Improving the Effectiveness of Healthcare: Diagnosis-Centered Care Vs. Person-Centered Health Promotion, a Long Forgotten New Model

Epidemiological (secular) trends of pelvic and acetabular fractures (2006-2022) in South Korea using a nationwide cohort data over ages 50: is it osteoporosis related?

Osteoporotic pelvic and acetabular fractures (PAFs) rose significantly from 2006 to 2022, especially among those aged 80-89. Despite increased cases, one-year mortality rates declined from 7.29 to 4.59%. Findings highlight the need for early osteoporosis detection and targeted interventions to address aging demographics and evolving fracture trends.

PURPOSES

Osteoporotic fractures present a growing health challenge, especially in the context aging population. The purpose of our epidemiologic study was to determine the current trend in the number and incidence of pelvic and acetabular fractures (PAFs) providing an in-depth analysis of prevalence, demographic patterns, and related mortality.

METHODS

This retrospective cohort study analyzed data from the National Health Insurance Review and Assessment claims database. Men and women who had pelvic and acetabular fractures, aged ≥ 50 years, between January 1 2006, and December 31 2022, were included. After proper identification using International Classification of Diseases, 10th revision (ICD-10) codes, we calculated absolute number and age-gender specific incidence rates for PAFs and one-year mortality rate following index fracture by sex and age groups.

RESULTS

The total number of PAFs increased considerably during the study period, from 11,607 in 2006 to 35,691 in 2022, 207.5% per 16 years, an average increase of 12.9% a year. When analyzed by age groups, the total number of PAFs increased in all age groups, but showed the highest increase in 80-89. While the crude incidence of PAFs showed a consistency in 50-59, 60-69, and 70-79, a steady increase was noted in 80-89. The annual total mortality rates of PAFs within 1 year showed a decreasing trend from 7.29% in 2006 to 4.59% in 2022. When analyzed by age groups, the highest mortality rates were observed in the 80-89 age group, followed by 70-79, 60-69, and 50-59, with a consistent trend in the latter two age groups but a decreasing trend in the 80-89 age group.

CONCLUSION

The secular trend of PAFs reflects features typical of osteoporotic fractures, characterized by age- and gender-dependent pattern, while mortality rates are declining. With the increasing aggressive surgical interventions for PAFs, it is essential to detect osteoporosis early and implement targeted interventions for treatment and prevention in elderly patients.

Cross-Cultural Adaptation and Validation of the Person-Centered Therapeutic Relationship in Physiotherapy Scale to European Portuguese

BACKGROUND/OBJECTIVES

Implementing a person-centered practice is considered a priority in healthcare, and the development of a solid and positive therapeutic relationship is a fundamental element. This study conducted a cross-cultural adaptation of the Person-Centered Therapeutic Relationship in Physiotherapy Scale to European Portuguese and contributed to its validation through the study of its structural validity and internal consistency.

METHODS

This study was conducted from October 2021 to July 2023 and included two phases: a methodological study of cross-cultural adaptation (phase 1) and a transversal study to assess the psychometric properties (phase 2). Structural validity was analyzed using exploratory factor analysis and internal consistency was estimated using Cronbach's alpha (α). A p-value < 0.05 was considered to indicate statistical significance.

RESULTS

The Person-Centered Therapeutic Relationship in Physiotherapy Scale was successfully culturally adapted to European Portuguese (phase 1). During phase 2, 203 individuals [mean age: 50.16 ± 13.10 years (range 18-80 years)] with musculoskeletal conditions, mostly female (63.1%), were recruited. The factorial solution explained 74.7% of the total variability and retained three factors, grouping items 9 to 15 in a common factor (professional empowerment and therapeutic communication). Adequate internal consistency was found (Cronbach's α = 0.889).

CONCLUSIONS

This study culturally adapted an instrument to European Portuguese, which allows the assessment of the person-centered therapeutic relationship in physiotherapy, presenting adequate internal consistency. Future studies should contribute to the remaining validation of the instrument so that it can be available to the Portuguese population.

Inquiring into conditions for engaging in narrative relations on a geriatric ward - how interpretation matters in everyday practices

Drawing on data from ethnographic fieldwork and interprofessional focus group discussions, this study enquires into staff's everyday life on a geriatric ward to explore and understand conditions for engaging in narrative relations in in-patient geriatric care. Avoiding individualistic understandings of narrative practices, we applied a narrative-in-action methodology built on a relational understanding of narrativity, where individual narratives are not separated from social and cultural features. This helped us explore how individual interpretations of the conditions for everyday practices come together with broader social or cultural understandings to gain situated insights about how these are continuously related and reformed by one another in everyday situations of geriatric care. The findings offer insights into the opportunities to engage in narrative relations based on how healthcare staff on a geriatric ward interpret conditions for their practices, and how they act based on such interpretations. While some interpretations were associated with attitudes and activities encouraging narrative relations, others simultaneously thwarted narrative relations by enacting task-orientation, division, or a focus on measurable biomedical or function-related outcomes. Moreover, the findings suggest and discuss consequences of the tensions created as interpretations are enacted in everyday healthcare situations, thus questioning assumptions about conditions as something static and linear.

Improvement of human performance in healthcare systems by taking into account physician behavior

PURPOSE

Efficiency standards, similar to industrial measures like overall equipment effectiveness (OEE), are being used in healthcare systems more and more. Performance indicator models applied to machines assume a constant completion time. However, for human resources, the completion time of a task may vary depending on the stress experienced. This study seeks to bridge this gap by integrating the human behavior of the physician into the performance evaluation.

DESIGN/METHODOLOGY/APPROACH

The paper presents a new algorithm called PerfoBalance that is intended to distribute waiting-patient values among doctors. By maximizing each physician's stress zones, this method helps to improve their performance as a whole. A thorough case study with medical professionals is carried out to confirm the effectiveness of the suggested methodology. The PerfoBalance algorithm is used in a variety of contexts to divide waiting-patient values among doctors and optimize stress zones.

FINDINGS

Experimental results demonstrate a significant improvement in physician efficiency when implementing the PerfoBalance algorithm. The algorithm strategically selects stress zones that contribute to higher performance rates for physicians by optimizing waiting-patient values.

ORIGINALITY/VALUE

By addressing the undervaluation of human performance difficulties in current efficiency models used in the healthcare industry, this research constitutes a significant contribution to the field. With its launch, the PerfoBalance algorithm offers a fresh viewpoint on waiting-patient value allocation and stress zone management in healthcare settings, hence representing a powerful method for increasing physician productivity.

The collaborative framework for the management of tuberculosis and type 2 diabetes syndemic in low- and middle-income countries: a rapid review

INTRODUCTION

Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC).

METHODS

A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022.

RESULTS

A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services.

CONCLUSIONS

This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening.

Preclinical Orthostatic Abnormalities May Predict Early Increase in Vascular Stiffness in Different Age Groups: A Pilot Study

Clinical orthostatic hypotension (OH) and hypertension (OHT) are risk factors for arterial hypertension (AH) and cardiovascular diseases (CVD) and are associated with increased vascular stiffness. Preclinical OH and OHT are poorly understood. The main objective was to investigate preclinical orthostatic abnormalities and their association with increased vascular stiffness in different age groups of adults. A specially designed head-up tilt test standardized for hydrostatic column height was used to detect them. Three age groups of clinically healthy subjects were examined. In the group of young adults up to 30 years old, a significant predominance of orthostatic normotension (ONT) and an insignificant number of subjects with preclinical OH and OHT were found. In the age group over 45 years, compared to the group under 30 years, there was a twofold decrease in the proportion of individuals with ONT and a significant increase with preclinical OH and OHT. In all age groups, there was a significant orthostatic increase in vascular stiffness (as measured by the brachial-ankle pulse wave velocity (baPWV), which was recovered to the baseline level when returning to the supine position. Overall, subjects with preclinical OH and OHT had significantly higher baPWV values compared to those with ONT (p = 0.001 and p = 0.002, respectively), with all subjects having vascular stiffness values within normal age-related values.

Detection of Preclinical Orthostatic Disorders in Young African and European Adults Using the Head-Up Tilt Test with a Standardized Hydrostatic Column Height: A Pilot Study

Arterial hypertension (AH) remains the most common disease. One possible way to improve the effectiveness of the primary prevention of AH is to identify and control the preclinical orthostatic disturbances that precede the development of AH. The aim of the study was to determine the feasibility of a new protocol for the head-up tilt test (HUTT) with a standardized hydrostatic column height for the detection of asymptomatic orthostatic circulatory disorders and their racial differences in young African and European adults. Methods. In total, 80 young healthy adults (40 African and 40 European) aged 20–23 years performed the HUTT with a standardized hydrostatic column height of 133 cm. The hemodynamic parameters were recorded using a Task Force Monitor (3040i). The cardio-ankle vascular index (CAVI) was measured using a VaSera VS-2000 volumetric sphygmograph. Results. The baseline and orthostatic hemodynamic changes in both racial groups were within normal limits. Orthostatic circulatory disturbances were not detected in 70% of the European participants and 65% of the African participants; however, preclinical orthostatic hypertension, which precedes AH, was detected using the new HUTT protocol in 32.5% of the African participants and 20% of the European participants. The baseline CAVI was higher in the European group compared to the African group. Conclusion. The results of this study showed the feasibility of the detection of preclinical orthostatic disturbances in young adults and the detection of their racial differences using the HUTT protocol, providing the use of a standard gravity load. Further study on the evolution of preclinical orthostatic disturbances and their relation to increased vascular stiffness is necessary among large samples.

Care Recommendations for the Chronic Risk of COVID-19: Nursing Intervention for Behaviour Changes

The COVID-19 pandemic is a challenge for health systems. The absence of prior evidence makes it difficult to disseminate consensual care recommendations. However, lifestyle adaptation is key to controlling the pandemic. In light of this, nursing has its own model and language that allow these recommendations to be combined from global and person-centred perspectives. The purpose of the study is to design a population-oriented care recommendation guide for COVID-19. The methodology uses a group of experts who provide classified recommendations according to Gordon’s functional patterns, after which a technical team unifies them and returns them for validation through the content validity index (CVI). The experts send 1178 records representing 624 recommendations, which are unified into 258. In total, 246 recommendations (95.35%) are validated, 170 (65.89%) obtain high validation with CVI > 0.80, and 12 (4.65%) are not validated by CVI < 0.50. The mean CVI per pattern is 0.84 (0.70−0.93). These recommendations provide a general framework from a nursing care perspective. Each professional can use this guide to adapt the recommendations to each individual or community and thus measure the health impact. In the future, this guideline could be updated as more evidence becomes available.