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Pressure Injury (PI) is a major health problem which imposes a considerable social and economic burden nationally and globally. Aim of the study was to investigate the effect of PI care program on nurse's performance and patients' pressure injury wound healing outcomes. Study design was a quasi-experimental control group using pre-post and follow up design. Sample of thirty nurses and fifty patients were allocated in the current study in two medical units at one of the general hospitals in Ismailia City. Tools: Six tools included nurses' demographic data sheet, pressure injury knowledge questionnaire, and pressure injury care observational checklist, patients' demographic and medical profile data sheet, The Braden Scale, and patients’ pressure injury wound healing outcomes were used to collect data. Results: The study revealed that nurses' knowledge and practices, were significantly improved towards PI care post program implementation when compared to preprogram. Moreover, there was a significant improvement in PI wound healing among patients cared with nurses after receiving the educational program compared with patients who received care before the program. Conclusion: The PI educational program could improve nurses' performance as well as PI wound healing among cared patients. Recommendation: Endorse the educational program for pressure injury care in the nurses' orientation program plus continuous in-service education.

BACKGROUND: High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel. OBJECTIVE: Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP. DESIGN: Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients. SETTING: Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017–2018. PARTICIPANTS: Nine hundred twenty-nine CCP patients empaneled January 2017–June 2018, 929 matched control patients for the same period. INTERVENTIONS: The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations. MAIN OUTCOMES: Time to death and time to first hospital admission in the 180 days following empanelment or eligibility. RESULTS: Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084). LIMITATIONS: Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions. CONCLUSION: The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-06676-x.

Hip fractures decrease older adults’ physical activity and quality of life (QoL). However, no current self-efficacy care programs are managed by clinical nurses, and thus no studies have measured their effects on self-care self-efficacy (SCSE). Hence, this quasi-experimental study determined the effectiveness of a self-efficacy care program (SECP) in 104 older adults receiving hip-fracture surgery who were divided into intervention and control groups. The Strategies Used by People to Promote Health and Short Form-36 were administered pre-surgery and at 1 and 3-month intervals post-surgery. The SCSE and QoL of the SECP group were significantly better than the control group at 1- and 3-month follow-ups post-surgery. Both groups’ QoL decreased at one-month post-surgery but increased by 3-months post-surgery. The SECP group had higher psychological QoL than the control group post-surgery. This intervention increased the SCSE and QoL of older adults with hip fractures and improved post-operative care.

Background: Hip fractures are a major cause of mortality and disability in frail older adults. Therefore, orthogeriatrics has been embraced to improve patient outcomes. With the optimal template of orthogeriatric care still unknown, and to curtail rising healthcare expenditure we implemented a nurse practitioner-led orthogeriatric care program (NPOCP). The objective was to evaluate NPOCP by measuring 3-month and 1-year mortality, compared to usual care (UC). In addition, length of stay (LOS) and location of hospital discharge were reported. Methods: An anonymised data set, of hip fracture patients (n = 300) who presented to Maastricht University Medical Centre, the Netherlands, a level-1 trauma centre, was used. NPOCP was implemented on one of two surgical wards, while the other ward received UC. Patient allocation to these wards was random. Results: In total, 144 patients received NPOCP and 156 received UC. In the NPOCP, 3-month and 1-year mortality rates were 9.0% and 13.9%, compared to 24.4% and 34.0% in the UC group (P Conclusion: Implementation of NPOCP was associated with significantly reduced mortality in hip fracture patients and may contribute positively to high-quality care and improve outcomes in the frail orthogeriatric population.

Introduction Approximately one out of eight women are diagnosed with breast cancer in their lifetime. Women are recommended to begin annual mammograms at age 40 unless they are high-risk risk for breast cancer based on risk algorithms or positive germline mutations. Unfortunately, genetic testing and risk counseling are often not offered until a cancer diagnosis is already made. It is estimated that 5-10% of the general population has genetic predisposition to cancer. Purpose We established the Comprehensive Assessment, Risk & Education (CARE) Program at our mammogram center. Offered in partnership with Ambry Genetics, the CARE Program’s goal is to facilitate unaffected women in obtaining genetic testing and risk-counseling who otherwise may not have access to these services. Methods Patients undergoing a screening mammogram were given a tablet with a preprogrammed Progeny questionnaire. This questionnaire included questions on the patient’s gynecological history and family history. It calculates a Tyrer-Cuzick risk score and assesses National Comprehensive Cancer Network (NCCN) genetic testing criteria. Patients qualifying for genetic testing received pretest counseling by video and were offered genetic testing the same day as their mammogram appointment. Our genetic counselors performed follow-up counseling for patients receiving positive test results. Patients testing negative or inconclusive received a letter generated by Ambry. Our CARE program began on June 7th, 2019, and data was assessed through July 6th, 2020. Results 1,065 women met NCCN criteria for genetic testing. Of those women, 464 (43.6%) proceeded with testing, 387 (36.3%) declined testing and 214 (20.1%) were not able to obtain day-of genetic testing due to operational/personnel limitations. Of those who submitted tests, 403 (86.9%) completed testing and 61 tests were cancelled due to out of pocket costs or patient preference. Of the 403 patients who completed testing, 262 (65%) tested negative, 105 (26%) tested inconclusive and 35 (8.7%) tested positive. Positive test results were found in 15 genes (Table 1). Clinical Impact Over 13 months, we identified 35 patients at increased risk for cancer based on positive genetic test results. Based on these results, 6 (17%) patients were offered prophylactic surgeries, 16 (45.7%) were offered breast MRIs and enrollment in our high-risk breast clinic, 14 (40%) were offered increased colonoscopies and 9 (25.7%) were offered pancreatic screening based on family history. All patients were offered family variant testing. Conclusion Our experience integrating a screening questionnaire into our mammogram clinic shows that 44% of patients meeting NCCN criteria agree to do day of testing. Of those completing testing, 9% tested positive. This result is consistent with the national expected positive rate. Our CARE Program offers unaffected patients an opportunity to be tested in a comfortable low stress setting through the mammography suite. These patients and their families will now benefit from cancer prevention options that may not have been offered to them had they not been pre-emptively screened by our program. Table1. Positive test results for 35 patients.MutationNumber of patients identified (%)CHEK29 (25.7)MUTYH5 (14.2)HOXB134 (11.4)ATM3 (8.6)APC2 (5.7)BARD12 (5.7)PALB22 (5.7)BRCA21 (2.9)BRIP11 (2.9)MRE11A1 (2.9)MSH21 (2.9)MSH61 (2.9)RAD501 (2.9)RAD51D1 (2.9)TP531 (2.9) Citation Format: Lida Mina, Rebecca Luiten, Jennifer Siettmann, Vilert Loving. Identification of pathogenic mutations in otherwise unaffected patients through the CARE program [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-20.

La sentencia dictada, se entendió, infringió el artículo 43. 1 y 2º de la Ley 30/1992 por inaplicación (y actual art. 24.1. 3ª Ley 39/2015, de 1 de octubre) pues la revisión del PIA, acto administrativo anteriormente aprobado y notificado, implica, necesariamente, un procedimiento que se inicia e impulsa de oficio por la Autoridad competente aunque, en el presente caso, a instancias del interesado previa solicitud.A ello se añade que el propio contenido del Programa individual de atención hace inviable el régimen del sentido estimatorio del silencio ya que resulta materialmente imposible delimitar qué concreto servicio o prestación de entre las previstas para el grado y nivel sería la reconocida por silencio; cuestión distinta es que, si la resolución expresa implica o contiene prestaciones económicas, éstas deban retrotraerse en el tiempo. Aquéllas fueron invocadas por esta parte tanto ante el órgano juzgador de instancia como ante el Alto Tribunal Andaluz en apelación.

En este artículo se presenta una reflexión sobre las diferencias de género en las conductas infractoras de niñas y adolescentes a la luz, principalmente, de los hallazgos de un estudio del Programa de Atención Integral Familiar (PAIF) 24 horas de la Subsecretaría de Prevención del Delito de Chile. El marco interpretativo utilizado para la presente reflexión es el de la criminología feminista y desde esta perspectiva se plantea como las niñas y adolescentes han sido históricamente relegadas en los estudios sobre la delincuencia juvenil y la necesidad de incorporar en éstos la estratificación de género en la sociedad patriarcal, especialmente de cara a identificar las diferencias de género existentes en la delincuencia femenina adolescente y su tratamiento.

Aim: This study examined how communication between nurses and families in video consultations in a neonatal early in-home care program unfolded in the context of parents' homes.Design: A qualitative study based on focused observations supported by audio-re-corded video consultations.Methods: The data were collected through nine video consultations between nurses and families in an early in-home care program. The transcribed material was exam-ined using inductive content analysis.Findings: The analyses revealed the following themes: “Setting the scene,” “Weight as a point of reference” and “The pros and cons of technology.” The video consulta-tions unfolded in a relaxed atmosphere, but also as one-way communication domi-nated by nurses, with the infant's weight as the focus. The study finds that a focus on training in video communication is needed to take full advantage of video consulta-tions' potential.

OBJECTIVE Children with medical complexity (CMC) have significant health care costs, but they also experience substantial unmet health care needs, hospitalizations, and medical errors. Their parents often report psychosocial stressors and poor care satisfaction. Complex care programs can improve the care for CMC. At our tertiary care institution, we developed a consultative complex care program to improve the quality and cost of care for CMC and to improve the experience of care for patients and families. METHODS To address the needs of CMC at our institution, we developed the Compass Care Program, a consultative complex care program across inpatient and outpatient settings. Utilization data [hospital admissions per patient month; length of stay per admission; hospital days per patient month; emergency department (ED) visits per patient month; and institutional charges per patient month] and caregiver satisfaction data (obtained via paper survey at outpatient visits) were tracked over the period of participation in the program and compared preenrollment and postenrollment for program participants. RESULTS Participants had significant decreases in hospital admissions per patient month, length of stay per admission, hospital days per patient month, and charges per patient month following enrollment (P

Purpose: This study investigates the possible association between adolescent friendship networks and perceived physical activity skill competence in a summer care program. Design: Adolescents participated in researcher-administered surveys at the start (T1) and end (T2) of summer. Setting: Adolescents at a Boys & Girls Club were sampled. Sample: Adolescents (age 8-12) completed researcher-administered surveys at T1 (n = 100; µ age = 9.9 years; 47% male; 55% Black) and T2 (n = 77; µ age = 9.8 years; 51% male; 49% Black). Measures: Perceived skill competence was measured by asking adolescents to rate how good they felt they were at physical activity at the club. Adolescents were also asked to provide names of up to 5 peers whom they hung around with, talked to, and did things with the most while at the club. Analysis: Linear network autocorrelation models were used to determine network effects or clustering of perceived physical activity skill competence within the club. Results: There were significant network effects for adolescent perceived skill competency scores at T1 (β = 0.05, p < 0.01) and T2 (β = 0.05, p = 0.02), indicating adolescent perceived skill competence scores were associated with those of their friends. Conclusions: Practitioners may wish to encourage the use of group or collaborative skill competency improvement activities as well as possibly pairing adolescents with differing skill competencies to foster improvement and possible diffusion of perceived skill competency.

Children with medical complexity (CMC) have chronic, multisystem health conditions, substantial health care needs, major functional limitations, and high resource use. They represent

espanolEn el siguiente articulo se analizan las percepciones que tienen los cuidadores sobre el programa de acompanamiento a personas con discapacidad del Politecnico Colombiano Jaime Isaza Cadavid. Este estudio se realiza a traves de un metodo de investigacion que acoge elementos cualitativos y cuantitativos, con instrumentos de recoleccion de informacion como encuestas, entrevistas y redes semanticas naturales, las cuales soportan el analisis del trabajo. Dentro de los principales resultados, se identifico la importancia que tiene el componente valorico en el programa de atencion a familias con discapacidad, al igual que elementos relacionados con el aprendizaje y el componente social. La discusion de los resultados se da a partir de tres categorias: el rol de la familia, el rol del profesional y las caracteristicas de un modelo de atencion para personas con discapacidad. El estudio concluye que un programa de atencion para personas con discapacidad se debe centrar en un modelo basado en la familia. EnglishIn the following article, the caregivers’ perception of the accompaniment program for people with disabilities of the Politecnico Colombiano Jaime Isaza Cadavid is analyzed. This study was developed through a qualitative and quantitative research method that included information-gathering instruments such as surveys, interviews and natural semantic networks, which served as support for the analysis of the work. Among the main results, the importance of the value component of the care program to families with disabilities was identified, as well as elements related to learning and the social component. The discussion of the results is based on three categories: the role of the family, the role of the professional and the characteristics of a care model for people with disabilities. The study concludes that a care program for people with disabilities should focus on a family-based model.

Patients with heart failure experience system imbalance and have multiple symptoms. A nurse-led care program based on Johnson’s behavioral system model was used to improve the balance of the behavioral system of heart failure patients. One hundred and fifty patients were randomly assigned into two groups. In the experimental group, the patient’s status was evaluated by a behavioral subsystem assessment tool related to the level of imbalance. The patients in the intervention group received care individually based on their worst subsystem scores over a period of 2 weeks. The results showed significant improvement in restorative, ingestive, eliminative, aggressive/protective, dependency, and achievement ( p < .05) subsystems in the experimental group. However, no significant difference was seen in sexual and affiliative ( p > .05) subsystems.

Biomarker testing is recognized as being indispensable for selecting patients with advanced lung cancer. EGFR mutation is the first biomarker for therapeutic selection of lung cancer patients since the identification of the correlation between EGFR TKI response and EGFR mutation status. The biomarker testing in Japan mostly follows those corresponding to the US. However, there are some differences due to the national health care program and the medical environment. In this review, we introduce the history and current status of the biomarker testing for lung cancer in Japan and discuss perspectives, focusing on cell-free DNA (cfDNA)-based panel testing.

Background: Although community-based serious-illness care (CBSC) is an innovative care model, it is unclear to what extent CBSC addresses palliative care needs, particularly for those patients near...

The ACERTO project is a multimodal peri-operative care program. The set of routines and prescriptions of the ACERTO project is based on evidence-based medicine as opposed to traditional care, often empirical and taught in the same routine by successive generations of surgeons. Traditional care such as the use of nasogastric tube, abdominal drainage, preoperative colonic preparation, preoperative fasting of 6-8 hours are modified in the project based on evidence from randomized studies and meta-analysis. In addition, the project reinforces the restriction of intravenous fluids and the use of nutritional therapy in the peri-operative. The application of the ACERTO project since 2005 has been modifying results, showing significant reduction of hospitalization days and postoperative morbidity in successive clinical studies. The ACERTO project is free to use.

Purpose This report describes the growth and development of the Pharmacy Transitions of Care (PTOC) program at a Florida health system and examines its impact on 30-day readmission rates for Medicare core-measure patients. Summary BayCare Health System is a large not-for-profit community health system with 15 hospitals in central Florida. In 2015, the PTOC program was developed to integrate 2 pharmacists into the transitions-of-care space to reduce readmissions, enhance patient care, and improve medication safety. The PTOC program focuses on traditional Medicare beneficiaries 65 years of age or older with the goal of preventing 30-day readmissions. The service model includes integration of a pharmacist into the discharge medication reconciliation process, as well as postacute care telephonic follow-up. Data and outcomes have been carefully tracked since program inception and consistently demonstrate a reduction in 30-day readmissions, with a 63% relative risk reduction during the beginning phases of the program and a ratio of observed to expected readmissions of 0.77. As a result, in less than 3 years the PTOC program has grown from 2 to 23 pharmacists and is a key component of BayCare Health System’s patient care strategy. Conclusion Medication reconciliation, clinical interventions, and patient education by pharmacists after hospital discharge reduced 30-day readmission rates for Medicare core-measure patients across a large health system. The adaptability of this program to other health systems and hospitals of varying size to achieve similar outcomes is valuable to share with the profession.

BACKGROUND: Seriously ill patients in hospital have indicated that better communication with practitioners is vital for improving care. The aim of this study was to assess whether the quality of conversations about serious illness improved after implementation of the Serious Illness Care Program (SICP). METHODS: In this retrospective chart review study, we evaluated patients who were admitted to a medical ward at Hamilton General Hospital, had a stay of at least 48 hours, and were at risk for a lengthy stay or increased need for community-based services (inter-RAI Emergency Department Screener score of 5 or 6). The SICP study period was from Mar. 1, 2017, to Jan. 19, 2018. We used a validated codebook to assess the quality of documented conversations regarding serious illness for eligible patients before (usual care [control group]) and after SICP implementation (intervention group), specifically examining the following domains: patients’ values and goals, understanding of prognosis and illness, end-of-life care planning, and code status or desire for other life-sustaining treatments. RESULTS: The study sample included 56 patients in the control group and 56 patients in the intervention group. The overall quality of documented conversations about serious illness was significantly higher in the intervention group than in the control group (p < 0.001) and was significantly higher in the subdomains of values and goals (p < 0.001), understanding of prognosis and illness (p < 0.001) and life-sustaining treatments (p = 0.03) but not end-of-life care planning (p = 0.48). INTERPRETATION: Implementation of the SICP in a hospital setting was associated with higher quality of documented conversations regarding serious illness with patients at high risk for clinical or functional deterioration. The SICP is transferable and adaptable to a hospital setting, and was associated with an increase in adherence to best practices compared to usual care.

BackgroundResidents living and dying in long-term care (LTC) homes represent one of society’s most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality of life in their last months of life. The purpose of this study is to evaluate the feasibility, acceptability, and effects of Namaste Care: an innovative program to improve end-of-life care for people with advanced dementia.MethodsThis study used a mixed-method survey design to evaluate the Namaste Care program in two LTC homes in Canada. Pain, quality of life, and medication costs were assessed for 31 residents before and 6 months after they participated in Namaste Care. The program consisted of two 2-h sessions per day for 5 days per week. Namaste Care staff provided high sensory care to residents in a calm, therapeutic environment in a small group setting. Feasibility was assessed in terms of recruitment rate, number of sessions attended, retention rate, and any adverse events. Acceptability was assessed using qualitative interviews with staff and family.ResultsThe feasibility of Namaste Care was acceptable with a participation rate of 89%. However, participants received only 72% of the sessions delivered and only 78% stayed in the program for at least 3 months due to mortality. After attending Namaste Care, participants’ pain and quality of life improved and medication costs decreased. Family members and staff perceived the program to be beneficial, noting positive changes in residents. The majority of participants were very satisfied with the program, providing suggestions for ongoing engagement throughout the implementation process.ConclusionsThese study findings support the implementation of the Namaste Care program in Canadian LTC homes to improve the quality of life for residents. However, further testing is needed on a larger scale.

The aim of this study was to evaluate patients’ outlook and satisfaction with “Joven & Fuerte: Program for Young Women with Breast Cancer (YWBC) in Mexico” (J&F) and to determine its strengths and areas of improvement to better fulfill patients’ information and supportive care needs. Patients enrolled in J&F for ≥ 6 months at three cancer referral centers were invited via a messaging application to anonymously complete an online survey exploring their perspectives of the program’s information delivery, support services, and research component. Descriptive statistics, chi2 test, Student t, and ANOVA were used for analysis. Of 484 eligible patients, 28% completed the survey. The program overall was useful/very useful according to 97% and aided 82% to better cope with their illness. The timing, clarity, and usefulness of the information provided were each described as good/very good by ≥ 83% for the written format and ≥ 98% for the verbal one. Eighty-four percent of patients were very satisfied (≥ 9/10) with psychological support and genetic assessment. The number of support services used was significantly associated with patients’ perception of J&F’s usefulness. Regarding fertility issues, 45% recalled being informed about preservation strategies and J&F financially supported 27/39 of interested patients. Fifty-eight percent were unaware of J&F’s ongoing research component. Patients’ satisfaction with J&F is very high, reflecting that the program is meeting Mexican YWBC’s needs by providing useful information means and support services in a limited-resource setting. Efforts must keep up to guarantee the program’s continuity and advocate for its extension to other oncologic centers.

يهدف البحث الى رصد واقع برامج رعاية الأطفال الموهوبين بدولة الکويت و الاسترشاد بأساس الإبداع وقواعده في تقويم برامج رعاية الاطفال بدولة الکويت ،معرفة مدى فاعلية برنامج رعاية الاطفال الموهوبين فى ضوء خصائصهم من وجهة نظر الموهوبين. واسـتخدمت الباحثة المنهج الوصفي وهو منهج وطريقة علمية لوصف ظاهرة ما ودراستها من خلال منهجية علمية صحيحة، وتصوير النتائج التي يتم الحصول عليها، في شکل ارقام معبرة يمکن تفسيرها، وهو طريقة من طرق البحث العلمي، تعتمد على اساس وصف ظاهرة ما وتفسيرها، کما هي في الواقع. ولقد توصلت الباحثة الى النتيجة التالية: ان جميع تلاميذ المدرسة بحاجة إلى برامج خاصة وفرص تربوية متنوعة تبرز من خلالها مواهبهم المتعددة ويشعرون من خلالها بالرضا عن النفس وأن المدرسة مجال فسيح لا يقتصر على جانب واحد فقط من التفوق بل يستوعب جميع طاقاتهم وقدراتهم مهما کانت متنوعة. إن وجود معلم رعاية الموهوبين يجعل من تلبية حاجات المواهب المتعددة والمتنوعة أمرا ميسورا ـ إن شاء الله تعالى ـ حيث يعمل على تتبع مواهب التلاميذ المتعددة وتقديم فرص تربوية لتنميتها إما بشکل فردي أو جماعي. ولقد اوصت الباحثة - تنمية قدرات الطفل الموهوب. تنمية التربية الاستقلالية الذاتية للطفل الموهوب. تنمية التفکير العلمي للطفل الموهوب. توفير المواقف التربوية المکسبة للخبرات المربية للطفل الموهوب. إنشاء مراکز لرعاية الأطفال الموهوبين على مستوى المنطقة التعليمية أو المحافظة بحيث يتوفر في هذه المراکز متخصصات يستخدمن المقاييس والاختبارات لاکتشاف الأطفال الموهوبين من خلال المؤسسات المختلفة في المجتمع. کلمات مفتاحية: رعاية الموهوبين، تقويم برامج رعاية الاطفال الموهوبين، الابداع ABSTRACT The purpose of the research is to monitor the reality of the programs of caring for talented children in the State of Kuwait. The basis of innovation and its rules in evaluating children's care programs in Kuwait is to determine the effectiveness of the gifted children's care program in light of their characteristics from the point of view of the gifted. The researcher used the descriptive approach, which is a scientific method and method to describe a phenomenon and study it through a correct scientific methodology, and to portray the results obtained in the form of expressive figures that can be explained. This is a wide range of human studies. What they interpret, as they are really. The researcher reached the following conclusion: All school students need special programs and educational opportunities to show their multiple talents through which they feel self-satisfied and that the school is a wide area that is not limited to only one aspect of excellence, but absorbs all their energies and abilities no matter how varied. The presence of a gifted teacher helps make it possible to meet the needs of diverse and diverse talents, God willing, where he works to follow the talents of various pupils and provide educational opportunities for their development either individually or collectively. The researcher recommended developing the abilities of gifted children. Development of self-autonomy of gifted children. Developing the scientific thinking of gifted children. Providing pedagogical attitudes to the gifted child's gifted experiences. The establishment of centers for the care of gifted children at the level of the educational district or governorate so that there are specialists in these centers use the standards and tests to discover talented children through various institutions in the community. Keywords: The care of talented children, the evaluation of programs for the care of talented children, creativity.

Abstract PURPOSE High-quality, comprehensive care of vulnerable populations requires interprofessional ambulatory care teams skilled in addressing complex social, medical, and psychological needs. Training health professionals in interprofessional settings is crucial for building a competent future workforce. The impacts on care utilization of adding continuity trainees to ambulatory teams serving vulnerable populations have not been described. We aim to understand how the addition of interprofessional trainees to an ambulatory clinic caring for Veterans experiencing homelessness impacts medical and mental health services utilization. METHODS Trainees from five professions were incorporated into an interprofessional ambulatory clinic for Veterans experiencing homelessness starting in July 2016. We performed clinic-level interrupted time series (ITS) analyses of pre- and post-intervention utilization measures among patients enrolled in this training continuity clinic, compared to three similar VA homeless clinics without training programs from October 2015 to September 2018. RESULTS Our sample consisted of 37,671 patient- months. There was no significant difference between the intervention and comparison groups’ post-intervention slopes for numbers of primary care visits (difference in slopes =−0.16 visits/100 patients/month; 95% CI −0.40, 0.08; p=0.19), emergency department visits (difference in slopes = 0.08 visits/100 patients/month; 95% CI −0.16, 0.32; p=0.50), mental health visits (difference in slopes = −1.37 visits/month; 95% CI −2.95, 0.20; p= 0.09), and psychiatric hospitalizations (−0.005 admissions/100 patients/month; 95% CI −0.02, 0.01; p= 0.62). We found a clinically insignificant change in medical hospitalizations. CONCLUSIONS Adding continuity trainees from five health professions to an interprofessional ambulatory clinic caring for Veterans experiencing homelessness did not adversely impact inpatient and outpatient care utilization. An organized team-based care approach is beneficial for vulnerable patients and provides a meaningful educational experience for interprofessional trainees by building health professionals’ capabilities to care for vulnerable populations.

Adolescents and young adult (AYA) oncology care has evolved to address their unique supportive care needs, yet deficiencies remain. We planned a multiphase sequential mixed methods study beginning with focus groups (FGs) with AYAs receiving care at the Princess Margaret Cancer Centre, to improve supportive care delivery. Herewith, we report on the preliminary findings from first phase of project and outline future expected goals. Our findings suggest four major themes identified from FG discussion with AYAs: (1) having peer-driven support, (2) incorporating hybrid approach to information delivery, (3) integrating general practitioners in AYAs care, and (4) providing AYAs-specific supportive care programs.

Introduction: The efficacy of telemedicine in cancer survivors is uncertain. The Smart After-care Program (SAP), which is an interactive, smartphone-based remote health monitoring system, was developed to help individual patients manage their health after leaving the hospital. This study aims to evaluate the efficacy of our remote health care program for lung cancer patients. Methods We enrolled 50 lung cancer patients. Self-monitoring devices were supplied to all patients, who were instructed to enter their daily vital signs and subjective symptoms to the Smart After-care app. The app also provided information about rehabilitation exercises and a healthy diet for lung cancer patients. All patients received telephone health counseling once a week and visited an outpatient clinic on the 6th and 12th week to assess satisfaction with the SAP and changes in quality of life and physical performance. Results Overall satisfaction with the SAP was very high (very good, 61.9%; good, 26.2%). In the multivariate analysis for factors affecting satisfaction, the distance between the patient’s residence and the hospital was the only independent factor (p = 0.013). Quality of life was improved in all functional scales (p p = 0.012). Two-minute walk distance was also significantly improved (p = 0.028). Conclusion This study demonstrated that the SAP was acceptable among and supportive of patients with reduced pulmonary function after lung cancer treatment. The study proved that the SAP was more useful for patients living far away from a hospital.

OBJECTIVES: Low body mass index (BMI) and hyperglycemia are each important risk factors for tuberculosis (TB). However, the contribution of synergy between low BMI and hyperglycemia to risk of TB among people living with HIV (PLHIV) is unexplored. We compared TB incidence among PLHIV with different exposure profiles to low BMI (BMI

Introduction The average life expectancy is increasing, as well as the number of patients suffering from chronic diseases. Chronic diseases have become the most important reason for morbidity and mortality, as they make up for 63% of all deaths in the world. The Chronic Care Model (CCM) is often used to achieve a good organization of, and interprofessional collaboration between the different actors in the primary care. Successful implementation of such a model is dependent on different factors. The purpose of this study is to give an overview of the barriers and facilitators for a successful implementation of a care program based on the CCM in primary care. Methods In this systematic review, the databases Pubmed and Cinahl were used to obtain relevant literature. Both qualitative and quantitative studies were included. In the first phase screening was based on the title and abstract. During the second phase, the full text from included articles from phase one were assessed based on the in- and exclusion criteria. Data was then extracted from the remaining articles. Two types of data were acquired in this process. First of all, general data was obtained, specifically: study design, method, participants, setting, objective, components of the CCM and intervention. Afterwards, the barriers and facilitators were organized within the structure provided by the TICD-checklist. Results Of the 2075 screened results, 19 articles were included in the study. For every domain of the TICD-checklist, barriers and facilitators were found. The most prominent themes were professional interactions, and incentives and resources. Discussions There are a lot of barriers to the implementation of a care program based on the CCM. This systematic review showed that organizational, (intra)personal and policy factors are important for a successful implementation. Lessons learned This study offers an important overview of the barriers and facilitators for the implementation of a care program based on the CCM. Through these scientific insights, professionals can anticipate potential barriers and make use of identified facilitators to successfully implement a care program in practice. Limitations and suggestion for further research The focus was on care programs and chronic care. This focus was needed but in further research including individual diseases like diabetes, schizofrenia, … in the search terms would be a good idea since not all of these publications are found under the chronic diseases label.

Introduction Early conversations about patients’ goals and values improve care, but clinicians struggle to conduct them. The systems-based Serious Illness Care Program (SICP) helps clinicians have more, better, and earlier conversations. Central to this approach is a clinician conversation guide for patient encounters. While the SICP works for practicing clinicians, it has not been tested with medical trainees. Methods We adapted the SICP training to emphasize assessing prognostic awareness and responding to emotion. We developed a 2.5-hour SICP workshop for medical students and medical interns that included large- and small-group work, practice with an actor, and interdisciplinary clinician facilitators. We trained 81 students and 156 interns and obtained anonymous quantitative and qualitative feedback. Results Eighty-six percent of students and 91% of residents rated the session as “very good” or “excellent” and >90% of all learners would either recommend this training or intended to apply this to their practice. Post-session learner confidence increased in all communication skills. Learners said the training provided a helpful framework and useful language for these conversations. Resident documentation of serious illness conversations in the medical record increased dramatically during the year following training commencement. Discussion Grounded in principles of adult learning theory, this training was rated highly by trainees and resulted in demonstrable practice change. These early learners were more flexible and willing to try this approach than practicing clinicians who tend to resist or revert to old habits. A Guide represents a new paradigm for teaching communication skills and is valued by early learners.

Introduction Medical device-related complications often lead to emergency department (ED) visits and hospitalizations for children with medical complexity (CMC), and pediatric complex care programs may be one way to decrease unnecessary encounters. Methods A retrospective cohort study comparing ED and inpatient encounters due to device complications of 2 cohorts of CMC at a single children's hospital during 2014-2016; 99 enrolled in a complex care program and 244 in a propensity-matched comparison group. Structured chart reviews identified ED and inpatient encounters due to device complications. The outcome was a change in the frequency of these encounters from the year before to the year after enrollment in the hospital's complex care program. Program effects were estimated with weighted difference-in-differences (DiDs), comparing the change in mean encounter frequency for CMC enrolled in the program with change for propensity-matched children not enrolled in the program. Results Mean encounters related to device complications decreased for both groups. Complication-related ED encounters per year decreased from a weighted mean (SD) of 0.74 (0.85) to 0.30 (0.44) in enrolled children and 0.26 (0.89) to 0.12 (0.56) in comparison children, a DiD of 0.30 fewer [95% confidence interval (CI) -0.01 to 0.60]. The largest reductions in device complication ED visits were among those with enteral tubes [0.36 fewer (95% CI 0.04-0.68)]. Hospitalizations decreased over time, but DiDs were not significantly different between groups. Conclusions Acute care use from device complications decreased with time. Complex care program enrollment may be associated with more substantial reductions in device complication ED visits, and effects may be most pronounced for CMC with enteral tubes.

Background: Human factor has currently become the source of change in organizations. The evaluation of human performance is a practical issue in human resources management and the best way to obtain information for organizational decision-making. Objectives: The current study aimed to monitor the performance of health caregivers in the eastern health center of Ahvaz, Iran, in the self-care program. Methods: This cross-sectional descriptive study was conducted on 72 health caregivers in 20 affiliated and 31 non-affiliated health posts in the eastern health center of Ahvaz in 2018. The census sampling method and ministerial checklist were the tools of assessment for the performance measurement of the health caregivers. The checklist consisted of two parts for personal information and technical performance evaluation. The data were analyzed using the t-test and analysis of variance in SPSS software (version 22). Results: All the participants were female health caregivers. The results showed that there was notanysignificantdifferencebetweenthestudy dimensions with the participants’fieldofstudy (P = 0.798;F = 0.226), academic degree (P value =0.957; t = 0.003), age (P = 0.419; F = 0.955), and work experience (P-value = 0.537; F = 0.627). The health caregiversofthe eastern Ahvaz health center of Ahvaz scored 767.35 out of the total 1,000, indicating that their performance was generally at an acceptable level. Conclusions: The findings of this study can assist the managers and experts of the health sector in evaluating the performance of health caregivers in their self-care program. For the enhancement of the performance of health caregivers, not only health ambassadors should be identified and trained, but also the dimension of organizational self-care should be reinforced.

Increasingly, healthcare policies have changed focus from cure and care to behaviour and health. Prevention is becoming more important, which requires a change in the role of healthcare professionals. Healthcare professionals' role is changing from being a therapist to taking on the role of a coach. To prevent chronicity in Medically Unexplained Physical Symptoms (MUPS), an integrated blended care program was developed. To apply this new program in daily practice, it is important to gain insight into the usability. From the healthcare professionals' point of view the concept of usability consists of performance, satisfaction and acceptability. In this qualitative study participants were recruited after participating in the PARASOL program. Demographics were collected. Semi-structured interviews were conducted and analysed using thematic analysis. Ten healthcare professionals (six physical therapists and four mental health nurses) were interviewed. Four themes on usability were identified: (1) Who fits in the program, (2) preparation, (3) experience with the program and (4) interprofessional collaboration. This study gathered healthcare professionals' experiences with and attitudes towards integrating healthcare and offering blended care programs. An integrated blended care program offers the possibility to personalize treatment. Findings show attention should be given to the new responsibilities of healthcare professionals, and their role in integrated and blended care. This new approach of delivering healthcare can facilitate interprofessional collaboration. Achieving sustainable change in patients however still requires instruction and support for healthcare professionals implementing behavioural change techniques., Highlights • Attention should be given to new responsibilities of healthcare professionals in their role in blended care • The approach of offering integrated and blended care facilitates interprofessional collaboration • Achieving sustainable change in patients requires support for professionals implementing behavioural change techniques

IMPORTANCE: Medicare beneficiaries with end-stage renal disease (ESRD) are a medically complex group accounting for less than 1% of the Medicare population but more than 7% of Medicare fee-for-service payments. OBJECTIVE: To evaluate the association of the Comprehensive End-Stage Renal Disease Care (CEC) model with Medicare payments, health care use, and quality of care. DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, a difference-in-differences design estimated the change in outcomes for 73 094 Medicare fee-for-service beneficiaries aligned to CEC dialysis facilities between the baseline (from January 2014 to March 2015) and intervention periods (from October 2015 to December 2017) relative to 60 464 beneficiaries at matched dialysis facilities. In the CEC model, dialysis facilities, nephrologists, and other providers partner to form ESRD Seamless Care Organizations (ESCOs), specialty-oriented accountable care organizations that coordinate care for beneficiaries with ESRD. ESCOs with expenditures below a benchmark set by the Centers for Medicare & Medicaid Services are eligible to share in savings if they meet quality thresholds. A total of 685 dialysis facilities affiliated with 37 ESCOs participated in the CEC model as of January 2017. Thirteen ESCOs joined the CEC model on October 1, 2015 (wave 1), and 24 ESCOs joined on January 1, 2017 (wave 2). Patients with ESRD who were aligned with CEC dialysis facilities were compared with patients at matched dialysis facilities. MAIN OUTCOMES AND MEASURES: Medicare total and service-specific payments per beneficiary per month; hospitalizations, readmissions, and emergency department visits; and select quality measures. RESULTS: Relative to the comparison group (n = 60 464; 55% men; mean [SD] age, 63.5 [14.4] years), total Medicare payments for CEC beneficiaries (n = 73 094; 56% men; mean [SD] age, 63.0 [14.4] years) decreased by $114 in payments per beneficiary per month (95% CI, −$202 to −$26; P = .01), associated primarily with decreases in payments for hospitalizations and readmissions. Payment reductions were offset by shared savings payments to ESCOs, resulting in net losses of $78 in payments per beneficiary per month (95% CI, −$8 to $164; P = .07). Relative to the comparison group, CEC beneficiaries had 5.01 fewer hospitalizations per 1000 beneficiaries per month (95% CI, −8.45 to −1.56; P = .004), as well as fewer catheter placements (CEC beneficiaries with catheter as vascular access for periods longer than 90 days decreased by 0.78 percentage points [95% CI, −1.36 to −0.19; P = .01]) and fewer hospitalizations for ESRD complications (CEC beneficiaries were 0.11 percentage points less likely [95% CI, −0.20 to −0.02; P = .01] to be hospitalized in a given month). Total dialysis sessions and payments increased, suggesting improved adherence to dialysis treatments. CONCLUSIONS AND RELEVANCE: Early findings from the CEC model demonstrate that a specialty accountable care organization model focused on a particular population was associated with reduced payments and improved quality of care. Future research can assess the longer-term outcomes of the CEC model and its applicability to populations with other complex chronic conditions.

هدفت الدراسة تعرف واقع أهداف برامج رعاية الموهوبين بالمرحلة الابتدائية، ومعرفة مدى تحقيق الأهداف في الواقع الفعلي، وإبراز أهم سبل تطوير أهداف برامج رعاية الموهوبين للمرحلة الابتدائية من وجهة نظر المشرفات التربويات والمعلمات بمدينة الرياض. واستخدمت الدراسة المنهج الوصفي المسحي، وطبقت أداة الدراسة على کامل مجتمع الدراسة (94) من المشرفات التربويات على البرنامج بمدينة الرياض. وتوصلت الدراسة إلى موافقة أفراد عينة الدراسة (إلى حد ما) على أن محتوى البرنامج يتناسب مع أهداف وميول الطالبة واهتمامها، وعلى أنه ينمي مهارات مبادئ البحث العلمي لدى الطالبات، کما أن أنشطة البرنامج تفي باحتياجات الموهوبات المعرفية، والمهارية، والاجتماعية المتناسبة مع الأهداف. موافقة أفراد عينة الدراسة (إلى حد ما) فيما يتعلق بسبل تطوير أهداف البرنامج على عمل اختبارات دورية تکشف مواهب الطالبات المختلفة، وعلى تضمين النشاط الدراسي مشروعات للدراسة الحرة برعاية المعلم ودعمها، وعلى اشتمال برنامج الموهوبين على جميع طالبات مراحل المرحلة الابتدائية. وکان من أبرز التوصيات: تکثيف البرامج التدريبية القبلية والبعدية لتنمية مهارات معلمات الطالبات الموهوبات. وضرورة اعتماد معايير عالمية حديثة في نظام اختيار الطالبات الموهوبات، مع ضرورة التقييم المستمر لهن. This study identifies the objectives of the care of talented primary schoolchildren program in Riyadh. The researcher used the survey descriptive study and applied on a study population totaling (94) female educational supervisors and Teachers for the program. The following are the most significant findings: the program's content consists with objectives of students, this improves the schoolgirls’ principles of scientific research and program activities. qualifying teachers accessing to methods of instructions and means of promotion strengths in field of care of talented schoolgirls before being hired in the program. providing the opportunity to all schoolgirls upon exploring talented ones, follow-up schoolgirls performance on continuing basis. the development of program's objectives through concluding periodical exams for revealing the talented students, the school activities shall include free study projects under the care of teachers and the talented schoolchildren program shall include all schoolchildren of primary stage.

Background: The purpose of this study is to develop an addiction preventing program for nurses, which will improve nurses’ general competency of preventing the addiction problem. Methods: The develop process is in 3 steps. First, We analyzed the studies. A group of addiction experts did the focus group interview and drew out the core competency that is necessary to the general nurses. At the second step of the process, we developed 8 modules of addiction preventing program. For the last step, we calculated the content validity index (CVI) from the expert, and the average of CVI was 0.9. Results: Each module’s topic is; Overall understanding of addiction, Type and characteristic of addiction, Addiction preventing program with SBIRT (Alcoholism, Addiction of internet-game and smartphone, Gambling addiction, Substance addiction), and the Addiction management for internet-game and smartphone addicted adolescent, and employee’s alcoholism). Conclusions: This study provides the basic educational information of the four major addiction prevention. Since nurses are the first line medical staff who is responsible for the screening, it is very important to provide and educate nurse.

Home care services at midnight many residents complained and there is no distribution of home care officers at the Bara-Baraya Public Health Center in Makassar. The focus of research in this study is the evaluation of the implementation of home care programs at the Bara-Baraya Public Health Center in Makassar City. This study aims to evaluate the implementation of home care programs at the Makassar City of Bara Baraya Health Center. The approach used in this study is a qualitative approach that describes and observes deeply the evaluation of the implementation of home care programs at the Makassar City of Bara Baraya Health Center. This research also uses applied research design. The data source in this study was taken from four home care officers at the Bara-Baraya Public Health Center in Makassar City and four people who use home care services. The results showed that the input sub-variables can be quite good. Medical devices such as thermometers, tensimeters, and stethoscopes function properly and are suitable for use in home care health services. Then operational funds such as staff salaries are paid according to the number of visits to the community. The doctor for Rp. 100,000 / visit and nurses 75,000 / visit. But in the aspect of home care officers is still inadequate. Home care workers have a dual role between serving the community at the puskesmas, as well as serving the community at the residence. In the process sub-variables, it can be quite good. In the call center aspect, people can easily call the call center because this service is toll free. Home visits and observations have been carried out carefully. But the division of duties of home care officers is not optimal. In the output sub-variable, it can be said to be good because the public can directly benefit from home care services.

Background: In 2004, Aetna, a national health insurer, launched the Aetna Compassionate Care Program (ACCP) targeting members diagnosed with an advanced illness with a view to increase acc...

Purpose The purpose of this paper is to estimate the cost-effectiveness of tuberculosis (TB) treatment and care in two Thai hospitals located on the borders with Myanmar and Laos. Design/methodology/approach A retrospective data collection was conducted to analyze all costs relevant to TB treatment and care from Mae Sai and Chiang Sean Hospitals. The cost related to TB treatment and care and the number of successful TB treatment from January 1 to December 31, 2017 were used for the calculation. The cost-effectiveness ratio (C/E) and the incremental cost-effectiveness ratio (ICER) were the outcomes. Findings In 2017, the total cost of the TB treatment and care program at Mae Sai Hospital was 482,728.94 baht for 57 TB patients. The cast per treated case per year was 8,468.93 baht. The C/E was 10,971.11 baht per successful TB treatment (44 successful cases). The total cost of the TB treatment and care program at Chiang Sean Hospital was 330,578.73 baht for 39 TB patients. The cost per treated case per year was 8,476.38 baht. The C/E was 22,038.58 baht per successful TB treatment (15 successful cases). The ICER was 5,246.56 baht. The Mae Sai Hospital model was more cost-effective in terms of the treatment and care provided to Burmese patients with TB than the Chiang Sean Hospital model for Laotian patients with TB. Originality/value To improve the cost-effectiveness of TB treatment and care programs for foreign patients in hospitals located on the Thai border, focus should be placed on patient follow-up at the community or village level.