favour of such an approach, limits of translational education do exist as well and these comprise mainly the production of a common knowledge across multiple domains for the cost of neglecting in-depth understanding of specific knowledge domains.

Although, recently, the biopsychosocial approach has been emphasized in the practice of family medicine, how psychologists and physicians interact in collaborative family health care practice is still emerging in Portugal. This article describes a qualitative study that focused on the understanding of psychologists and family physicians' perceptions of their role and the collaborative approach in health care. A questionnaire gathered information regarding collaboration, referral, training and the practice of biopsychosocial medicine. A content analysis on respondents' discourse was performed. Results show that both physicians and psychologists agree on the importance of the biopsychosocial model and interdisciplinary collaboration. However, they also mentioned several difficulties that have to do with the lack of psychologists working full time in health care centers, lack of communication and different expectancies regarding each other roles in health care delivery. Both physicians and psychologists acknowledge the lack of academic training and consider the need for multidisciplinary teams in their training and practice to improve collaboration and integrative care. Implications for future research and for the practice of biopsychosocial medicine are addressed.

The burden of cancer continues to increase globally, with substantial personal, societal, and economic consequences. Population growth and aging underlie this increase&mdash, a reflection of the effect of population health interventions in the last two centuries. Much of this gain has come through observation, derivation of evidence, and rigorous application of valid science to the public, both healthy and affected by diseases such as cancer. Increasingly, molecular medicine will affect the knowledge of cause and the personalization of therapy. However, science informs the decision-making process and places evidence within the beliefs of individuals and society as they relate to innovation, judgment, and values&mdash, the &ldquo, logic&rdquo, underlying alignment of conventional and complementary (holistic) care as a basis for compelling, consistent, and confident decisions.

Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM) in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a) professional and research development, b) health human resource planning, c) regulation and legislation and d) practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.

The aim of the present article is to review QoL scales used in studies investigating patients with schizophrenia over the past 5 years, and to summarize the results of QoL assessment in clinical practice in these patients. Literature available from January 2009 to December 2013 was identified in a PubMed search using the key words "quality of life" and "schizophrenia" and in a cross-reference search for articles that were particularly relevant. A total of n=432 studies used 35 different standardized generic and specific QoL scales in patients with schizophrenia. Affective symptoms were major obstacles for QoL improvement in patients with schizophrenia. Though positive symptoms, negative symptoms, and cognitive functioning may be seen as largely independent parameters from subjective QoL, especially in cross-sectional trials, long-term studies confirmed a critical impact of early QoL improvement on long-term symptomatic and functional remission, as well as of early symptomatic response on long-term QoL. Results of the present review suggest that QoL is a valid and useful outcome criterion in patients with schizophrenia. As such, it should be consistently applied in clinical trials. Understanding the relationship between symptoms and functioning with QoL is important because interventions that focus on symptoms of psychosis or functioning alone may fail to improve subjective QoL to the same level. However, the lack of consensus on QoL scales hampers research on its predictive validity. Future research needs to find a consensus on the concept and measures of QoL and to test whether QoL predicts better outcomes with respect to remission and recovery under consideration of different treatment approaches in patients with schizophrenia.El objetivo del presente artículo es revisar las escalas de calidad de vida (CdV) utilízadas en estudíos que ínvestigan pacientes con esquizofrenía durante los últimos cínco años y resumir los resultados de la evaluación de la CdV en la práctica clínica en estos pacientes. Se identificó la literatura disponible en la base PubMed entre enero de 2009 y díciembre 2013 utilizando las palabras clave “calídad de vida” y “esquizofrenía” y en una búsqueda de referencias cruzadas para artículos especialmente relevantes. Un total de 432 estudios emplearon 35 escalas diferentes de CdV tanto genéricas como específicas estandarízadas en pacientes con esquizofrenía. Los príncípales obstáculos para la mejoría de la CdV en pacientes con esquizofrenía fueron los síntomas afectivos. Aunque los síntomas posítivos, los síntomas negativos y el funcíonamiento cognítivo pueden considerarse como parámetros en gran medída independientes de la CdV subjetiva-especialmente en ensayos transversales-, los estudios a largo plazo confírmaron un gran ímpacto de la mejoría precoz de la CdV en la remisión sintomática y funcional a largo plazo, como de la respuesta síntomática y funcional a largo plazo, como de la respuesta síntomática precoz en la CdV a largo plazo. Los resultados de la presente revisión sugieren que la CdV es un criterio de resultado válido y útil en pacíentes con esquizofrenía. Como tal debe ser aplicada sistemáticamente en ensayos clínicos. Es importante la comprensión de la relación entre síntomas y funcionamiento con la CdV, ya que las intervencíones que se enfoquen solo en los síntomas de la psicosis o en el funcíonamiento puede que no mejoren la CdV subjetiva en el mismo nivel. Sin embargo, la falta de consenso sobre las escalas de CdV díficulta la investigación sobre su validez predictiva. A futuro la investigación requiere encontrar un consenso acerca del concepto y medíciones de la CdV y comprobar si ésta predice mejores resultados para la remisión y la recuperación tomando en cuenta las diferentes aproximacíones terapéutícas en pacientes con esquizofrenía.Cet article évalue les échelles de qualité de vie (QdV) utilisées dans des études de patients schizophrènes ces 5 dernières années et résume les résultats de l'évaluation de la QdV en pratique clinique chez ces patients. Une recherche sur PubMed utilisant les mots clés « qualité de vie » et « schizophrénie » et une recherche de références croisées pour des articles très pertinents ont permis de sélectionner la littérature disponible de janvier 2003 à décembre 2013. Au total, 432 études utilisent 35 échelles de QdV standardisées différentes, spécifiques et génériques, chez les patients schizophrènes. Les symptômes affectifs constituent un obstacle très important à l'amélioration de la QdV chez ces patients. Les symptômes positifs, négatifs et le fonctionnement cognitif sont considérés comme des paramètres en grande partie indépendants de la QdV subjective, surtout dans les études croisées, mais les études à long terme confirment l'impact essentiel d'une amélioration précoce de la QdV sur la rémission fonctionnelle et symptomatique à long terme et d'une réponse symptomatique précoce sur la QdV à long terme. D'après les résultats de cet article, la QdV est un critère de résultat valable et utile chez les patients schizophrènes. À ce titre, les études cliniques devraient l'employer régulièrement. Il est important de comprendre la relation entre les symptômes et le fonctionnement par l'intermédiaire de la QdV car les traitements qui ne s'intéressent qu'aux symptômes de la psychose ou qu'au fonctionnement seul peuvent ne pas réussir à améliorer la QdV subjective de la même façon. L'absence de consensus sur les échelles de QdV entrave néanmoins la recherche sur leur validité prédictive. À l'avenir, la recherche doit trouver un consensus sur le concept et les mesures de QdV et vérifier si la QdV prédit de meilleurs résultats en ce qui concerne la rémission et la guérison en examinant les différentes approches thérapeutiques chez les patients schizophrènes.