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This article discusses strategies to reduce same-day surgical cancellations, which can lead to harm for patients and inefficiencies in healthcare delivery. The study focuses on a successful intervention implemented at an academic surgery center, which involved automating pre-operative risk stratification and improving pre-operative communication with patients. The authors found a significant decline in same-day cancellations following the intervention, resulting in cost savings for the healthcare system. While the study has limitations and may not be applicable to all settings, it provides valuable insights for other hospital systems to explore solutions for reducing same-day surgical cancellations. [Extracted from the article]

BackgroundParkinson's disease (PD) complexity poses challenges for individuals with Parkinson's, providers, and researchers. A recent multisite randomized trial of a proactive, telephone-based, nurse-led care management intervention - Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS) - demonstrated improved PD care quality. Implementation details and supportive stakeholder feedback were subsequently published. To inform decisions on dissemination, CHAPS Model components require evaluations of their fidelity to the Chronic Care Model and to their implementation. Additionally, assessment is needed on whether CHAPS addresses care challenges cited in recent literature.MethodsThese analyses are based on data from a subset of 140 intervention arm participants and other CHAPS data. To examine CHAPS Model fidelity, we identified CHAPS components corresponding to the Chronic Care Model's six essential elements. To assess implementation fidelity of these components, we examined data corresponding to Hasson's modified implementation fidelity framework. Finally, we identified challenges cited in current Parkinson's care management literature, grouped these into themes using open card sorting techniques, and examined CHAPS data for evidence that CHAPS met these challenges.ResultsAll Chronic Care Model essential elements were addressed by 17 CHAPS components, thus achieving CHAPS Model fidelity. CHAPS implementation fidelity was demonstrated by adherence to content, frequency, and duration with partial fidelity to telephone encounter frequency. We identified potential fidelity moderators for all six of Hasson's moderator types. Through card sorting, four Parkinson's care management challenge themes emerged: unmet needs and suggestions for providers (by patient and/or care partner), patient characteristics needing consideration, and standardizing models for Parkinson's care management. CHAPS activities and stakeholder perceptions addressed all these themes.ConclusionsCHAPS, a supportive nurse-led proactive Parkinson's care management program, improved care quality and is designed to be reproducible and supportive to clinicians. Findings indicated CHAPS Model fidelity occurred to the Chronic Care Model and fidelity to implementation of the CHAPS components was demonstrated. Current Parkinson's care management challenges were met through CHAPS activities. Thus, dissemination of CHAPS merits consideration by those responsible for implementing changes in clinical practice and reaching people in need.Trial registrationClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.

Abstract Aim To explore the value of the 6S management strategies in COVID‐19 wards. Design Nurses from the first Fujian medical team in aiding Hubei Province at Wuhan Jinyintan Hospital (2 February, 2020–24 March, 2020) were recruited and instructed to adopt the 6S management strategies for nursing management. Methods The paired‐sample t‐test was performed to compare the nursing quality, core capabilities of nurses, nursing preparation time, and nursing error rates before and after implementation. Results After implementation of the 6S management strategies, a total of 93 nurses experienced significant improvements in nursing quality, especially in workplace stress, material preparation, and medication management (p

Abstract Aims To identify informational and practical deficits of mothers of hospitalized children with acute gastroenteritis and to determine the effect of intervention on enhancing mothers' participation in providing care. Design This study was a two‐group pre‐ and post‐test quasi‐experimental study. Methods Sample size was eighty mothers of hospitalized children younger than 5 years with acute gastroenteritis in each group using consecutive sampling method. Based on the needs assessment, the training and practical demonstration were performed individually in the intervention group. The control group received usual and standard care. The care practice of mothers were observed before and three times after the intervention at a 1‐day interval. The confidence level was 0.95. Results After intervention, there was a significant increase in the mothers' care practice in the intervention group and a significant difference between the two groups. The participatory care approach could enhance mothers' practice in providing care to the hospitalized children with AGE.

Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age

Abstract Background Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses’ perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. Methods We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian’s definition of structures regarding the quality of care. Results The structural conditions were represented by three themes; (I) “Distances and inaccessibility” explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) “Competence of the actors” explains continuity, knowledge and collaboration among the individuals involved. (III) “Levels of organizational governance” explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. Conclusions Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.

Objectives: Examine the understanding of terminologies and management patterns of bacillus Calmette‐Guérin (BCG)‐unresponsive nonmuscle invasive bladder cancer (NMIBC) in six territories in Asia‐Pacific. Methods: This study involved two phases: (1) a survey with 32 urologists and 7 medical oncologists (MOs) and (2) a factorial experiment and in‐depth interviews with 23 urologists and 2 MOs. All clinicians had ≥8 years' experience managing NMIBC patients in Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. Data from Phase 1 were summarized using descriptive statistics; content and thematic analyses applied in Phase 2. Results: In phase 1, 35% of clinicians defined BCG‐unresponsive as BCG‐refractory, ‐relapse and ‐resistant, 6% defined it as BCG‐refractory and ‐relapse; 22% classified BCG‐failure as BCG‐refractory, ‐relapse, ‐resistant, and when muscle‐invasive bladder cancer is detected. If eligible and willing, 50% (interquartile range [IQR], 50%–80%) of BCG‐unresponsive patients would undergo radical cystectomy (RC), and 50% (IQR 20%–50%) of RC‐eligible patients would receive bladder‐sparing treatment or surveillance. In phase 2, we found that 32%, 88%, and 48% of clinicians, respectively, used "BCG‐unresponsive," "BCG‐refractory," and "BCG‐relapse" in clinical practice but with no consistent interpretation of the terms. Compared with EAU definitions, 8%–60% of clinicians appropriately classified 9 tumor types that are persistent or recurrent after adequate BCG. Fifty percent of clinicians mentioned a lack of bladder‐preserving treatment that outperforms RC in quality of life as a reason to retreat BCG‐unresponsive patients with BCG. Conclusions: Our study revealed varied understanding and application of BCG‐unresponsive terminologies in practice. There is a need for a uniform and simple definition of BCG‐unresponsive disease in Asia‐Pacific. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems are increasingly turning to data‐driven approaches, such as clustering techniques, to inform interventions for medically complex older adults. However, patients seeking care in multiple healthcare systems may have missing diagnoses across systems, leading to misclassification of resulting groups. We evaluated the impact of multi‐system use on the accuracy and composition of multimorbidity groups among older adults in the Veterans Health Administration (VA). Methods: Eligible patients were VA primary care users aged ≥65 years and in the top decile of predicted 1‐year hospitalization risk in 2018 (n = 558,864). Diagnoses of 26 chronic conditions were coded using a 24‐month lookback period and input into latent class analysis (LCA) models. In a random 10% sample (n = 56,008), we compared the resulting model fit, class profiles, and patient assignments from models using only VA system data versus VA with Medicare data. Results: LCA identified six patient comorbidity groups using VA system data. We labeled groups based on diagnoses with higher within‐group prevalence relative to the average: Substance Use Disorders (7% of patients), Mental Health (15%), Heart Disease (22%), Diabetes (16%), Tumor (14%), and High Complexity (10%). VA with Medicare data showed improved model fit and assigned more patients with high accuracy. Over 70% of patients assigned to the Substance, Mental Health, High Complexity, and Tumor groups using VA data were assigned to the same group in VA with Medicare data. However, 41.9% of the Heart Disease group and 14.7% of the Diabetes group were reassigned to a new group characterized by multiple cardiometabolic conditions. Conclusions: The addition of Medicare data to VA data for older high‐risk adults improved clustering model accuracy and altered the clinical profiles of groups. Accessing or accounting for multi‐system data is key to the success of interventions based on empiric grouping in populations with dual‐system use. [ABSTRACT FROM AUTHOR]

Background: Epidemics are threats to communities and their health. The preparedness of makeshift hospitals in epidemics in management, planning, implementation, and structure to provide appropriate and timely services is essential. Studies show that the incidence command system and the operational fact sheet based on task descriptions and instructions in makeshift hospitals are not considered. This study is designed to develop an appropriate organizational structure for makeshift hospitals. Materials and Methods: This was a descriptive-analytical cross-sectional study in two stages, including review and expert panel studies, to develop a national fact sheet guide and the structure of makeshift hospitals. Results: Based on the nature of disasters, makeshift hospitals should have specific structures. In the structure designed for a makeshift hospital, according to the center's services and time of activation, it is necessary to have a manager, management, and executive staff. A medical specialist, such as an infectious or pulmonary specialist, is essential, depending on the situation. Considering the limited resources in developing countries and the importance of managing resources (financial, human, and equipment) and improving the quality of health services, it will be helpful to formulate a management structure and implement operational worksheets in the least possible time. Conclusion: The use of command and management structure will improve decision-making in critical situations, especially in cases of epidemics, the need for quarantine, and the provision of services to injured patients. [ABSTRACT FROM AUTHOR]

Background: Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020. Objective: This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine's integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine. Methods: We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring. Results: Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care. Conclusions: The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF. [ABSTRACT FROM AUTHOR]

Background: Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in a patient population at significant risk—Medicare enrollees with multiple chronic illnesses enrolled in care management services—and measure their prevalence prior to any systematic screening. Methods: We partnered with Renova Health, an independent Medicare Chronic Care Management (CCM) provider with patients in 10 states during our study period (January 2017 through August 2020). Our data included over 3,000 Medicare CCM patients, representing nearly 20,000 encounters. We used a dictionary-based natural language processing approach to ascertain the prevalence of six domains of barriers to care (food insecurity, housing instability, utility hardship) and unmet social needs (health care affordability, need for supportive services, transportation) in notes taken during telephonic Medicare CCM patient encounters. Results: Barriers to care, specifically need for supportive services (2.4%) and health care affordability (0.8%), were the most prevalent domains identified. Transportation as a barrier to care came up relatively less frequently in CCM encounters (0.1%). Unmet social needs were identified at a comparatively lower rate, with potential housing instability (0.3%) flagged most followed by potential utility hardship (0.2%) and food insecurity (0.1%). Conclusions: There is substantial untapped opportunity to systematically screen for social determinants of health and unmet social needs in care management. [ABSTRACT FROM AUTHOR]

Crush syndrome is a systemic picture that develops as a result of prolonged compression, immobilization, and crushing of muscle groups after trauma and collapse. It affects numerous physiological systems and lays the groundwork for surgical and medical issues. After direct trauma, crush syndrome is the second most common cause of death in large-scale disasters like earthquakes. Rhabdomyolysis, which develops with loss of perfusion owing to compression of the limb muscles, is the primary initiator of crush syndrome.Rhabdomyolysis has a systemic effect whereby intracellular products including electrolytes, enzymes, and myoglobin rise quickly in the bloodstream and result in potentially fatal acute kidney injury and electrolyte imbalances. The 2 main factors that contribute to this syndrome’s mortality are hyperkalemia and acute tubular necrosis. Infections, compartment syndrome, hemorrhage, hypovolemic shock, heart failure, respiratory failure, and other problems are also brought on by it. The management of electrolyte imbalances and associated arrhythmias, the successful treatment of compartment syndrome, the avoidance of infections, and the prevention of potential consequences are all important tasks for intensive care nurses. The administration of the care and treatment process for a trauma patient admitted to intensive care depends heavily on the knowledge, abilities, and experience of nurses. [ABSTRACT FROM AUTHOR]

This scoping review focuses on post-stroke patients in India and highlights the high rate of stroke-related hospitalizations and the financial burden it places on patients and their families. It emphasizes the lack of post-stroke rehabilitation resources and limited patient care management, which contribute to the challenges faced by stroke survivors. The article calls for accessible and culturally sensitive rehabilitation interventions, government policies to improve post-stroke care, and increased patient education and stroke awareness. It suggests the implementation of affordable home rehabilitation programs and tele-rehabilitation services for elderly stroke survivors. The document also emphasizes the importance of continuous observation and assessment by nurses in identifying patients at risk of clinical deterioration and calls for a multidisciplinary approach to stroke rehabilitation in India, including the use of technology-based rehabilitation plans. [Extracted from the article]

Introduction: Preoperative tests (EPO) aim to detect abnormalities and give greater safety to the procedure. However, the request for these tests is still controversial, either because they do not bring about changes in conduct for the procedure or result in some harm to the patient. The objective is to assess the frequency of EPO requests and abnormalities in aesthetic plastic surgery patients, to verify what these abnormalities are, what preoperative management should be done based on the finding, and to associate the data obtained with the patient’s profile and the planned surgery. Method: Retrospective study evaluating medical records of aesthetic plastic surgery patients who underwent routine EPO in a plastic surgery hospital in 2019. Results: 978 patients were studied, and 51% had some abnormality in EPO. 93.7% were women, with a mean age of 46.5 years. 12.3 exams were performed per patient, and abnormality was observed in 6.1% of EPO. The exams that had the most abnormalities were the lipidogram (23.8%) and the cardiac evaluation (14.1%). Hypothyroidism was the most common comorbidity (18.4% of patients); 70% of diabetics had a glycemic level above the recommended level. Only 3.4% of the patients suffered a change in preoperative management due to EPO abnormality, and in 57.9% of these cases, the surgery was postponed. Test alterations were more frequent in male patients (p

Purpose A doctor’s professional behavior and clinical competency reflect a range of personal and interpersonal qualities, attributes, commitments, and values. This study aimed to identify the most influential factor of medical competence regarding patient management ability. Methods We used an analytic observational design with a cross-sectional approach, and gathered the perceptions of medical school graduates of Bandung Islamic University via an online questionnaire scored on a Likert scale. Two hundred and six medical graduates who graduated at least 3 years prior to survey were included in the study. The factors evaluated included humanism, cognitive competence, clinical skill competence, professional behavior, patient management ability, and interpersonal skill. IBM AMOS ver. 26.0 (IBM Corp., Armonk, USA) was used for structural equation modelling of the six variables latent and 35 indicator variables. Results We found that graduates have highly positive perceptions of the humanism (95.67%). Followed by interpersonal skills (91.26%), patient management (89.53%), professional behavior (88.47%), and cognitive competence (87.12%). They rated clinical skill competence the lowest (81.7%). Regarding factors that contribute to patient management ability, the aspects of humanism, interpersonal skill, and professional behavior were found to significantly affect patient management ability (p-value=0.035, 0.00, and 0.00, respectively) with a critical rate of 2.11, 4.31, and 4.26 consecutively. Conclusion Humanism and interpersonal skill are two important factors that medical graduates assessed very positively. According to surveyed medical graduates, their expectations of the institution were met regarding humanism. However, there is a need to strengthen medical students’ clinical skills and improve their cognitive abilities through educational programs.

Acquired cardiovascular conditions are a leading cause of maternal morbidity and mortality. A growing number of pregnant women have acquired and heritable cardiovascular conditions and cardiovascular risk factors. As the average age of childbearing women increases, the prevalence of acute coronary syndromes, cardiomyopathy, and other cardiovascular complications in pregnancy are also expected to increase. This document, the third of a 5-part series, aims to provide practical guidance on the management of such conditions encompassing pre-conception through acute management and considerations for delivery.

AbstractBackground Most COVID-19 patients were treated in primary health care (PHC) in Europe.Objectives To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient’s clinical pathways in Europe.Methods Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020.Results COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30).Conclusion In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.

Background/objectivesCognitive and mobility impairments are common and underdiagnosed chronic conditions that afflict community-dwelling older adults. This study describes the organization, implementation, and evaluation of an intervention for underserved and ethnically diverse older patients with dementia and/or falls risk.DesignObservation, baseline and 1 year after intervention.SettingCommunity-based primary care county clinics in inland southern California.ParticipantsA total of 272 persons, aged 70 years and older, who screened positive for falls and/or dementia and enrolled in the Cognition and Mobility Care Management program during the study period.InterventionA nurse care manager performed a patient and caregiver evaluation and created and implemented a care plan with medical, behavioral, and psychosocial interventions in partnership with patients and their primary care providers.MeasurementsProcess outcomes included rates of positive screening for dementia and fall risk, referral, enrollment, and visit completion. Patient outcomes included fall history, mobility and cognitive assessments, and depression scales. Patients and/or caregivers completed questionnaires rating perceived benefits of enrollment after 1 year in the program.ResultsMedical assistants screened 573 patients aged 70 years and older during the study period; 78% screened positive for dementia and/or fall risk. Of the patients who screened positive, 94% were referred; 91% of contacted patients elected to enroll, and 272 patients completed an intake visit (meanage = 77 years; 65% female; 75% Latino; 10% African American). The patients and caregivers who completed satisfaction questionnaires 1 year after enrollment rated the program highly, and 92% would recommend the program to others.ConclusionA primary care-based screening and comanagement program to identify and manage dementia and falls risk in primarily Latino and African American older adult patients living in an underserved area was well received, with high satisfaction and perceived benefit from patients and caregivers.

Aims: To identify how the nursing process (assessment, planning, intervention and outcome evaluation) has been incorporated into digital health systems (electronic medical records, electronic care plans and clinical decision support systems) to gain an understanding of known benefits and challenges posed to nurses' decision‐making processes. Background: Nursing terminologies, including the International Classification for Nursing Practice (ICNP), and Nursing Minimum Data Set's (NMDS), have been developed to improve standardised language integration of components of nursing care into digital systems. However, there is limited evidence regarding whether the complete nursing process is effectively being incorporated into digital health systems. Methods: An integrative systematic review following PRISMA guidelines. A search strategy was applied to extract articles from included databases: CINAHL, MEDLINE, SCOPUS and Web of Science Core Collection. Articles were limited to English language and published January 2007–March 2022 and assessed using a pre‐determined eligibility criteria. Quality assessment and a narrative synthesis were conducted. Results: A total of 3321 articles were identified, and 27 studies included. There were (n = 10) qualitative, (n = 4) quantitative non‐randomised controlled trials, (n = 3) quantitative descriptive studies and (n = 10) mixed methods. Nurse assessment and planning components were the most comprehensive phases incorporated into digital health systems, and interventions and outcome evaluation were scarcely reported. Conclusions: Inadequate capture of nursing work is a problem unresolved by digital health systems. This omission may be hindering nurse clinical decision‐making for patient care and limiting the visibility of the nursing role in health care interventions and the associated impact on patient outcomes. Relevance to clinical practice: Further research is needed on how digital systems can support nurses to apply the full nursing process and to further evaluate patient outcomes. Digital systems can support health‐service level evaluation through capturing missed nursing care and the consequences on patients utilising nurse‐sensitive‐outcomes; however, this is not yet being realised. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the impact of UI TEAM RX, a pharmacy-based enhanced services and care model, on adherence in patients with hypertension and prescribed a renin-angiotensin system antagonist (RASA). Methods A single-center, retrospective, observational cohort study was conducted in an academic health system, University of Illinois Hospital & Health Sciences System (UI Health). The cohort consisted of patients who utilized UI Health's outpatient pharmacies between May 2016 and December 2018 to fill RASA prescriptions. Patients who were not part of the UI TEAM RX care model served as the control group, while patients enrolled in UI TEAM RX formed the intervention group. The control and intervention groups were matched based on index date, age, gender, and race. The primary outcome was mean change in a rolling 6-month calculation of proportion of days covered (PDC). The secondary outcome was the percentage of patients who had reached their blood pressure goal at follow-up at 12 months. Results Patients receiving UI TEAM RX intervention showed significant improvement in mean PDC at 6-month follow-up compared to control patients (P < 0.01). The proportion of patients with a PDC above 0.8 was higher in the intervention group, but this difference was not statistically significant. There was also a 16.4% increase in the proportion of patients who reached their blood pressure goal in the intervention group, although this increase was not statistically significant. Conclusion The UI TEAM RX program had a statistically significant impact on patients' mean PDCs. An increase in the number of patients reaching their blood pressure goal was also seen. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To explore the value of the 6S management strategies in COVID‐19 wards. Design: Nurses from the first Fujian medical team in aiding Hubei Province at Wuhan Jinyintan Hospital (2 February, 2020–24 March, 2020) were recruited and instructed to adopt the 6S management strategies for nursing management. Methods: The paired‐sample t‐test was performed to compare the nursing quality, core capabilities of nurses, nursing preparation time, and nursing error rates before and after implementation. Results: After implementation of the 6S management strategies, a total of 93 nurses experienced significant improvements in nursing quality, especially in workplace stress, material preparation, and medication management (p <.001). Adoption of the 6S model for nursing management in COVID‐19 wards effectively improves nursing quality, enhances the core capabilities of nurses, reduces nursing preparation time, and lowers nursing error rates. [ABSTRACT FROM AUTHOR]

Rationale, Aimsand Objectives: Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient‐centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face. Method: We used an embedded multiple case study design to describe in‐depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within‐case analysis followed by a cross‐case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted. Results: Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging. Conclusion: The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Asociación Odontológica Argentina is the property of Asociacion Odontologica Argentina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To identify informational and practical deficits of mothers of hospitalized children with acute gastroenteritis and to determine the effect of intervention on enhancing mothers' participation in providing care. Design: This study was a two‐group pre‐ and post‐test quasi‐experimental study. Methods: Sample size was eighty mothers of hospitalized children younger than 5 years with acute gastroenteritis in each group using consecutive sampling method. Based on the needs assessment, the training and practical demonstration were performed individually in the intervention group. The control group received usual and standard care. The care practice of mothers were observed before and three times after the intervention at a 1‐day interval. The confidence level was 0.95. Results: After intervention, there was a significant increase in the mothers' care practice in the intervention group and a significant difference between the two groups. The participatory care approach could enhance mothers' practice in providing care to the hospitalized children with AGE. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to explore diversity and perceptions related to culture among New York City sonography clinicians and educators and determine whether this specific workforce is keeping pace with the changing demographics of the city population. Materials and Methods: An 18-question survey, which addressed demographics, work environment, and perceptions about diversity and inclusion in the workplace, was disseminated to sonography educators and hospitals in the five boroughs of New York City. Results: A total of 112 sonographers responded and 50% were White/Caucasian, 34.16% represented Asian/Pacific Islander (17.5%), Black/African American (10.83%), Hispanic/Latino (5%), and Native American/Alaskan Native (0.83%) populations, as well as 15.83% preferred not to respond. Most sonographers identified their gender as female. The 21 to 30 years age group was the least represented, and the age group 31 to 51+ years represented over three-quarters of the workforce. Most respondents worked with culturally diverse staff and were satisfied with their work environment. However, the Black/African American group showed the lowest average satisfaction score, and their responses were the least positive. Conclusion: In this cohort of respondents, Black/African, Hispanic, and Native American ethnicities were underrepresented compared with the city's reported diverse population. Consequently, new programs and initiatives should be considered to increase ethnic and racial inclusivity, to respond to the needs of citizens of New York City. [ABSTRACT FROM AUTHOR]

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses' perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. Methods: We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian's definition of structures regarding the quality of care. Results: The structural conditions were represented by three themes; (I) "Distances and inaccessibility" explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) "Competence of the actors" explains continuity, knowledge and collaboration among the individuals involved. (III) "Levels of organizational governance" explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. Conclusions: Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop a drainage tube management protocol for nursing students to enhance their core nursing skills and improve the quality of the nursing practicum. Methods: A drainage tube (Jackson-Pratt drain or Hemovac) management protocol for nursing students was developed in four stages: a preliminary survey (stage 1), establishment of criteria for the implementation of the protocol (stage 2), finalization of the protocol (stage 3), and development of nursing scenarios to implement the developed protocol (stage 4). Results: The final drainage tube management protocol outlined 23 steps, and the scoring system reflected whether each step was fully performed (2), partially performed (1), and not performed (0) for a total possible score of 46. The example nursing scenario was designed to evaluate the process through which nursing students provide care for a postoperative patient with a Jackson-Pratt drain (or Hemovac) with level 1 (fundamentals of nursing practice for sophomores in the first stage). Conclusion: It is important to educate and evaluate nursing students on core nursing skills that must be learned and acquired during their school years, owing to their high frequency of use and importance in nursing practice. To this end, standardized protocols for each core nursing skill should be used to ensure consistent education and evaluation in nursing situations that resemble the clinical setting, in which continual updating of core nursing protocols is required. [ABSTRACT FROM AUTHOR]

BackgroundA recent nurse-led proactive care management intervention, Care Coordination for Health Promotion and Activities in Parkinson Disease (CHAPS), improved care quality when compared to usual care in a randomized controlled trial. Therefore, stakeholder (patient participants, nurse care managers, and Parkinson disease (PD) specialists) perceptions of key intervention components merit evaluation to inform decisions about dissemination.MethodsThis multi-site study occurred in five southwest United States Veterans Health Administration medical centers. Stakeholders were surveyed on their perceptions of CHAPS including the CHAPS Assessment, CHAPS nurse care managers, the Siebens Domain Management Model™ (a practical clinical model), and the Siebens Health Care Notebook (Notebook) (self-care tool). Participants' electronic medical records were abstracted for perceptions of the Notebook. Statistical analysis software was used to provide summary statistics; open card sorting methodology was used to identify themes and attributes in qualitative data including usability of some components.ResultsParticipants, overall, highly rated their medication self-management, acknowledged some challenges with the CHAPS self-care tools, reported knowledge of PD specialist follow-up and PD red flags, and rated CHAPS nurse care managers as helpful. Nurse care manager responses indicated the CHAPS Assessment and Program highly facilitated care of their patients. Most all PD specialists would refer other patients to CHAPS. Nurse care manager and PD specialist responses indicated improved participant management of their PD. Three themes emerged in participant perceptions of the Notebook: Notebook Assets (e.g., benefits and features-liked); Deferring Notebook Review (e.g., no time to review); and Reasons for Not Using (e.g., participant preference). Shared attributes regarding the Siebens Domain Management Model and Notebook usability, reported by nurse care managers, were user-friendly, person/patient-centered, and organized. Some challenges to their use were also reported.ConclusionsOverall, stakeholder perceptions of the proactive nurse-led CHAPS intervention indicated its value in the care of individuals with PD. Responses about the CHAPS Assessment, Siebens Domain Management Model, and Notebook self-care tool signified their usefulness. Stakeholders' constructive suggestions indicated their engagement in CHAPS. These findings support CHAPS dissemination and contribute to research in care management.Trial registrationClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.

BackgroundA recent nurse-led, telephone-administered 18-month intervention, Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS), was tested in a randomized controlled trial and improved care quality. Therefore, intervention details on nurse care manager activity (types and frequencies) and participant actions are needed to support potential dissemination. Activities include nurse care manager use of a holistic organizing framework, identification of Parkinson's disease (PD)-related problems/topics, communication with PD specialists and care coordination, participant coaching, and participant self-care actions including use of a notebook self-care tool.MethodsThis article reports descriptive data on the CHAPS intervention. The study setting was five sites in the Veterans Affairs Healthcare System. Sociodemographic data were gathered from surveys of study participants (community-dwelling veterans with PD). Nurse care manager intervention activities were abstracted from electronic medical records and logbooks. Statistical analysis software was used to provide summary statistics; closed card sorting was used to group some data.ResultsIntervention participants (n = 140) were primarily men, mean age 69.4 years (standard deviation 10.3) and community-dwelling. All received the CHAPS Initial Assessment, which had algorithms designed to identify 31 unique CHAPS standard problems/topics. These were frequently documented (n = 4938), and 98.6% were grouped by assigned domain from the Organizing Framework (Siebens Domain Management Model™). Nurse care managers performed 27 unique activity types to address identified problems, collaborating with participants and PD specialists. The two most frequent unique activities were counseling/emotional support (n = 387) and medication management (n = 349). Both were among 2749 total performed activities in the category Implementing Interventions (coaching). Participants reported unique self-care action types (n = 23) including use of a new notebook self-care tool.ConclusionsCHAPS nurse care managers implemented multiple activities including participant coaching and care coordination per the CHAPS protocol. Participants reported various self-care actions including use of a personalized notebook. These findings indicate good quality and extent of implementation, contribute to ensuring reproducibility, and support CHAPS dissemination as a real-world approach to improve care quality.Trial registrationClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.

BACKGROUND: Live kidney donors (LKDs) account for nearly a third of kidney transplants in the United States. While donor nephrectomy poses minimal post-surgical risk, LKDs face an elevated adjusted risk of developing chronic diseases such as hypertension, diabetes, and end-stage renal disease. Routine screening presents an opportunity for the early detection and management of chronic conditions. Transplant hospital reporting requirements mandate the submission of laboratory and clinical data at 6-months, 1-year, and 2-years after kidney donation, but less than 50% of hospitals are able to comply. Strategies to increase patient engagement in follow-up efforts while minimizing administrative burden are needed. We seek to evaluate the effectiveness of using small financial incentives to promote patient compliance with LKD follow-up. METHODS/DESIGN: We are conducting a two-arm randomized controlled trial (RCT) of patients who undergo live donor nephrectomy at The Johns Hopkins Hospital Comprehensive Transplant Center (MDJH) and the University of Maryland Medical Center Transplant Center (MDUM). Eligible donors will be recruited in-person at their first post-surgical clinic visit or over the phone. We will use block randomization to assign LKDs to the intervention ($25 gift card at each follow-up visit) or control arm (current standard of care). Follow-up compliance will be tracked over time. The primary outcome will be complete (all components addressed) and timely (60 days before or after expected visit date), submission of LKD follow-up data at required 6-month, 1-year, and 2-year time points. The secondary outcome will be transplant hospital-level compliance with federal reporting requirements at each visit. Rates will be compared between the two arms following the intention-to-treat principle. DISCUSSION: Small financial incentivization might increase patient compliance in the context of LKD follow-up, without placing undue administrative burden on transplant providers. The findings of this RCT will inform potential center- and national-level initiatives to provide all LKDs with small financial incentives to promote engagement with post-donation monitoring efforts. TRIAL REGISTRATION: ClinicalTrials.gov number: NCT03090646 Date of registration: March 2, 2017 Sponsors: Johns Hopkins University, University of Maryland Medical Center Funding: The Living Legacy Foundation of Maryland.

BackgroundInjuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.MethodsWe conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.ResultsThe demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups.ConclusionsA multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.).

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.

The evidence for outpatient management of hemodynamically stable, low-risk patients with acute symptomatic pulmonary embolism (PE) is mounting. Guidance in identifying patients who are eligible for outpatient (ambulatory) care is available in the literature and society guidelines. Less is known about who can identify patients eligible for outpatient management and in what clinical practice settings. To answer the question, "Can primary care do this?" (provide comprehensive outpatient management of low-risk PE). We undertook a narrative review of the literature on the outpatient management of acute PE focusing on site of care. We searched the English-language literature in PubMed and Embase from January 1, 1950, through July 15, 2019. We identified 26 eligible studies. We found no studies that evaluated comprehensive PE management in a primary care clinic or general practice setting. In 19 studies, the site-of-care decision making occurred in the Emergency Department (or after a short period of supplemental observation) and in 7 studies the decision occurred in a specialty clinic. We discuss the components of care involved in the diagnosis, outpatient eligibility assessment, treatment, and follow-up of ambulatory patients with acute PE. We see no formal reason why a trained primary care physician could not provide comprehensive care for select patients with low-risk PE. Leading obstacles include lack of ready access to advanced pulmonary imaging and the time constraints of a busy outpatient clinic. Until studies establish safe parameters of such a practice, the question "Can primary care do this?" must remain open.

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

Parkinson disease is a complex, age-related, neurodegenerative disease associated with dopamine deficiency and both motor and nonmotor deficits. Many environmental and genetic factors influence Parkinson disease risk, with different factors predominating in different patients. These factors converge on specific pathways, including mitochondrial dysfunction, oxidative stress, protein aggregation, impaired autophagy, and neuroinflammation. Ultimately, treatment of Parkinson disease may focus on targeted therapies for pathophysiologically defined subtypes of Parkinson disease patients.

Abstract Background Fatigue is one of the most common problems in patients with multiple sclerosis (MS) and has adverse effects on their sleep status and self-efficacy. This study aimed to determine the effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with MS. Methods This quasi-experimental study was performed on 60 patients with MS in Arak, Iran. Subjects were randomly assigned into intervention and control groups. The intervention group received eight sessions of nurse-led fatigue management training through the Skyroom platform. The control group received only the usual programs. Data were collected before and two months after the intervention using the Fatigue Severity Scale, the Pittsburgh Sleep Quality Index, and the Multiple Sclerosis Self-Efficacy Scale. The significance level in this study was determined 0.05. Results After the intervention, the mean score of fatigue severity in the intervention group was significantly lower than the control group (2.52 ± 0.40 vs 5.65 ± 0.52) (P

Abstract Aim The aim of the study was to describe the process of developing a Professional Practice Model by a Nursing School and Nursing Department of University Hospital. Design and Method (s) This is a descriptive nursing methodology research, developed along three stages: preliminary, empirical and validation. The empirical phase used qualitative and quantitative methodology. 28 teachers from the nursing school and nurses from the hospital participated. We defined the elements of the nursing meta‐paradigm from narratives and focus group. Then, we extracted propositions regarding the nature of nursing from the relationship between the meta‐paradigm elements, which concluded in the core elements. Results The core elements of this nursing professional practice model are nursing seeks the well‐being of the person, family or group; nursing is total and global, person‐centred; nursing is compassionate; nursing entails up‐to‐date, quality scientific, technical and human competencies; nursing is delivered in a teaching hospital environment, with a Christian ethical perspective.

AbstractObjectives Medication errors are leading causes of hospitalization and death in western countries and WHO encourages health care providers to implement non-dispensing pharmacist services in primary care to improve medication work. However, these services struggle to provide any impact on clinical outcomes. We wanted to explore health care professionals’ views on medication work to illuminate determinants of the implementation success. The research was designed to inform and adapt implementation strategies for non-dispensing pharmacist services.Design Semi-structured interview study with nine healthcare professionals.Setting Four Norwegian home care wards.Subjects Nine healthcare professionals working at different wards within one home care unit.Main outcome measures Determinants of implementation outcomes.Results Contextual determinants of the implementation process were mainly related to characteristics of the setting such as poorly designed information systems, work overload, and chaotic work environments. The identified barriers question the innovation’s appropriateness related to the setting’s needs but also provide possibilities for tailoring pharmacist services to local medication work issues. The observable positive effects and the perceived advantage of the pharmacist services are likely to facilitate the implementation process.Conclusion Our study provided information on contextual elements that influence the implementation process of non-dispensing pharmacist services. Awareness of these factors can help develop strategies to help the organization succeed in in achieving program outcomes.

Abstract Purpose This study aimed to compare the length of stay (LOS) and treatment outcomes based on the application and achievement of a newly developed emergency department (ED) LOS management system for severely ill patients. Methods Data were retrospectively collected from electronic medical records (EMRs) for the system evaluation and research purpose. The study subjects are severely ill patients whose diagnosis codes are designated by the Ministry of Health and Welfare and who visited the ED of a tertiary hospital from January to December 2019. The control group (Group 1) refers to those who have neither applied nor achieved the goal (5 hours or less) of the ED LOS management system even after it was applied, and the experimental group (Group 2) refers to those who have achieved the 5-hour goal after applying the system. Results A total of 2034 severely ill patients applied the ED LOS management system. Group 1 included 837 patients and Group 2 included 1197 patients. Thirty days in-hospital mortality corresponded to 10.6% in Group 1 and 6.6% in Group 2 (χ2 = 10.58, p = .001). The total duration of hospitalization was 14.66 ± 18.26 days in Group 1 and 10.19 ± 16.00 days in Group 2 (t = 9.03, p

Abstract Background The ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity they are trained to. Methods We surveyed all GP trainees of “Ile de France”. The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients’ care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. Results 525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient’s (210 answers, 40%) and relative’s communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in “at risk” hospital settings. Conclusion Self-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.

Abstract Background Segmentation models such as latent class analysis are an increasingly popular approach to inform group-tailored interventions for high-risk complex patients. Multiple studies have identified clinically meaningful high-risk segments, but few have evaluated change in groupings over time. Objectives To describe population-level and individual change over time in latent comorbidity groups among Veterans at high-risk of hospitalization in the Veterans Health Administration (VA). Research design Using a repeated cross-sectional design, we conducted a latent class analysis of chronic condition diagnoses. We compared latent class composition, patient high-risk status, and patient class assignment in 2018 to 2020. Subjects Two cohorts of eligible patients were selected: those active in VA primary care and in the top decile of predicted one-year hospitalization risk in 2018 (n = 951,771) or 2020 (n = 978,771). Measures Medical record data were observed from January 2016–December 2020. Latent classes were modeled using indicators for 26 chronic health conditions measured with a 2-year lookback period from study entry. Results Five groups were identified in both years, labeled based on high prevalence conditions: Cardiometabolic (23% in 2018), Mental Health (18%), Substance Use Disorders (16%), Low Diagnosis (25%), and High Complexity (10%). The remaining 8% of 2018 patients were not assigned to a group due to low predicted probability. Condition prevalence overall and within groups was stable between years. However, among the 563,725 patients identified as high risk in both years, 40.8% (n = 230,185) had a different group assignment in 2018 versus 2020. Conclusions In a repeated latent class analysis of nearly 1 million Veterans at high-risk for hospitalization, population-level groups were stable over two years, but individuals often moved between groups. Interventions tailored to latent groups need to account for change in patient status and group assignment over time.

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The timing and type of surgery may influence the World Health Organization (WHO) safety surgical checklist compliance. The aim was therefore to determine the prevalence of compliance and completion of the WHO surgical checklist with regard to time of the day, day of the week and type of operation. The WHO surgical safety checklist for all patients who underwent surgery were evaluated using a cross-sectional observation study. The time of surgery was categorised as occurring during the working-hours or after-hours. The day of surgery was categorised as occurring during the weekday or weekend. The type of surgery was categorised as an emergency or elective procedure. From 421 operations, 207 (49.2%) checklists were incomplete, 201 (47.7%) were completed and 13 (3.1%) with no attempt at the checklist. Compliance of the checklist during working-hours was similar to after-hours, with 97.6% and 95.3% respectively. Compliance of the checklist during weekdays was similar to the weekend, with 97.1% and 95.6% respectively. Elective operations had a compliance of 97.1%, compared to emergency operations at 96.7%. There was no significant difference between checklist compliance compared to time of day (P = 0.446), day of week (P = 0.766) and type of operation (P = 0.710). Time of day, day of week and type of operation does not influence the WHO surgical checklist compliance. Although the majority attempt the checklist, completion rate still requires improvement. [ABSTRACT FROM AUTHOR]

La sédentarité gagne du terrain dans la plupart des pays occidentaux et coûte des milliards d'euros à nos sociétés. La France n'est pas épargnée par cette tendance et a entrepris des actions de grande ampleur pour y remédier, en autorisant notamment les médecins généralistes à prescrire une activité physique adaptée à leurs patients en affection longue durée grâce à la loi de 2016. Cependant, cette possibilité est très peu exploitée par les praticiens. Déterminer les freins à la prescription d'APA en France et à l'étranger et trouver des leviers pour que cette thérapeutique soit davantage prescrite à l'avenir. Une revue systématique de la littérature a été effectuée selon le modèle PRISMA, en interrogeant 6 moteurs de recherche scientifiques et la littérature grise. L'ensemble des publications sélectionnées a été rassemblé grâce au logiciel Zotero à partir duquel ont été éliminés les doublons. La recherche a été réalisée entre le 5 et le 24 juin 2021, avec une veille bibliographique jusqu'au 11 février 2022. La sélection des articles s'est faite en double aveugle à l'aide de l'outil informatique Rayyan, en se basant d'abord sur le titre et le résumé, et ensuite sur le texte intégral. Nous recherchions un consensus en cas de désaccord à chaque étape de la sélection. Un total final de 58 articles a servi de base pour ce travail. Le manque de connaissances et de formation à l'APA, le manque de temps des médecins et des patients, le non-remboursement par la CPAM et la complexité de la prescription sont les freins qui sont le plus ressortis dans notre recherche. L'amélioration de la formation des MG, de la communication et de l'information auprès des professionnels et de la population générale, ou encore la simplification de la prescription nous semblent nécessaires. Les questions de la prise en charge de l'APA par la CPAM et de la revalorisation de la consultation dédiée doivent être posées, afin que cette thérapeutique soit plus utilisée. médecine générale. Sedentary lifestyle is gaining ground in most Western countries and is costing our societies billions of euros. France is not spared from this trend and has undertaken large-scale actions to remedy it, in particular by authorizing general practitioners to prescribe an APA to their ALD patients thanks to the 2016 law. However, this possibility is very little used by practitioners. To determine the obstacles to the prescription of APA in France and abroad and to find levers to increase the prescription of this therapy in the future. A systematic review of the literature was conducted using the PRISMA model, by searching 6 scientific search engines and the grey literature. All selected publications were collected using Zotero software from which duplicates were eliminated. The search was conducted between June 5 and 24, 2021, with a bibliographic watch until February 11, 2022. Articles were selected in a double-blind fashion using the Rayyan computer tool, based first on the title and abstract, and then on the full text. We sought consensus in case of disagreement at each stage of selection. A final total of 58 articles served as the basis for this work. Lack of knowledge and training in APA, lack of time on the part of physicians and patients, non-reimbursement by the CPAM, and the complexity of prescribing were the obstacles that emerged most in our research. We believe that it is necessary to improve the training of general practitioners, communication and information for professionals and the general population, and to simplify prescribing. The questions of the coverage of APA by the CPAM and of the revaluation of the dedicated consultation must be asked, so that this therapy is more widely used. General medicine. [ABSTRACT FROM AUTHOR]

Purpose: A doctor’s professional behavior and clinical competency reflect a range of personal and interpersonal qualities, attributes, commitments, and values. This study aimed to identify the most influential factor of medical competence regarding patient management ability. Methods: We used an analytic observational design with a cross-sectional approach, and gathered the perceptions of medical school graduates of Bandung Islamic University via an online questionnaire scored on a Likert scale. Two hundred and six medical graduates who graduated at least 3 years prior to survey were included in the study. The factors evaluated included humanism, cognitive competence, clinical skill competence, professional behavior, patient management ability, and interpersonal skill. IBM AMOS ver. 26.0 (IBM Corp., Armonk, USA) was used for structural equation modelling of the six variables latent and 35 indicator variables. Results: We found that graduates have highly positive perceptions of the humanism (95.67%). Followed by interpersonal skills (91.26%), patient management (89.53%), professional behavior (88.47%), and cognitive competence (87.12%). They rated clinical skill competence the lowest (81.7%). Regarding factors that contribute to patient management ability, the aspects of humanism, interpersonal skill, and professional behavior were found to significantly affect patient management ability (p-value=0.035, 0.00, and 0.00, respectively) with a critical rate of 2.11, 4.31, and 4.26 consecutively. Conclusion: Humanism and interpersonal skill are two important factors that medical graduates assessed very positively. According to surveyed medical graduates, their expectations of the institution were met regarding humanism. However, there is a need to strengthen medical students’ clinical skills and improve their cognitive abilities through educational programs. [ABSTRACT FROM AUTHOR]

Objectives: The current study investigates the prevalence of illegitimate tasks in a hospital setting and their association with patient safety culture outcomes, which has not been previously investigated.Methods: We conducted a cross-sectional survey in a tertiary referral hospital. Patient safety culture outcomes were measured using the Hospital Survey on Patient Safety Culture questionnaire; the primary outcome measures were a low safety rating for the respondent’s unit and whether the respondent had completed one or more safety event reports in the last 12 months. Analyses were adjusted for hospital department and staff member characteristics relating to work and health.Results: A total of 2,276 respondents answered the survey (participation rate: 35.0%). Overall, 26.2% of respondents perceived illegitimate tasks to occur frequently, 8.1% reported a low level of safety in their unit, and 60.3% reported having completed one or more safety event reports. In multivariable analyses, perception of a higher frequency of illegitimate tasks was associated with a higher risk of reporting a low safety rating and with a higher chance of having completed event reports.Conclusion: The prevalence of perceived illegitimate tasks was rather high. A programme aiming to reduce illegitimate tasks could provide support for a causal effect of these tasks on safety culture outcomes.

The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.