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Background: Managing heart failure (HF) is challenging because of its complexity and high rates of hospitalization, morbidity, and mortality. Effective management requires coordination between patients' abilities and healthcare services; however, low health literacy among patients with heart failure can adversely affect their health status. Therefore, the understanding relationship between health literacy and health status would provide the evidence for developing future intervention. Methods: This analytical study explored multilevel factors influencing health literacy and health status in patients with heart failure (HF) who underwent health service delivery at outpatient clinics. The sample consisted of 453 patients with HF from 12 hospitals located in five regional areas (north, south, east, northeast, central, and Bangkok) in Thailand. A hypothetical model was used to test the association between comorbidity, social support, patient-centered care, health service delivery, health literacy, and health status. Path analysis was used to analyze the data. Results: The results indicated that 40.8% of patients with HF exhibited low or inadequate levels of health literacy, yet perceived their health status as good, with an average of 25.2± 19.8 points. Health service delivery by a cardiologist and nurse case manager directly influences health literacy. Comorbidity had a direct impact on health status, whereas social support, patient-centered care, and the aforementioned health service delivery indirectly affected health status through health literacy. Importantly, health literacy status directly influences health status. Conclusion: Comorbidity, social support, patient-centered care, and health service delivery were related with health literacy and high level of health literacy could influence the better health status. To increase the quality of health care services, health care providers should promote health literacy and integrate the concept of patient-centered care for HF patients at outpatient clinics. Recommendations include the training of nurses as case managers. [ABSTRACT FROM AUTHOR]

Objective: To assess the present status of the emergency department (ED) triage system in 162 hospitals across the Lao People's Democratic Republic (Lao PDR). Materials and Methods: The nationwide survey participants were ED administrators of all hospitals in Lao PDR. The standard questionnaire package was used for data collection including patients' demographics and triage systemic factors. Descriptive analysis was applied to analysis the outcome of interest. Results: A majority of triage officers were emergency room nurses (58.6%), general physicians (20.4%), or both (11.1%). Most hospitals (89.5%) used informal triage scales such as clinical experiences or colors to prioritize ED patients. Only 17 hospitals (10.5%) had a formal triage scale in their ED care systems and used it in their practice. Conclusion: These findings provide knowledge of the ED triage system in the Lao PDR. The results indicate that the Lao PDR lacks a formal ED triage scale but uses a variety of informal scales. Thus, it is necessary to set up a standard triage system at all hospitals to standardize ED healthcare across the country. [ABSTRACT FROM AUTHOR]

Background: Chronic limb-threatening ischemia (CLTI) represents the late stage of atherosclerotic peripheral arterial disease (PAD). Similar to atherosclerosis in other vascular beds, it is preceded by a long-standing early disease and pre-disposing conditions. Thus, the care of this patient population is theoretically best delivered by a multidisciplinary team. The authors studied the outcomes of a multidisciplinary, well-structured, and evidence-based protocol that might influence better outcomes for CLTI patients. Materials and Methods: The present study was a retrospective study done in a single center. Between January 2018 and December 2020, data were reviewed from CLTI patients that received the multidisciplinary, well-structured, and evidence-base protocol for the treatment of CLTI. The primary outcome was the perioperative clinical outcome of the patients. The secondary outcomes were the 1-year clinical outcome and the admission cost for vascular operation. Results: Two hundred thirty CLTI cases between January 2018 and December 2020 were retrospectively reviewed. Of the 230 cases, 87.9% were elderly (older than 60-years-old) with significant comorbidities including diabetes (74.3%) and hypertension (74.8%). The protocol implementation resulted in clinical outcomes in terms of both major adverse cardiac event (MACE) and major adverse limb event (MALE) at 1.3% and 6.52%, respectively. The survival rates at 1-and 2-years post-revascularization were 84.3% and 74.1%, and the 1-year follow-up MACE and MALE were 6.08% and 12.2%, respectively. Moreover, the protocol statistically improved the quality of life as measured by EuroQoL group-5 Dimensions-5 Levels (EQ-5D-5L) utility score. The median 1-year mean EQ-5D-5Q score increased from 0.332 to 0.863. The cost of the treatments was significantly higher with the increasing severities of CLTI. Conclusion: A multidisciplinary, well-structured, and evidence-based protocol may potentially be effective in improving the quality of care among CLTI patients, both in terms of clinical outcomes and overall health status. [ABSTRACT FROM AUTHOR]