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This study investigated the impact of multimorbidity patterns on physical activity and capacity outcomes over the course of a year-long exercise intervention, and on physical activity 1 year later. Participants were 314 physically inactive community-dwelling men and women aged 70–85 years, with no contraindications for exercise at baseline. Physical activity was self-reported. Physical capacity measurements included five-time chair-stand time, 6-minute walking distance, and maximal isometric knee-extension strength. The intervention included supervised and home-based strength, balance, and walking exercises. Multimorbidity patterns comprised physician-diagnosed chronic disease conditions as a predictor cluster and body mass index as a measure of obesity. Multimorbidity patterns explained 0%–12% of baseline variance and 0%–3% of the change in outcomes. The magnitude and direction of the impact of unique conditions varied by outcome, time point, and sex. Multimorbid older adults with no contraindications for exercise may benefit from multimodal physical training. [ABSTRACT FROM AUTHOR]

This canine in vivo study assessed the effect of recombinant human platelet-derived growth factor (rhPDGF) on the healing of periapical tissues following apical surgery. From a total of 96 premolar teeth, 64 teeth from six beagle dogs (2 years old) were classified as experimental and were randomly assigned to four experimental groups (16 teeth per group). After having the pulp extirpated, leaving teeth open to the oral cavity for 1 week, and sealing with an immediate restorative material for 8 weeks, nonsurgical endodontic treatment was performed. A split-mouth design was used, and intra-animal randomization of treatment sides was applied to the groups as follows: apical curettage + 1.5-mm root-end resection (Group 1); apicoectomy + mineral trioxide aggregate (MTA) root-end filling (Group 2); apicoectomy + MTA root-end filling + rhPDGF (Group 3); and apical curettage + rhPDGF (Group 4). The animals were sacrificed 24 months after apical surgery, and histologic and µCT analyses were performed for bone volume loss (BVL). Group 1 showed partial resolution of the periapical lesions without signs of tissue regeneration (BVL: 49.09 ± 10.97 mm3). Group 2 had minimal bone regeneration and showed cementum reformation in 9 teeth, with no direct attachment to the MTA (BVL: 35.34 ± 10.97 mm3). Group 3 showed regeneration of all damaged apical tissues without direct contact between the cementum and MTA (BLV: 4.51 ± 1.55 mm3). Group 4 showed regeneration of PDL, bone, and cementum and attachment of functional cementum fibers (BVL: 2.82 ± 2.3 mm3). The difference in BVL was statistically significant only for Groups 1 and 2 (P < .05). rhPDGF may help regenerate apical tissue structures following apical surgery. [ABSTRACT FROM AUTHOR]

Background: Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. Methods: A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. Results: A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P< .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P<.001); grip strength +33.6% (P<.001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). Conclusion: At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy. [ABSTRACT FROM AUTHOR]

Minimally invasive nonsurgical treatment (MINST) aims to remove an etiology with minimal damage to the healthy periodontium and provide the ideal healing environment. This case series introduces the novel protocol of laser-assisted MINST (LAMINST), combining minimally invasive surgery with a dental laser. A total of 25 patients (32 teeth) with advanced periodontal disease were enrolled and received periodontal treatment by following the LAMINST protocol. Probing depth (PD), recession, clinical attachment level (CAL), bleeding on probing (BOP), plaque presence, and site mobility were evaluated preoperatively and at 6 months. Based on the periodontal evaluations, all cases were diagnosed as stage III grade C periodontitis. Six months after LAMINST, the average PD reduction was 4.44 mm and CAL improved by 4.38 mm. Baseline mobility scores of 1 (6 teeth), 2 (9 teeth), and 3 (3 teeth) decreased to 1 (5 teeth) or 0 (13 teeth). The initial prognoses of 5 (hopeless; 15 teeth), 4 (questionable; 13 teeth), and 3 (poor; 4 teeth), improved to 4 (5 teeth), 3 (12 teeth), 2 (fair; 13 teeth), and 1 (good; 2 teeth). The number of BOP sites reduced from 179 to 12, and the number of plaque sites reduced from 173 to 9. All clinical parameters were improved after LAMINST. The application of LAMINST may overcome the traditional limitations of nonsurgical treatment, such as poor accessibility. [ABSTRACT FROM AUTHOR]

Background: The Centers for Medicare and Medicaid Services (CMS) introduced chronic care management (CCM) services in 2015 for patients with multiple chronic diseases. Few studies examine the utilization of CCM services by geographic region, sociodemographic, and clinical characteristics. Methods: We used 2014–2019 Medicare claims data from a 5% random sample of fee‐for‐service beneficiaries aged 65 years or over. We included beneficiaries potentially eligible for CCM services because they had multiple chronic conditions (1,073,729 in 2015 and 1,130,523 in 2019). We calculated the proportion of potentially eligible beneficiaries receiving CCM service each year for the total population and by geographic region, sociodemographic, and clinical characteristics. Results: The proportion of beneficiaries with two or more chronic conditions receiving CCM services increased from 1.1% in 2015 to 3.4% in 2019. The increase in CCM use was higher in the southern region, among dually eligible beneficiaries and beneficiaries with a greater burden of chronic conditions (2–5 conditions vs ≥10 conditions: 0.7% vs 2.0% in 2015; 2.1% vs 7.0% in 2019) and frailty (robust vs severely frail: 0.6% vs 3.3% in 2015; 1.9% vs 9.4% in 2019). Nearly one out of five recipients did not continue CCM service after the initial service. Conclusion: We found that CCM service is being used by a very small fraction of eligible patients. Barriers and facilitators to more effective CCM adoption should be identified and incorporated into strategies that encourage more widespread use of this Medicare benefit. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to investigate the intensity of needs for home health care services (HHCs) among elderly patients with chronic diseases and to identify the associated factors. Design: A cross‐sectional survey was conducted in Wuhou District, Chengdu, Sichuan Province, China, from April to November 2021. Methods: Convenient sampling was used to screen elderly patients with chronic diseases managed by Yulin Community Health Service Center. The questionnaires included general information and the Chinese version of the Community Healthy Intensity Rating Scale were completed according to patients' conditions. The data were analyzed using descriptive statistics and binary logistic regression. Results: A total of 371 patients (10.40%) completed the survey. The mean age of the elderly patients was 84.04 years (SD = 7.07); these patients suffered from 1 to 7 kinds of chronic diseases, and the most common were hypertension (78.98%) and diabetes (40.97%). The need intensity of patients for HHCs was moderate (41.51%) or severe (58.49%). For each additional chronic disease that patients suffered from, the need intensity increases by 1.289 times (OR = 1.289; 95% CI: 1.055–1.575, p =.013); in additional, those aged more than 90 years, with a personal monthly income less than 2500 yuan ($387.00), with a poor health current status, and with only basic medical insurance presented greater need intensity (p <.05). Conclusion: Our data analysis revealed that economic status, insurance condition, poor health status, and multiple comorbidities may be the most common factors associated with the need intensity for HHCs. These characteristics may help medical staff to identify and help those with urgent health problems. [ABSTRACT FROM AUTHOR]

Aim: To explore the health beliefs and health behaviours of older Vietnam‐born people living with chronic disease in Western Australia. Design: This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care. Methods: Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation. Results: This study included 12 participants. The health perspectives and practices of older Vietnam‐born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self‐blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese‐oriented and Westernized‐orientated practices. Individual factors were also identified as contributing to chronic disease self‐care among participants. Conclusion: This study emphasizes culture played a significant role in shaping the way that older Vietnam‐born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed. Implications: A better understanding of the health beliefs and practices of older Vietnam‐born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors. Patient and public contribution: This study encompassed the contribution of 12 older Vietnam‐born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease contribute significantly to societal and individual impact globally. High‐quality management of these long‐term health conditions is important to prevent deterioration of health, although potentially more complex for patients with intellectual disabilities in residential care. Disease management in this context particularly benefits from complete and accurate recording of disease management. Without complete records, long‐term health conditions are more difficult to track due to the level of uncertainty regarding which clinical examinations have and have not been performed. This study therefore aims to examine the recording routines of quality indicators for disease monitoring for chronically ill patients with intellectual disabilities in Dutch residential care. Methods: This retrospective study utilised medical record data from a large Dutch long‐term care provider. We assessed the occurrence of cardiovascular disease (ICPC‐2 codes K74, K75, K76, K89 and K90), type 2 diabetes mellitus (T90, T90.02) and/or COPD (R91, R95). For adults with intellectual disabilities and long‐term condition, we analysed data entries in an 18‐month period (between July 2020 and December 2021). Observed consultation rates were calculated and presented in median with interquartile range and contrasted against the baseline number of consultations in primary care. Information on recorded quality indicators was presented in frequencies and percentages. Findings: Of the three long‐term conditions investigated, the most common was type 2 diabetes mellitus (8.6%; n = 287), followed by cardiovascular disease (5.8%; n = 195) and COPD (3.0%; n = 101). Of those who received management for their long‐term condition from their contracted GP, patients with type 2 diabetes mellitus, cardiovascular disease, or COPD had fewer consultations in 2021 than the Dutch baseline. Discussion of lifestyle was often not recorded. Disease monitoring quality indicators were recorded more often but at a lower frequency than expected. Conclusions: Because of the infrequent recording of quality indicators, recording of management of long‐term conditions for patients with intellectual disabilities in long‐term care appears suboptimal. Although this may not directly harm individual patients, it may jeopardise the quality of management of long‐term conditions, as suboptimal recording limits opportunities for evaluation and improvement. Within a broader trend towards data‐driven work methods in healthcare, recording of quality indicators requires attention from practice, research and policy. We should watch over long‐term diseases to help people stay healthy. We run tests, like checking blood pressure. The results are written in their medical records. These tests are like quality checks.We wanted to see if and how these quality checks were used, mostly for people with a learning disability living in care homes who also have heart disease, diabetes, or lung problems.We looked at their medical papers to see if these checks were there. We also looked at how often they saw the doctor.We found that chronically ill people with a learning disability went to the doctor quite often. But not as often as we expected. Also, the checks were not always written down. The talks about their lifestyle with the doctors were not noted very often.This can impact how well doctors care for the health issues of people with learning disability. [ABSTRACT FROM AUTHOR]

Rationale: Clinical pathways (CPWs) are structured care plans that set out essential steps in the care of patients with a specific clinical problem. Amidst calls for the prioritisation of integrated mental and physical health care for young people, multidisciplinary CPWs have been proposed as a step towards closer integration. There is very limited evidence around CPWs for young people with mental and physical health needs, necessitating a review of the literature. Aims and Objectives: The aim of this review is to understand how clinical pathways have been used to deliver mental health support to children and young people with long‐term physical health conditions and their effectiveness across a range of outcomes. Methods: The databases MEDLINE, CENTRAL, PsycINFO and CINAHL were searched from inception to 6 September 2023. Keywords linked to children and young people, mental health, long‐term physical health conditions and CPWs were used. Studies using either quantitative or qualitative research designs were included. All studies must have evaluated a CPW to provide mental health support to children and young people (up to 25 years old) with long‐term health physical conditions. Both mental and physical health outcomes were considered. Pathways were grouped by integration 'model' as described in the wider literature. Results: The initial search returned 4082 studies after deduplication. A total of eight studies detailing six distinct care pathways (232 participants [170 children and young people; 50 caregivers; 12 healthcare professionals]) met eligibility criteria and were included in the analysis. Four pathways were conducted within an 'integrated model'; two were a combination of 'integrated' and 'colocated'; and none within a 'co‐ordinated model'. Only pathways within an integrated model reported quantitative health outcomes, with improvements across a range of mental health measures. One negative physical health outcome was reported from an integrated diabetes pathway, but this should be interpreted with caution. Conclusion: This review identified a range of CPW designs but most fell under an integrated model. The results suggest that calls for integrated mental health pathways in this population may be appropriate; however, conclusions are limited by a paucity of evidence. [ABSTRACT FROM AUTHOR]

Background: Autogenic training (AT) is a structured meditative‐style practice, consisting of a sequence of simple mental exercises intended to induce a relaxed state in patients. There is some emerging evidence to suggest that AT can be effective in treating certain chronic conditions, however, further evidence is required. A service evaluation of AT services at the Royal London Hospital for Integrated Medicine was conducted to evaluate the impact of AT on patients with chronic conditions. Methods: The service evaluation consisted of the completion of validated quantitative outcome measures pre and posttreatment to explore the impact of AT. AT patients were asked to complete the Measure Yourself Medical Outcomes Profile (MYMOP) and Perceived Stress Scale (PSS) at their first hospital appointment (baseline) and then again 8 weeks later following completion of their AT sessions. Pre‐ and posttreatment scores for each outcome measure were analysed in SPSS using the Wilcoxon signed‐rank test. Results: One hundred ninety‐nine patients completed both initial and follow‐up MYMOP forms and were included in the evaluation. The most common presenting complaints for MYMOP symptom 1 were prolonged anxiety/stress and depression (n = 70, 35.2%), chronic pain and migraine headache (n = 44, 22.1%), chronic insomnia and sleep problems (n = 42, 21.1%) and, long‐term exhaustion and fatigue (n = 18, 9%). The change in median score pre‐ and posttreatment for all MYMOP categories (symptoms, activity and well‐being) were statistically highly significant p < 0.001. Anxiety, stress, depression, pain and insomnia were the symptoms that had the largest statistically significant difference between the median score pre‐ and posttreatment. Fifty‐five patients completed the PSS questionnaire at two time points (pre‐ and posttreatment). It showed a highly statistically significant change in PSS median score in patients experiencing stress (p < 0.001). Discussion: The findings of the evaluation indicate that 8 weeks of AT appears to be effective in improving symptoms of concern to patients and enhancing patients' overall well‐being. In particular, AT was found to be beneficial for patients with symptoms of anxiety, stress, depression, pain and insomnia. [ABSTRACT FROM AUTHOR]

Noninvasive respiratory support delivered through a face mask has become a cornerstone treatment for adults and children with acute or chronic respiratory failure. However, an imperfect mask fit by using commercially available interfaces is frequently encountered, which may result in patient discomfort and treatment inefficiency or failure. To overcome this challenge, over the past decade, increasing attention has been given to the development of personalized face masks, which are custom-made to address the specific facial dimensions of an individual patient. With this scoping review, we aim to provide a comprehensive overview of the current advances and gaps in knowledge with regard to the personalization masks for CPAP and NIV. We performed a systematic search of the literature and identified and summarized a total of 23 studies. Most studies included were involved in the development of nasal masks. Studies that targeted adult respiratory care mainly focused on chronic (home) ventilation and included some clinical testing in a relevant subject population. In contrast, pediatric studies focused mostly on respiratory support in the acute setting, whereas testing was limited to bench or case studies only. Most studies were positive with regard to the performance (ie, comfort, level of air leak, and mask pressure applied to the skin) of personalized masks in bench testing or in human, healthy or patient, subjects. Advances in the field of 3-dimensional scanning and soft material printing were identified, but important gaps in knowledge remain. In particular, more insight into cushion materials, headgear design, clinical feasibility, and cost-effectiveness is needed before definite recommendations can be made with regard to implementation of large-scale clinical programs that personalize noninvasive respiratory support masks for adults and children. [ABSTRACT FROM AUTHOR]

Background: People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities. Methods: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities. Results: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic's location became more White. Conclusions: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities. [ABSTRACT FROM AUTHOR]

Hypertension (HTN) is a chronic condition that requires careful monitoring and management. Blood pressure readings in the clinic and self-reported blood pressure readings are often too intermittent to allow for careful management. Remote patient monitoring is a solution that may have positive impacts on HTN management. Individuals at cardiac and primary care clinics were prescribed a remote patient-monitoring (RPM) program. Patients were sent blood pressure monitors that were enabled to transmit data over cellular networks. We reviewed trends in HTN management retrospectively in patients who had previously been on conventional therapy for a year and participated in RPM for a minimum of 90 days. There were 6595 patients enrolled, and the mean duration on RPM was 289 days. A total of 4370 participants (66.3%) had uncontrolled HTN, and 2476 (37.5%) had stage 2 HTN. After at least 90 days on the RPM program, the number of patients with uncontrolled HTN reduced to 2648 (40.2%, p < 0.01), and the number of patients with stage 2 HTN reduced to 1261 (19.1%, p < 0.01). Systolic blood pressure improved by 7.3 mmHg for all patients and 16.7 mmHg for stage 2 HTN. There was improvement in mean arterial pressure (MAP) in all patients with uncontrolled HTN by 8.5 mmHg (p < 0.0001). RPM is associated with improved HTN control and provides further evidence supporting telehealth programs which can aid in chronic disease management. [ABSTRACT FROM AUTHOR]

Background: Fatigue is an important symptom for most patients with axial spondyloarthritis (axSpA). The FACIT-Fatigue is a 13-item patient-reported outcome (PRO) instrument that has been used in axSpA clinical trials to measure fatigue severity and impact on daily activities. However, the psychometric properties of the FACIT-Fatigue are not fully evaluated across the entire spectrum of axSpA including non-radiographic axSpA (nr-axSpA) and radiographic axSpA (r-axSpA). This study determined: (1) the psychometric properties of the FACIT-Fatigue in nr-axSpA, r-axSpA, and the broad axSpA population and (2) FACIT-Fatigue scores representing meaningful within-patient change (MWPC), meaningful between-group differences, and cross-sectional severity bands. Methods: Data from two Phase 3 trials in adults with nr-axSpA (BE MOBILE 1; N = 254) and r-axSpA (BE MOBILE 2; N = 332) were analyzed pooled and separately to assess the psychometric properties of the FACIT-Fatigue. MWPC and meaningful between-group difference estimates were derived using anchor-based and distribution-based methods. Cross-sectional fatigue severity bands were estimated using logistic regression analysis. Results: The FACIT-Fatigue presented good internal consistency, adequate convergent and known-groups validity, and was sensitive to change over time across the full axSpA spectrum. A 5–11-point increase in FACIT-Fatigue score was estimated to represent a MWPC, with an 8-point increase selected as the responder definition. A 2.14–5.34-point difference in FACIT-Fatigue score change over a 16-week period was estimated to represent a small-to-medium meaningful between-group difference. FACIT-Fatigue score severity bands were defined as: none or minimal (>40), mild (>30 to ≤40), moderate (>21 to ≤30), and severe (≤21). Conclusions: These findings support the use of the FACIT-Fatigue as a fit-for-purpose measure to assess fatigue-related treatment benefit in axSpA clinical trials. The proposed score estimates and thresholds can guide FACIT-Fatigue score interpretation across the full axSpA spectrum. Trial registration: ClinicalTrials.Gov, NCT03928704. Registered 26 April 2019—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT03928704. ClinicalTrials.Gov, NCT03928743. Registered 26 April 2019—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT03928743. Plain English summary: Fatigue is common in patients with axial spondyloarthritis (axSpA)—a painful, chronic disease that mainly affects the joints of the spine. Measuring fatigue in clinical trials is important to see if new treatments for axSpA help reduce this symptom. This study investigated whether a patient-completed measure of fatigue, the 'FACIT-Fatigue', is suitable for use by patients with either of the two main types of axSpA—radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA). This study was needed because we did not know if the FACIT-Fatigue is valid and reliable in both axSpA subtypes and because we are lacking information to interpret the FACIT-Fatigue score in axSpA. Psychometric analysis of clinical trial data showed that the FACIT-Fatigue accurately measures fatigue severity in both types of axSpA. The study additionally pinpointed what change in FACIT-Fatigue score can be used to define whether a treatment has reduced fatigue in a patient, or what constitutes a meaningful between-group difference. It also identified severity score bands that can be used to classify patients into those with no, mild, moderate, or severe fatigue. These findings support using the FACIT-Fatigue in axSpA clinical trials to measure how well treatments reduce fatigue. [ABSTRACT FROM AUTHOR]

Objective: The family physician team has become the core carrier for delivery primary health care in China. This study aimed to measure the effect of the network structural characteristics of family physician team processes on health performance. Strategic recommendations for optimizing the family physician team processes with a view to improving performance were presented. Methods: A cross-sectional survey was conducted from October to December 2021 in Qianjiang in Hubei Province and Changsha in Hunan Province. Task performance, contextual performance, social networks, and sociodemographic characteristics were collected. Social network analysis was conducted to calculate density and centralization, then hierarchical linear regression analysis was employed to explore the relationship between the network structural characteristics of family physician team processes and performance. Results: In total, 88 family physician teams attended in this investigation. The transition processes of family physician team showed a distinctive low density (0.272 ± 0.112), high centralization (0.866 ± 0.197) network structure. For family physician team, the density of action processes significantly and positively affected task performance (B = 0.600, P < 0.05); the centralization of action processes positively affected task performance (B = 0.604, P < 0.01); the density of action processes positively affected contextual performance (B = 0.545, P < 0.01); the density of interpersonal processes significantly and positively affected contextual performance (B = 0.326, P < 0.05). Conclusion: The network density and centralization of family physician team processes have positive effects on chronic disease management performance. The results from this study help to enhance our conceptual understanding of social network and its implications for team-dynamics. Optimizing family physician team processes is an effective way to strengthen the construction of family physician team and promote the quality and efficiency of family physician-contracted service. It is recommended to strengthen the management of team processes, enhance the internal collaboration mechanism, and optimize the centralized network structure of family physician team. [ABSTRACT FROM AUTHOR]

Background: The current Italian scenario of pediatric palliative care (PPC) services is characterized by inadequate coverage of the territory. Therefore, it is important to improve the referral of patients to the most appropriate setting (community care, general PPC, or specialized PPC) and to improve the delivery of PPC care. Methods: Aiming at obtaining information about the referrals to the Padua Pediatric Hospice that could help estimate the investments needed to improve the provision of care, a retrospective analysis has been carried out. The rate of proper referral and discharge, the number of patients followed at the hospice, the mortality rate, and the length of follow-up were analyzed, and, when possible, data were stratified by oncological and non-oncological diseases. Results: The analysis showed that of the 870 patients referred to the Padua Pediatric Hospice between 2008 and 2022, 76% were affected by non-oncological conditions. 82% of patients referred were taken in charge and most of the remaining patients have been inappropriately referred. The analysis showed a growing number of total referrals, which increased by 195% from 2008 to 2022. An increase in proper referrals and referrals of non-oncological patients was observed alongside a decrease in oncological patient referrals and a trend toward a decrease in discharge rates. A decreased mortality was observed in patients with non-oncological conditions, with only 6% of deceased patients in 2022. Moreover, a longer survival with a median follow-up length of 43 months was observed among patients with non-oncological conditions who were followed up at the Padua Pediatric Hospice for more than 12 months. Conversely, the short survival rate observed for oncological patients suggests that those patients should have been referred to PPC earlier to benefit from palliative care for longer periods. Conclusions: Considering these data, it is expected that the number of patients needing PPC services will steadily increase in the next years. Hence, there is a need to invest resources to provide the best care delivery model encompassing specific pathways for the transition into adulthood, the establishment of networks within all the Italian regions, and an efficient referral to the more suitable setting of care. [ABSTRACT FROM AUTHOR]

Introduction: Chronic back pain is one of the most prevalent conditions and has a large socio-economic impact. The lack of routine use of non-pharmacological options and issues associated with pharmacological treatments underscore high unmet needs in the treatment of back pain. Although blue light phototherapy has proven efficacy in dermatology, limited information is available about its use in back pain. Methods: In this proof-of-concept, randomized controlled trial, a pain relief patch (PRP) delivered blue light at the site of back pain for 30 min during five treatment sessions. The comparator device delivered green light for 5 s but was worn for 30 min. A follow-up visit took place after the last treatment. The primary objective was to demonstrate the superiority of treatment by PRP, compared to the control device, in reducing pain intensity at the end of the treatment period. The post-treatment visual analog scale (VAS) pain intensity score for each group was calculated across the five treatment sessions and compared to the baseline. Secondary objectives included the disability score (Roland-Morris Disability Questionnaire) and safety. Results: The full analysis set included 171 patients. A statistically significant reduction in pain intensity occurred after the use of PRP (p < 0.02), but the study did not meet its primary objective of a superiority trial aimed at demonstrating a 0.6 cm difference in favor of PRP on the VAS scale. There was no significant change in the disability scores. Subgroup analyses were performed to identify the treatment response by patient characteristics such as pain intensity at baseline and skin type. As expected, safety data showed erythema and skin discoloration in the PRP group but not in the control group. Discussion/conclusion: This trial had multiple limitations that need to be addressed in future research. Although the primary objective was not achieved, this proof-of-concept study provides important efficacy and safety data in relation to the use of blue light in the treatment of chronic back pain and key insights that may support further research on similar devices. [ABSTRACT FROM AUTHOR]

Evidence suggests that communication-based aphasia group treatment may increase formal assessment scores and improve features of discourse production. The real-life interactions which occur during group treatment may increase use of grammatically complete and relevant utterances. To examine the effects of communication-based group treatment on production of complete utterances during structured and conversational discourse in adults with chronic aphasia. We analyzed structured and conversational discourse samples from 23 adults with chronic aphasia originally collected by Elman and Bernstein-Ellis (1999a). Bayesian generalized linear mixed-effects models were used to evaluate changes in use of complete utterances and its two components, syntactic completeness and relevance, at treatment exit and 4-6 weeks post-treatment. Results are presented with reference to the region of practical equivalence (ROPE, i.e., the range of effect sizes small enough to ignore) and in terms of the probability, derived from Bayesian model posterior distributions, that the effect in question exceeded, fell within, or fell below the ROPE. At the group level, syntactic completeness improved in structured discourse, but syntactic completeness, relevance, and complete utterances did not change during conversational discourse. Individual response to treatment varied and participants with mild aphasia and without concomitant apraxia of speech were more likely to demonstrate post-treatment change in complete utterances. Use of syntactically complete utterances during structured discourse increased at treatment exit and follow-up. Participants, especially those with severe aphasia and apraxia of speech, may have changed in ways not revealed by the complete utterance measure. [ABSTRACT FROM AUTHOR]

Background: Chronic disease management is an essential part of public health management and a fundamental means of slowing down the progression of major diseases. Unlike traditional medical care, proactive health management focuses on the combination of prevention and treatment. Proactive health management can reduce the re-admission rate of patients with chronic diseases, improve long-term prognosis, and effectively reduce the disability and mortality rates of major health events. This study aimed to establish a proactive health management model based on a grid-based medical service team arrangement, and to explore the effect of this model on managing chronic diseases in community health service institutions. Methods: A grid-based medical service team was established in Binzhou, Shandong, China, consisting of general practitioners, nurses, public health doctors, health promoters and community grid liaison staff. Each team was responsible for several areas to monitor critical populations within the grid and compile statistics on the health management of these key populations in 2022–2023. Results: A total of 2050 patients with coronary artery disease, 4973 patients with hypertension, and 1621 patients with type 2 diabetes were followed up in 2022. Compared with 155,612 resident health records in 2022, the number of records increased by 140.50% in 2023. The number of patients with hypertension under health management in 2023 increased by 50.92%; patients with type 2 diabetes increased by 74.65%; and the number of coronary artery disease increased by 42.00%. After the implementation of grid management, the hospitalisation rate for patients with type 2 diabetes significantly decreased in 2023 (P < 0.05). However, the hospitalisation rate for patients with coronary artery disease and hypertension was similar in 2023 to that in 2022 (P > 0.05). Conclusion: The grid-based community proactive health management model makes full use of the advantages of community resources and improves the pertinence and coverage of community health services. Moreover, it reduces hospitalisation for patients with type 2 diabetes. The grid-based community active health management model accentuates the significance of primary care and harnesses the full potential of community resources. The grid-based community proactive health management model improves the coverage of community health services and reduces hospitalisation of patients with chronic diseases. Strengthening primary care through the grid-based community proactive health management model contributes to achieving universal health coverage. [ABSTRACT FROM AUTHOR]

An interview with Isaac Eliaz, founder of Amitabha Medical Clinic in Santa Rosa, California, is presented. Eliaz talks about his training and education in Chinese medicine and the factors that influence his decision to become a licensed acupuncturist. He discusses his research on the protein called galectin-3 and its role in affecting cancer metastasis, sepsis and sepsis-associated acute kidney disease, as well as the ketogenic diet and intermittent fasting, and the development of apheresis.

The secrecy surrounding HIV continues to be a major concern for older people living with HIV (OPWH) despite their long-term experience of HIV and the presence of other chronic diseases. Our study aims to highlight how the secrecy surrounding HIV can affect the management of the other conditions. The results of this socio-anthropological sub-study of the ANRS EP66 SEPTAVIH study, which assesses frailty in OPWH, are based on in-depth interviews conducted with 20 OPWH with multimorbidities aged 70 years and over and 9 caregivers. Based on a cross-sectional thematic analysis, this study shows that HIV infection differs from other chronic diseases due to the secrecy and stigma associated with HIV. These specific issues associated with HIV complicate the lives of OPWH, depriving them of support from loved ones and forcing them to exclude their general practitioner from their care system. This then causes OPWH with multiple chronic diseases to become socially vulnerable and isolated. Interventions that support the sharing of information on HIV among OPWH and also among caregivers need to be identified as a matter of urgency in order to improve the lives and management of OPWH with multimorbidities. Trial Registration: ClinicalTrials.gov identifier: NCT03958786. [ABSTRACT FROM AUTHOR]

Within a small geographic area, Marion County contains a stark spectrum of health outcomes and socioeconomic statuses. The Indiana University Student Outreach Clinic (IUSOC) serves as a safety net provider, offering free health and social services in the Near Eastside neighborhood of Indianapolis. The aim of this study was to characterize the demographics and geographic distribution of the IUSOC's patient population. From January to September 2023, 612 patients visited the IUSOC, and 460 self-identified as Marion County residents. 63.9% of patients were between 45 and 64 years old. 66.8% were Non-Hispanic (NH) Black, and 23.3% were Hispanic. 18.9% spoke Spanish and had limited English proficiency. Based on the Distressed Communities Index (DCI), 58.7% lived in "Distressed" zip codes, indicating economic vulnerability and disparities. The zip code with the greatest number of IUSOC patients had the highest rate of uninsured adults in Marion County. IUSOC patients are primarily middle-aged minorities who live in zip codes with low socioeconomic rankings by DCI. This information can be used to improve community resource referral pathways in the clinic. [ABSTRACT FROM AUTHOR]

Introduction: Central Serous Chorioretinopathy (CSC), a leading cause of vision loss, presents diverse treatment challenges based on its acute or chronic manifestation. Areas covered: In acute CSC, treatment typically involves observation, reserving intervention for cases where optimal vision is crucial for professional activities. Emerging evidence advocates the use of half-dose or half-fluence Photodynamic Therapy (PDT), directed by Indocyanine Green Angiography (ICGA) or Fluorescein Angiography (FA), to hasten subretinal fluid (SRF) resolution, improve vision, and minimize recurrence. Chronic CSC, on the other hand, increasingly favors half-dose PDT, a recommendation strengthened by studies such as the PLACE trial. CSC complicated by Choroidal Neovascularization (CNV) necessitates management through intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections and/or half-dose PDT. In cases of polypoidal choroidal vasculopathy (PCV), a combination of anti-VEGF therapy with PDT proves beneficial. For scenarios where standard treatments are impractical, Eplerenone emerges as the primary oral medication. Methods: A literature search of all original articles was performed using the major online databases. The following keywords 'Central Serous Chorioretinopathy' and 'Treatment,' were searched in combination with 'Photodynamic therapy,' 'Focal Laser Photocoagulation,' 'Subthreshold Micropulse Laser' and 'Systemic treatments.' Expert opinion: Managing CSC requires a patient-centered approach. In acute CSC, careful monitoring and lifestyle modifications may suffice, while in chronic CSC, PDT is a primary therapeutic option. [ABSTRACT FROM AUTHOR]

Objective: Chronic rhinosinusitis (CRS) can be classified as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). The aim of this study was to evaluate and compare the Systemic Immune-Inflammation Index (SII) and Pan-I mmune -Infl ammat ion Value (PIV) levels of patients diagnosed with chronic rhinosinusitis (CRS) with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP) along with healthy controls. Methods: The study analyzed 320 patients from 2022 to 2023. Patients were divided into three groups. 110 CRSwNP patients, 110 CRSsNP patients, and 100 healthy individuals were included in Groups A, B, and C, respectively. SII and PIV levels were assessed after CRSwNP or CRSsNP diagnosis. The values of complete blood count, SII, and PIV were compared. Results: The mean SII levels of patients in groups A, B, and C were 685.3 ± 641.3; 1034.18 ± 1083.12; and 532.18 ± 310.77, respectively. The mean SII levels were significantly higher in group B compared to groups A and C (P = .012 and P = .000). The mean PIV levels of patients in groups A;B and C were 405.31 ± 486.15; 539.08 ± 599.63; and 311.29 ± 217.52, respectively. The mean PIV levels were significantly higher in group B compared to group C (P = 0.001). Results of the ROC analyses for both SII and PIV were statistically significant. Patients with an SII cut-of value of 278.6 had a sensitivity of 91% and sensitivity 91%, specificity of 90%. Patients with a PIV cut-off value of 117.51 had a sensitivity of 92% and sensitivity 92%, specificity of 90%. Conclusions: SII and PIV, which are important inflammatory markers, especially in systemic inflammation, were significantly elevated in CRSwNP patients compared to CRSsNP patients and healthy controls. This may support the presence of chronic mucosal inflammation in CRSwNP patients. However, SII and PIV are indirect markers of inflammation, and further studies with larger patient groups are warranted. [ABSTRACT FROM AUTHOR]

Individuals who migrate from their home country face a variety of challenges while adapting to the culture in the United States. Immigrant communities are at a significantly higher risk for poor health outcomes; therefore, assessing healthcare treatment for diverse and resilient immigrant populations, including Hispanic/Latine communities, is crucial to preserving their health, culture, and spirit. A paucity of literature exists surrounding perceptions of well-being in immigrant, Hispanic/Latine adults managing chronic diseases. Past studies have shown a discrepancy between providers' and patients' perceptions of healthcare options for overall well-being. We aim to share varying perspectives found within our work geared towards improving the quality of life for Hispanic/Latine immigrants managing chronic disease, especially type 2 diabetes mellitus and hypertension. The primary objective of this article is to strengthen the understanding of intersections between social, physical, financial, and spiritual health within an (im)migrant Hispanic/Latine community using semi-structured ethnographic interviews. These interviews have highlighted community resilience, demonstrating that individuals can adapt to major life transitions while maintaining balance across dimensions of health. This knowledge could be implemented by actively listening to patient concerns regarding their health dimensions to improve individualized and patient-centric care. [ABSTRACT FROM AUTHOR]

This report seeks to discuss sequelae of chronic cellulitis that is commonly treated in the ambulatory setting, as exacerbated by the conditions of living outside. Further we hope to identify etiologic factors that contribute to complication development. Additionally, this article will touch on unique treatment plan considerations for unhoused patients with the intention to educate providers and reduce mortality and morbidity relating to pedal skin and soft tissue infections in this population. This piece examines the case of a 52-year-old man with a history of chronic diseases, substance use disorder, and recurrent cellulitis. We highlight systemic issues in healthcare delivery for unhoused patients, including inadequate discharge planning, limited access to medication, and challenges in shelter placement. The discussion section emphasizes the importance of accurate diagnosis and tailored treatment plans for cellulitis in houseless individuals, the importance of a multidisciplinary approach incorporating social work services, and addressing chronic illnesses, substance use disorder, and housing issues. The report advocates for heightened awareness of bilateral cellulitis in unhoused populations, emphasizing the need for comprehensive, individualized treatment plans. [ABSTRACT FROM AUTHOR]

Background: Low awareness of chronic conditions raises the risk of poorer health outcomes and may result in healthcare utilization and spending in response to symptoms of undiagnosed conditions. Little evidence exists, particularly from lower-middle-income countries, on the health and healthcare use of undiagnosed people with an indication of a condition. This study aimed to compare health (physical, mental, and health-related quality of life (HRQoL)) and healthcare (inpatient and outpatient visits and out-of-pocket (OOP) medical spending) outcomes of undiagnosed Sri Lankans with an indication of coronary heart disease (CHD), hypertension, diabetes, and depression with the outcomes of their compatriots who were diagnosed or had no indication of these conditions. Methods: This study used a nationally representative survey of Sri Lankan adults to identify people with an indication of CHD, hypertension, diabetes, or depression, and ascertain if they were diagnosed. Outcomes were self-reported measures of physical and mental functioning (12-Item Short Form Survey (SF-12)), HRQoL (EQ-5D-5L), inpatient and outpatient visits, and OOP spending. For each condition, we estimated the mean of each outcome for respondents with (a) no indication, (b) an indication without diagnosis, and (c) a diagnosis. We adjusted the group differences in these means for socio-demographic covariates using ordinary least squares (OLS) regression for physical and mental function, Tobit regression for HRQoL, and a generalized linear model (GLM) for healthcare visits and OOP spending. Results: An indication of each of CHD and depression, which are typically symptomatic, was associated with a lower adjusted mean of physical (CHD -2.65, 95% CI -3.66, -1.63; depression -5.78, 95% CI -6.91, -4.64) and mental functioning (CHD -2.25, 95% CI -3.38, -1.12; depression -6.70, 95% CI -7.97, -5.43) and, for CHD, more annual outpatient visits (2.13, 95% CI 0.81, 3.44) compared with no indication of the respective condition. There were no such differences for indications of hypertension and diabetes, which are often asymptomatic. Conclusions: Living with undiagnosed CHD and depression was associated with worse health and, for CHD, greater utilization of healthcare. Diagnosis and management of these symptomatic conditions can potentially improve health partly through substitution of effective healthcare for that which primarily responds to symptoms. [ABSTRACT FROM AUTHOR]

Background and purpose: Little is known about the applicability, utilization, and effectiveness of mind–body interventions (MBIs) for conditions that are not predominantly pain, neoplastic, or psychiatric, particularly in pediatric patients. This scoping review describes research pertaining to such interventions in youth with nonpain, noncancer, and nonpsychiatric predominant chronic medical conditions. Methods: Searches of EBSCO CINAHL, Elsevier Scopus, Ovid for MEDLINE, and Ovid PsycInfo were conducted to investigate MBIs in youth under 18 years of age with nonpain, noncancer, and nonpsychiatric predominant chronic medical conditions. Articles published between 2010 and 2020 were included. Abstracts were screened by three authors for inclusion, and disagreements were resolved by a designated author. Selected full-text articles were divided among all authors for review of study quality, intervention feasibility and acceptability, and effectiveness. Results: The search yielded 1010 titles with 15 meeting the final inclusion criteria, studying a total of 641 youth. Participants ranged in age from 6 to 19 years (included studies had data on participants <18 years reported separately); 61.5% were female (n = 394) and 38.5% were male (n = 247). The two most common conditions studied were asthma and irritable bowel syndrome, with yoga being the most popular intervention. Overall, MBIs showed promising preliminary evidence for improving symptoms and quality of life in youth with chronic medical conditions. Conclusion: MBIs have been successfully delivered and show promise in symptom palliation and quality of life improvement for youth with a variety of chronic medical conditions. More data from high-quality randomized controlled trials are needed to further characterize the effectiveness of specific modalities for specific conditions. [ABSTRACT FROM AUTHOR]

Adolescent disclosure to parents is a key aspect of positive parent-adolescent relationships and youth adjustment. We leveraged a study of diverse families with an adolescent with type 1 diabetes to examine how observed parental empathy during parent-adolescent conflict discussions about diabetes management was associated with observed adolescent disclosure and adolescent self-reported disclosure to parents. Adolescents with type 1 diabetes and the parent most involved in their diabetes care (N = 67 dyads) participated in the study. Parent empathy, adolescent disclosure, and parent positive affect during parent-adolescent conversations were rated by trained coders. Parents reported on their own empathy and adolescents reported on their own disclosure, parental knowledge of their diabetes management, and parental acceptance. Results indicated that observed parental empathy was associated with both observed and self-reported disclosure. This association remained after covarying other parent-adolescent relationship and parent dispositional, demographic, and diabetes variables. This study holds implications for promoting greater parental communication of empathy to encourage adolescent disclosure in the context of chronic illness management. [ABSTRACT FROM AUTHOR]

Background and Objectives There are a growing number of early-phase (i.e. Stage I, NIH Stage Model) interventions targeted at family care dyads navigating chronic health conditions in older adults. Currently, the benefits of these interventions are often evaluated for older adults and their family care partners separately, even when controlling for interdependence. Without understanding the benefits (and potential harms) for dyads as a whole, understanding of program impact is incomplete. Moreover, few health behavior interventions involving dyads include relational measures to ensure no unintended consequences for the dyad or account for within-dyad pretest risk level. Research Design and Methods We used secondary data from a quasi-experimental trial involving 39 couples in which 1 member of the dyad was living with Parkinson's disease as an exemplar demonstration of 3 proposed approaches: an above-zero approach, a pretest risk status approach, and an expanded pattern analysis matrix approach. Results Approaches provided evidence for dyadic benefits of the intervention compared to the wait-list comparison condition, but carried different assumptions that did not always categorize dyads similarly. Discussion and Implications Implications of using each approach and selecting different benchmarks for defining success are discussed. The descriptive approaches proposed, provide a rationale for more intentional evaluation of small-sample, early-phase dyadic interventions. [ABSTRACT FROM AUTHOR]

Background: Literature supports including occupational therapists on primary care teams. Few occupational therapists practice in this setting. The health care community needs more information regarding the benefits of occupational therapists on the team. Method: We completed an 18-month pilot integrating an occupational therapist in a primary care team, tracking conditions treated by the occupational therapist, visit duration, reimbursement, and level of primary care providers’ (PCP) satisfaction. We then evaluated outcomes via a retrospective chart review. Results: Visits were brief, averaging 35 min. Longer visits did not improve outcomes. Occupational therapists were reimbursed by Medicare (47%), commercial (47%), both (6%). PCPs referred numerous conditions, and > 50% related to musculoskeletal pain. Most of the patients, 84%, reported partial (30%) or complete (54%) improvement; 60% required one-time treatment; and 40% were referred for further treatment on-site or outside the department for additional or specialty treatment. After the pilot, most of the PCPs felt an occupational therapist on the team was absolutely essential (n = 14; 61%), or very important (n = 7; 30%). Conclusion: Embedded occupational therapy treatment resulted in symptom improvement in 84% of patients across a variety of conditions, and brief visits were effective. Occupational therapist services were reimbursed across insurance plans. After working with an occupational therapist, 91% of the PCPs viewed the occupational therapist as a very important or essential team member. [ABSTRACT FROM AUTHOR]

Objectives: Periodontitis is one of the most common chronic inflammatory diseases. It causes changes in the biting abilities of individuals. However, periodontal treatment has positive effects on masticatory function. The aim of this study is to determine the effect of periodontitis and periodontal treatment on masticatory abilities by measuring masseter and temporal muscle thicknesses with ultrasonography before and after periodontal treatment in chronic periodontitis patients. Methods: The patients included in the study were determined by clinical and radiological examination. The thickness of the masseter and temporal muscles of the patients were measured by ultrasonography. Periodontal measurements and treatments of the patients were completed by a single physician. IBM SPSS 20.0 (IBM Corp., Armonk, NY) statistical program was used for statistical analysis. Results: A statistically significant difference was found between the values of periodontal measurements before and after treatment (p<0.05). In the ultrasonography measurements of the thickness of masseter and anterior temporal muscles, a statistically significant increase was observed in both rest and contraction values at all time intervals (p<0.05). Muscle thicknesses of male patients were higher than female patients. Conclusions: Periodontitis negatively affects the masticatory performance of individuals. Chronic periodontitis patients should be referred for periodontal treatment without wasting time. [ABSTRACT FROM AUTHOR]

There is no longer any serious doubt that daily habits and actions profoundly impact on both short- and long-term health and quality of life. An overwhelming body of scientific and medical literature supports this contention. Thousands of studies support the concept that regular physical activity, healthy nutrition and maintaining a healthy body weight, not smoking cigarettes, obtaining healthy sleep, reducing stress and maintaining positive connections with other individuals all profoundly impact on health. The scientific literature the supports the health impact of these daily habits and actions is underscored by its incorporation into virtually every evidence-based clinical guideline in the area of metabolic diseases. Thus, the scientific basis for lifestyle medicine rests on an enormous body of evidence-based literature. The key issue in lifestyle medicine is to provide an overall framework where these studies, which are often spread over scientific literature in multiple disciplines, can be made accessible to the medical community and to the public at large. This is the essence of the field of lifestyle medicine. The academic basis of lifestyle medicine is robust and needs to be emphasized by all practitioners of lifestyle medicine. This is the key to moving this field forward into the future. [ABSTRACT FROM AUTHOR]

Introduction: Nurse-led preventive home visiting programmes can improve health-related outcomes in community-dwelling older adults, but they have not proven to be cost-effective. Home visiting programmes led by nursing students could be a viable alternative. However, we do not know how community-dwelling older adults with chronic multimorbidity experience home visiting programmes in which nursing students carry out health promotion activities. The aim of the study is to understand how community-dwelling older adults with chronic multimorbidity experience a home visiting programme led by nursing students. Methods: A qualitative study based on Gadamer's hermeneutics. Thirty-one community-dwelling older adults with chronic multimorbidity were interviewed in-depth. Fleming's method for conducting hermeneutic, Gadamerian-based studies was followed and ATLAS.ti software was used for data analysis. Results: Two main themes were generated: (1) 'The empowering experience of a personalised health-promoting intervention', and (2) 'The emancipatory effect of going beyond standardised self-care education'. Conclusions: The home visiting programme contributed to the community-dwelling older adults feeling more empowered to engage in health-promoting self-care behaviours. It also improved the older adults' sense of autonomy and self-efficacy, while reducing their loneliness and addressing some perceived shortcomings of the healthcare system. Clinical relevance: Older adults participating in a home visiting programme led by nursing students feel empowered to implement self-care behaviours, which has a positive impact on their perceived health status. Nurse leaders and nursing regulatory bodies could collaborate with nursing faculties to integrate preventive home visiting programmes led by nursing students into the services offered to community-dwelling older adults with chronic multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Chronic osteomyelitis is a debilitating bone infection, characterized by a persistent infection over months to years, poses diagnostic and therapeutic challenges due to its insidious nature and potential for severe bone and soft tissue destruction. This systematic review and meta-analysis aims to review the literature on the treatment of chronic osteomyelitis in long bones and assess cure rates in single versus two-stage surgery. Methods: Following the PRISMA guidelines and registered with PROSPERO (ID: CRD42021231237), this review included studies that reported on the management of chronic osteomyelitis in long bones using either a planned one-stage or two-stage surgical approach in adult patients. Databases searched included Medline, Embase, Web of Science, CINAHL, HMIC, and AMED, using keywords related to osteomyelitis, long bones, and surgical management. Eligibility criteria focused on adults with chronic osteomyelitis in long bones, with outcomes reported after a minimum follow-up of 12 months. The meta-analysis utilized the random-effects model to pool cure rates. Results: The analysis included 42 studies with a total of 1605 patients. The overall pooled cure rate was 91% (CI 95%) with no significant difference observed between single-stage and two-stage surgeries (X2 = 0.76, P > 0.05). Complications were reported in 26.6% of cases in single-stage procedures and 27.6% in two-stage procedures, with prolonged wound drainage noted as a common issue. Dead space management techniques varied across studies, with antibiotic-loaded calcium sulphate beads used in 30.4% of cases. Conclusion: This meta-analysis reveals no significant difference in cure rates between single and two-stage surgical treatments for chronic osteomyelitis in long bones, supporting the efficacy of both approaches. The current treatment strategy should include a combination of debridement, dead space management using local and systematic antibiotics and soft tissue reconstruction if necessary. [ABSTRACT FROM AUTHOR]

Objective: The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches. Methods: Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests. Results: Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P <.05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P =.057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services. Conclusion: Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system. [ABSTRACT FROM AUTHOR]

Background: Pressure injuries (PIs) are prevalent in palliative care. Lack of knowledge and skills among informal caregivers on PI prevention and management contributes significantly to the occurance or deterioration of PIs. Aim: The aims of this study were to: (1) determine the level of knowledge and practices of informal caregivers on PI prevention and treatment; (2) explore the socio-demographic characteristics of informal caregivers that influence PI prevention and treatment among patients who need palliative care. Methods: The quantitative cross-sectional descriptive design was used to collect data from 146 informal caregivers, and a valid and reliable questionnaire was used. Results: A total of 146 informal caregivers of patients with PI completed the study. Most participants had a relatively low level of PI prevention, treatment knowledge and practice. Participants who were older than 28 years, working for the government and married had significantly better knowledge and practice of PI prevention and treatment than other participants. Conclusion: Information for informal caregivers in different settings about PI prevention and treatment is needed. Informal caregivers need to acquire more professional practices and knowledge to improve the quality of patient care. [ABSTRACT FROM AUTHOR]

Improving the overall care of children with medical complexity (CMC) is often beset by challenges in proactively identifying the population most in need of clinical management and quality improvement. The objective of the current study was to create a system to better capture longitudinal risk for sustained and elevated utilization across time using real-time electronic health record (EHR) data. A new Pediatric Population Management Classification (PPMC), drawn from visit diagnoses and continuity problem lists within the EHR of a tristate health system, was compared with an existing complex chronic conditions (CCC) system for agreement (with weighted κ) on identifying CCMC, as well as persistence of elevated charges and utilization from 2016 to 2019. Agreement of assignment PPMC was lower among primary care provider (PCP) populations than among other children traversing the health system for specialty or hospital services only (weighted κ 62% for PCP vs. 82% for non-PCP). The PPMC classification scheme, displaying greater precision in identifying CMC with persistently high utilization and charges for those who receive primary care within a large integrated health network, may offer a more pragmatic approach to selecting children with CMC for longitudinal care management. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this article was to report best practices for reducing undue burden on nurses related to limited care partner visitation. BACKGROUND: Care partners are beneficial to hospitalized patients. Restricted care partner visitation not only impacts patients and care partners but also affects nurses. METHODS: Using the Johns Hopkins Evidence-Based Practice model, best practices for reducing nurse burden during periods of restricted visitation were evaluated. RESULTS: Best practices include evidence-based visiting policies, technology to facilitate communication, creation of a communication liaison role or team, and communication skills training for nurses. CONCLUSIONS: Nursing leaders should proactively prevent the harmful impact that visitor restrictions have on nurses. [ABSTRACT FROM AUTHOR]

Background: To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods: Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results: Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions: Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability. Limited studies have sought to implement and evaluate novel workforce approaches to reducing differential diabetes-related outcomes in the Aboriginal and Torres Strait Islander peoples populations. This review described the characteristics of the chronic disease management training programs and their effectiveness for Aboriginal Health Workers and Practitioners. Most included studies reported satisfaction with the training content, whereas some reported improved knowledge, confidence, and clinical and non-clinical skills of the participants. However, few studies reported knowledge transfer into clinical practice and client-related outcomes. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare the demographic and clinical characteristics, perceptions of disease, stigma, social support levels and psychosocial adaptations of patients with COVID-19 and patients with chronic infections (TB, hepatitis, HIV) who were followed as inpatients. Methods: The cross-sectional and descriptive study was conducted with 100 patients receiving inpatient treatment between January 2021 and January 2022. Criteria for selecting patients were being able to understand and speak Turkish, being at least literate, having TB, hepatitis, HIV or severe COVID-19 disease, and being an adult (over 18 years old). Data were collected using a personal information form, "Psychosocial Adjustment to Illness Scale-Self-Report", "Revised Illness Perception Questionnaire", and "Multidimensional Perceived Social Support Scale". Results: We determined that there was a significant difference in terms of demographic characteristics (age, education, marital and employment status) and hospitalization duration of individuals with COVID-19 and chronic infections (TB, hepatitis, HIV) who received inpatient treatment. There was also a significant difference in personal and treatment control, illness coherence, emotional representation dimensions, and attributions towards possible causes of the disease, as well as feelings of stigma, social support perceptions, and psychosocial adaptation. Conclusion: This study not only underscores the need for a biopsychosocial approach to individuals with contagious infectious diseases but also provides practical insights for healthcare professionals. Addressing the patients' perception of their illness early on can significantly improve patient beliefs, leading to more effective patient-centered treatment outcomes. Moreover, supporting individuals with infectious diseases in biopsychosocial management can play a crucial role in reducing psychological morbidity. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of compression therapy (CT) and the best compression modality choice are questioned in many clinical stages of chronic venous disease (CVD). This work aims to obtain information on indications, contraindications, and the best treatment option for CT in different clinical scenarios of CVD. Method: An online survey was made among members of the International Compression Club, experts in CT. Results: The experts apply CT in all clinical stages of CVD, even when evidence is missing. Regarding compression materials, experts use inelastic materials in the advanced stages of CVD and compression stockings in the early or chronic stages of CVD. Conclusion: The authors highlight the gap between experts' practical use of CT and evidence-based medicine results. They also suggested that, given the cost of randomized clinical trials aimed at specifying specific indications for different devices, artificial intelligence could be used for large-scale practice surveys in the future. [ABSTRACT FROM AUTHOR]

Background: People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long‐term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout. Methods: This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically. Results: We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high‐risk situations, leading to hypervigilance and paternalistic approaches to care. Conclusion: The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden. Patient or Public Contribution: Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write‐up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors. [ABSTRACT FROM AUTHOR]

Background and Objectives Although coordinated care (CC) seeks to improve patient experiences and ultimately health outcomes, evidence from empirical research on the impacts of CC is mixed. This study examined the relationship between CC and healthcare outcomes over a 4-year period among older adults with multiple chronic conditions. Research Design and Methods This observational cohort study is based on data from the 2016–2020 Health and Retirement Study. Analysis is limited to respondents with 2+ chronic conditions who completed an experimental module on CC in 2016 (n  = 906). Three domains of CC were assessed: perceptions, informal (family/friends) and formal (healthcare staff) tangible support, and technical support (using a "patient portal"). The longitudinal relationship between CC and health (e.g. pain, functioning, and self-rated health [SRH]) and healthcare (e.g. doctor visits, hospitalization, and care satisfaction) outcomes was investigated using mixed-effects models. Results Better perceptions of CC were associated with lower odds of ADL limitations (Odds ratio [OR] = 0.91; 95% CI = 0.84–0.99) and greater satisfaction with care (B = 0.04, 95% CI = 0.02–0.06). Receipt of more informal tangible support was associated with 1.34 higher odds of ADL limitations (95% CI = 1.19–1.51) and 1.74 higher odds of hospitalization (95% CI = 1.07–1.21). Use of technical support was associated with better SRH and greater satisfaction with care. Discussion and Implications The longitudinal relationship between CC and health is multifaceted. Although positive perceptions and more technical support have beneficial effects on health outcomes, higher utilization of tangible support may reflect a higher demand among older adults with more complex healthcare needs. [ABSTRACT FROM AUTHOR]

Objectives: Advancements in medicine and science have enabled more and more people to live longer with a chronic medical condition, namely cancer. Nevertheless, the palliative care (PC) approach continues to be introduced and incorporated later in the lives of patients and families dealing with such conditions. Thus, the need for individuals to care for this population in our society is increasing, giving rise to the so-called "informal caregivers." The present study intends to examine the main obstacles faced by informal caregivers taking care of a cancer patient receiving PC based on what health professionals working in these settings perceive and write down. To achieve this goal, the written files of 2 Portuguese palliative care institutions were analyzed. Methods: An inductive thematic analysis was conducted, focusing on the contact between health professionals and family caregivers and based on the notes taken by health professionals. Results: Three main overarching themes were identified: (1) burden, (2) intra-family impact of the illness, and (3) network vulnerabilities. Included in this are the emphasis on the role of the family and social support, the high levels of psychological morbidity and caregiver burden present over this period, and a great need for information about the illness. Significance of results: This study provided a broader awareness regarding the daily struggle experienced by family caregivers, particularly those who juggle between "roles." It is vital to understand the scope of the obstacles experienced by caregivers during the terminal phase of their loved one's illness, given how important it is to address the family's needs. Future studies and practitioners should consider these observations and topics when considering new approaches for this population, as they ought to be quite focused and short in time in order to meet people's needs. [ABSTRACT FROM AUTHOR]

Background: Aging populations are driving a shift in emphasis toward enhancing chronic disease care, reflected in Catalonia's regional plan which prioritizes standardized nursing care plans in primary care settings. To achieve this, the ARES-AP program was established with a focus on harmonizing standards and supporting routine nursing clinical decision-making. This study evaluates nurses' perceptions of ARES-AP's standardized care plans for chronic diseases. Methods: A mixed-methods approach based on an ad hoc questionnaire (n = 141) and a focus group (n = 14) was used. Quantitative data were statistically analysed, setting significance at p < 0.05. Qualitative data were explored via content analysis. Results: ARES-AP training was assessed positively. The resources for motivational interviewing and care plans for the most prevalent chronic diseases were rated very positively. This study identified key factors influencing program implementation, including facilitators such as structured information and nursing autonomy, barriers such as resistance to change, motivators such as managerial support, and suggested improvements such as technological improvements and time management strategies. Conclusions: This study identifies areas for improvement in implementing standardized nursing care plans, including additional time, motivation, enhanced IT infrastructure, and collaboration among primary care professionals. It enhances understanding of these plans in primary care, especially in managing chronic diseases in aging populations. Further research should assess the program's long-term impact on chronic patients. This study was not registered. [ABSTRACT FROM AUTHOR]

Identifying hepatic fibrosis is paramount in managing patients with chronic liver disease. The etiology of liver disease can be owing to many factors, including chronic viral hepatitis, steatotic liver diseases such as alcohol-associated liver disease or metabolic dysfunction-associated steatotic liver disease, autoimmune hepatitis, and cholestatic liver diseases. Currently, invasive liver biopsy with histopathologic evaluation is the gold standard; however, noninvasive tests are becoming more prevalent, especially because they do not carry the risks of invasive procedures such as biopsy. This article reviews noninvasive tests for fibrosis, separating them into blood-based and imaging-based tests. [ABSTRACT FROM AUTHOR]

The article focuses on the critical role of General Practice Nurses (GPNs) in recognizing, diagnosing, and managing hypertension within the context of various long-term conditions such as diabetes, asthma/COPD, autoimmune rheumatic diseases, and inflammatory bowel disease. It emphasizes the importance of regular monitoring and discusses both pharmacological and non-pharmacological interventions to ensure patient-centered care.

Background: Personalised Care and Support Planning (PCSP) replaces conventional annual reviews for people with long-term conditions. It is designed to help healthcare professionals (HCPs) and patients engage in conversations as equals and collaboratively plan actions oriented to each patient's priorities, alongside biomedical concerns. Little is known about how the shift to remote consulting initiated with COVID-19 restrictions has impacted PCSP. Aim: To investigate HCPs' experiences of conducting PCSP conversations remotely and consider implications for the fulfilment of PCSP ambitions as remote consulting continues beyond COVID-19 restrictions. Methods: 19 semi-structured interviews with HCPs in England and Scotland; interpretive analysis. Results: HCPs' accounts made clear that COVID-19 restrictions impacted multiple aspects of PCSP delivery, not just the mode of conversation. Broader disruption to general practice systems for gathering and sharing information ahead of PCSP conversations, and moves to 'wide window' appointment times, made it harder for patients to be prepared for PCSP conversations. This constrained scope to achieve PCSP ambitions even with the best professional communication skills. Most remote PCSP conversations were conducted by telephone. In the absence of visual communication with patients, it was sometimes harder to achieve the ambitions of PCSP conversations, including to balance patient and professional agendas, fulfil key planning activities, and foster a relational ethos of equal, collaborative partnership. The challenges were particularly severe when working with new patients and people with complex clinical and social problems. Although options for telephone appointments now offer valued flexibility, sustained experience of struggling to achieve PCSP ambitions via remote consulting led some HCPs to lower their standards for judging a "good" PCSP conversation, and to diminished professional satisfaction. Conclusions: There are significant challenges to fulfilling the ambitions of PCSP via telephone, especially when preparatory support is limited. This study provides grounds for scepticism about how compatible telephone appointments can be with this person-centred model of working, especially for people who are socially disadvantaged and live with complex health conditions. These threats to the provision of person-centred support for people with long-term conditions warrant careful attention going forward if the PCSP model and its benefits are to be sustained. [ABSTRACT FROM AUTHOR]

Background: Home mechanical ventilation (HMV) is a treatment method for patients with chronic respiratory failure. HMV is a challenge for both patients and their caregivers. Some studies have shown a higher risk of depression, job loss, or lifestyle disturbance in family members caring for HMV patients. The purpose of the study was to measure caregiver burden, perceived social support, and coping strategies. Methods: In the cross-sectional study, 58 caregivers (65.52% female) of HMV patients treated at five healthcare institutions were surveyed. The questionnaires including patient/caregiver demographic data, the type and duration of MV, the Caregiver Burden Scale (CBS), the Social Support Scale (SSS), and the Brief-COPE questionnaire were applied. For statistical analysis, the Mann‒Whitney U test, the Kruskal‒Wallis H test, Dunn's test, and Spearman correlations were used. Results: In the CBS, a high level of burden was observed mainly in the isolation and disappointment subscales. The female caregivers achieved a higher score for general strain than did the male caregivers (p = 0.023). Differences in the distribution of the isolation (p = 0.028) and disappointment (p = 0.03) variables between the financial situation groups were observed. The older the patient, the lower the burden in the domains of isolation (p = 0.015) and disappointment (p = 0.005) was elicited. Invasive MV was associated with greater burdens of general strain (p = 0.005), isolation (p = 0.001), and disappointment (p = 0.001). A medium total SSS score was shown (74.5 ± 7.56). Caregivers used various coping strategies. The most common were planning, acceptance, and active coping. Self-blame and denial were positively related to several CBS subscales, whereas acceptance of difficult situations and positive reframing were related to lower scores. Conclusions: Caregivers most frequently experienced a medium level of burden. Female caregivers were characterized by higher level of burden. Invasive ventilation increased the burden. Respondents who assessed their financial situations as good, had lower burden in the selected subscales. Using some positive coping strategies may reduce the level of burden. Interventions to ensure that caregivers overcome these burdens should be undertaken. [ABSTRACT FROM AUTHOR]