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Jung W, Ahn A, Lee G, Kong S, Kang D, Lee D, Kim TE, Shim YM, Kim HK, Cho J, Cho J, Shin DW. Supporting Life Adjustment in Patients With Lung Cancer Through a Comprehensive Care Program: Protocol for a Controlled Before-and-After Trial. JMIR Res Protoc 2024; 13:e54707. [PMID: 38349712 PMCID: PMC10900087 DOI: 10.2196/54707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Lung cancer diagnosis affects an individual's quality of life as well as physical and emotional functioning. Information on survivorship care tends to be introduced at the end of treatment, but early intervention may affect posttreatment adjustment. However, to the best of our knowledge, no study has explored the effect of early information intervention on the return to work, family, and societal roles of lung cancer survivors. OBJECTIVE We report the study protocol of a comprehensive care prehabilitation intervention designed to facilitate lung cancer survivors' psychological adjustment after treatment. METHODS A comprehensive care program was developed based on a literature review and a qualitative study of patients with lung cancer and health professionals. The Lung Cancer Comprehensive Care Program consists of educational videos and follow-up visits by a family medicine physician. To prevent contamination, the control group received routine education, whereas the intervention group received routine care and intervention. Both groups completed questionnaires before surgery (T0) and at 1-month (T1), 6-month (T2), and 1-year (T3) follow-up visits after surgery. The primary outcome was survivors' psychological adjustment to cancer 6 months after pulmonary resection. RESULTS The historical control group (n=441) was recruited from September 8, 2021, to April 20, 2022, and the intervention group (n=350) was recruited from April 22, 2022, to October 17, 2022. All statistical analyses will be performed upon completion of the study. CONCLUSIONS This study examined the effectiveness of an intervention that provided general and tailored informational support to lung cancer survivors, ranging from before to the end of treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT05078918; https://clinicaltrials.gov/ct2/show/NCT05078918. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54707.
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Affiliation(s)
- Wonyoung Jung
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Alice Ahn
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, United States
| | - Genehee Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Sunga Kong
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Danbee Kang
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Dongok Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Tae Eun Kim
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jongho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Cho
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Green HM, Diaz L, Carmona-Barrera V, Grobman WA, Yeh C, Williams B, Davis K, Kominiarek MA, Feinglass J, Zera C, Yee LM. Mapping the Postpartum Experience Through Obstetric Patient Navigation for Low-Income Individuals. J Womens Health (Larchmt) 2024. [PMID: 38265478 DOI: 10.1089/jwh.2023.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Although the postpartum period is an opportunity to address long-term health, fragmented care systems, inadequate attention to social needs, and a lack of structured transition to primary care threaten patient wellbeing, particularly for low-income individuals. Postpartum patient navigation is an emerging innovation to address these disparities. Methods: This mixed-methods analysis uses data from the first year of an ongoing randomized controlled trial to understand the needs of low-income postpartum individuals through 1 year of patient navigation. We designed standardized logs for navigators to record their services, tracking mode, content, intensity, and target of interactions. Navigators also completed semistructured interviews every 3 months regarding relationships with patients and care teams, care system gaps, and navigation process. Log data were categorized, quantified, and mapped temporally through 1 year postpartum. Qualitative data were analyzed using the constant comparative method. Results: Log data from 50 participants who received navigation revealed the most frequent needs related to health care access (45.4%), health and wellness (18.2%), patient-navigator relationship building (14.8%), parenting (13.6%), and social determinants of health (8.0%). Navigation activities included supporting physical and mental recovery, accomplishing health goals, connecting patients to primary and specialty care, preparing for health system utilization beyond navigation, and referring individuals to community resources. Participant needs fluctuated, yielding a dynamic timeline of the first postpartum year. Conclusion: Postpartum needs evolved throughout the year, requiring support from various teams. Navigation beyond the typical postpartum care window may be useful in mitigating health system barriers, and tracking patient needs may be useful in optimizing postpartum care. Clinical Trial Registration: Registered April 19, 2019, enrollment beginning January 21, 2020, NCT03922334, https://clinicaltrials.gov/ct2/show/NCT03922334.
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Affiliation(s)
- Hannah M Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Chen Yeh
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chloe Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Seger C, Tuten M, Storr CL, Majer JM. Delivery Outcomes Among Pregnant Women With Comorbid Psychiatric and Substance Use Disorders Receiving Comprehensive Treatment. J Am Psychiatr Nurses Assoc 2024; 30:121-131. [PMID: 35184607 DOI: 10.1177/10783903221079384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Pregnant women with substance use disorders (SUDs) are at risk for adverse delivery outcomes, and some of these women have psychiatric comorbidities that increase this risk. AIMS: Although comprehensive care models offering prenatal care services and substance abuse treatment have been found to positively affect delivery outcomes for pregnant women with SUDs, there is a dearth of research to support such models for women who have psychiatric comorbidities. METHODS: A secondary data analysis was conducted to understand the relationship between pretreatment psychiatric comorbidity and delivery outcomes for pregnant clients with SUDs receiving comprehensive treatment. We analyzed two groups of pregnant women with SUDs and hypothesized that women with psychiatric comorbidities would have worse neonatal and maternal outcomes compared with those who did not have any pretreatment psychiatric comorbidity. Regression models were used to examine changes in delivery outcome criteria (birthweight, neonatal abstinence syndrome, maternal urine toxicology screens at delivery, and hospital length of stay) in relation to psychiatric comorbidity among a sample of 74 mother-baby dyads receiving comprehensive care treatment. RESULTS: Results did not support our hypothesis as delivery outcomes were statistically similar for both groups. CONCLUSION: Findings suggest comprehensive care can reduce the risk of negative delivery outcomes among women with SUDs who have psychiatric comorbidities. Treatment and research implications are provided.
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Affiliation(s)
- Celeste Seger
- Celeste Seger, PhD, RN, University of Maryland, Baltimore, MD, USA
| | - Michelle Tuten
- Michelle Tuten, MSW, LCSW-C, PhD, University of Maryland, Baltimore, MD, USA
| | - Carla L Storr
- Carla L. Storr, ScD, MPH, University of Maryland, Baltimore, MD, USA
| | - John M Majer
- John M. Majer, PhD, Harry S. Truman College, Chicago, IL, USA
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Nomura S. Current Status and Challenges in Delivering Comprehensive Care for Patients with Hemophilia. J Blood Med 2023; 14:629-637. [PMID: 38125786 PMCID: PMC10730945 DOI: 10.2147/jbm.s446204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
The importance of comprehensive care as a treatment strategy for patients with hemophilia is recognized worldwide. Comprehensive care entails addressing full spectrum of medical and psychological aspects impacting both patients and their families. The primary objective of comprehensive care for individuals with hemophilia is to enable them to lead their daily lives just as anyone else would. To achieve this goal, it is necessary to have a positive and collaborative approach across various healthcare disciplines. This extends beyond clinical specialists, encompassing pediatricians, hematologists, orthopedic surgeons, dental and oral surgeons, gynecologists, nurses, physical therapists, clinical psychologists, and other professionals from diverse fields. This review article discusses the current status and challenges associated with comprehensive care for patients with hemophilia. We categorize these challenges as follows: hemophilic arthritis, rehabilitation, oral care, transitioning from pediatric to adult care, addressing carrier issues, and providing psychological care. There is still substantial work to be undertaken in addressing these hurdles and advancing the quality of comprehensive care for hemophilia patients.
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Affiliation(s)
- Shosaku Nomura
- Center of Thrombosis and Hemostasis, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
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Babalola O, Levin J, Goudge J, Griffiths F. Community health workers' quality of comprehensive care: a cross-sectional observational study across three districts in South Africa. Front Public Health 2023; 11:1180663. [PMID: 38162597 PMCID: PMC10755947 DOI: 10.3389/fpubh.2023.1180663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Community healthcare worker (CHW) training programs are becoming increasingly comprehensive (an expanded range of diseases). However, the CHWs that the program relies on have limited training. Since CHWs' activities occur largely during household visits, which often go unsupervised and unassessed, long-term, ongoing assessment is needed to identify gaps in CHW competency, and improve any such gaps. We observed CHWs during household visits and gave scores according to the proportion of health messages/activities provided for the health conditions encountered in households. We aimed to determine (1) messages/activities scores derived from the proportion of health messages given in the households by CHWs who provide comprehensive care in South Africa, and (2) the associated factors. Methods In three districts (from two provinces), we trained five fieldworkers to score the messages provided by, and activities of, 34 CHWs that we randomly selected during 376 household visits in 2018 and 2020 using a cross-sectional study designs. Multilevel models were fitted to identify factors associated with the messages/activities scores, adjusted for the clustering of observations within CHWs. The models were adjusted for fieldworkers and study facilities (n = 5, respectively) as fixed effects. CHW-related (age, education level, and phase of CHW training attended/passed) and household-related factors (household size [number of persons per household], number of conditions per household, and number of persons with a condition [hypertension, diabetes, HIV, tuberculosis TB, and cough]) were investigated. Results In the final model, messages/activities scores increased with each extra 5-min increase in visit duration. Messages/activities scores were lower for households with either children/babies, hypertension, diabetes, a large household size, numerous household conditions, and members with either TB or cough. Increasing household size and number of conditions, also lower the score. The messages/activities scores were not associated with any CHW characteristics, including education and training. Conclusion This study identifies important factors related to the messages provided by and the activities of CHWs across CHW teams. Increasing efforts are needed to ensure that CHWs who provide comprehensive care are supported given the wider range of conditions for which they provide messages/activities, especially in households with hypertension, diabetes, TB/cough, and children or babies.
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Affiliation(s)
- Olukemi Babalola
- Center for Health Policy, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Jonathan Levin
- Division of Epidemiology and Biostatistics, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Jane Goudge
- Center for Health Policy, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
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Yadav P, Jaiswal A, Patel A, Reddy LS, Sindhu A. A Comprehensive Review on Asthma Challenges in Pregnancy: Exploring First Trimester Exacerbations and the Spectrum of Congenital Anomalies. Cureus 2023; 15:e49849. [PMID: 38169705 PMCID: PMC10758581 DOI: 10.7759/cureus.49849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
This comprehensive review delves into the intricate relationship between asthma and pregnancy, specifically focusing on the challenges encountered in the first trimester and the ensuing impact on maternal and fetal health. Examining physiological changes during pregnancy reveals the dynamic interplay influencing respiratory function and immune responses. Key findings underscore the vulnerability to asthma exacerbations in the critical first trimester, emphasizing the potential risks to both maternal and fetal well-being. Maternal and fetal outcomes are discussed, emphasizing the associations between poorly controlled asthma and adverse perinatal outcomes. Implications for clinical practice highlight the importance of preconception care, continuous monitoring, and collaborative efforts between obstetricians and pulmonologists. Patient education emerges as a fundamental aspect to empower pregnant women in managing their condition. The conclusion emphasizes the imperative for comprehensive care, advocating for individualized treatment plans, multidisciplinary collaboration, and public health initiatives. By adopting this holistic approach, healthcare providers can navigate the complexities of asthma during pregnancy, ultimately ensuring the optimal health of both the expectant mother and her developing fetus.
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Affiliation(s)
- Pallavi Yadav
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Archan Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky Srivani Reddy
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arman Sindhu
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Berner K, Louw QA. Factors affecting quality of life in adults with HIV: A local cross-sectional study. S Afr J Physiother 2023; 79:1921. [PMID: 38059059 PMCID: PMC10696562 DOI: 10.4102/sajp.v79i1.1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/26/2023] [Indexed: 12/08/2023] Open
Abstract
Background Understanding health-related quality of life (HRQOL) among people with HIV (PWH) can inform strategies to maintain or improve health and functioning. Most HRQOL research has focused on resource-rich settings, underrepresenting younger cohorts in low-resource settings. Objectives To assess HRQOL and associated factors in PWH visiting two primary healthcare clinics in the Western Cape, South Africa. Method A cross-sectional study included 48 PWH (58.3% women; mean age: 39.2 [10.3]). Health-related QOL was assessed using EQ-5D-5L descriptive domains, visual analogue scale (EQ-VAS), and index score (EQ-index). Mobility was assessed using clinical tests. Tobit regression determined associations. Results Mean and median EQ-VAS scores were 88.14 (16.35) and 95.00. Mean and median EQ-index scores were 0.84 (0.10) and 0.90. PWH reported problems as pain/discomfort (35.4%), depression/anxiety (25.0%), mobility (22.9%), usual activities (18.7%) and self-care (12.5%) domains. Slow chair rise (p = 0.012), low income (p = 0.030), longer HIV duration (p = 0.009) and polypharmacy (p = 0.034) were associated with lower HRQOL. Antiretroviral therapy (ART) adherence was associated with higher HRQOL (p = 0.020). Conclusion Despite high overall HRQOL, specific domains presented challenges to PWH. Health-related QOL was associated with chair rise repetitions, income, HIV duration, polypharmacy, and treatment adherence. Comprehensive care and contextualised interventions to address these through rehabilitation, including health promotion, are proposed strategies for future investigation. Clinical implications Clinicians should be cognisant of potential physical and mental functioning problems, and factors related to drug therapy, socio-economic status and disease duration that may affect HRQOL even in seemingly unimpaired PWH.
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Affiliation(s)
- Karina Berner
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette A. Louw
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Babu BV, Sharma Y, Sridevi P, Surti SB, Bhat D, Ranjit M, Sudhakar G, Sarmah J. Strengthening Health System and Community Mobilization for Sickle Cell Disease Screening and Management among Tribal Populations in India: An Interventional Study. Hemoglobin 2023; 47:227-236. [PMID: 38189147 DOI: 10.1080/03630269.2023.2300675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
Sickle cell disease (SCD) affects 5% of the global population, with over 300,000 infants born yearly. In India, 73% of those with the sickle hemoglobin gene belong to indigenous tribes in remote regions lacking proper healthcare. Despite the prevalence of SCD, India lacked state-led public health programs until recently, leaving a gap in screening and comprehensive care. Hence, the Indian Council of Medical Research conducted implementation research to address this gap. This paper discusses the development and impact of the program, including screening and treatment coverage for SCD in tribal areas. With a quasi-experimental design, this study was conducted in six tribal-dominated districts in three phases - formative, intervention, and evaluation. The intervention included advocacy, partnership building, building the health system's capacity and community mobilization, and enabling the health systems to screen and manage SCD patients. The capacity building included improving healthcare workers' skills through training and infrastructure development of primary healthcare (PHC) facilities. The impact of the intervention is visible in terms of people's participation (54%, 76% and 93% of the participants participated in some intervention activities, underwent symptomatic screening and demanded the continuity of the program, respectively), and improvement in SCD-related knowledge of the community and health workers (with more than 50% of net change in many of the knowledge-related outcomes). By developing screening and treatment models, this intervention model demonstrated the feasibility of SCD care at the PHC level in remote rural areas. This accessible approach allows the tribal population in India to routinely seek SCD care at their local PHCs, offering great convenience. Nevertheless, additional research employing rigorous methodology is required to fine-tune the model. National SCD program may adopt this model, specifically for community-level screening and management of SCD in remote and rural areas.
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Affiliation(s)
- Bontha V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
| | - Yogita Sharma
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India
| | - Parikipandla Sridevi
- Department of Biotechnology, Central Tribal University of Andhra Pradesh, Vizianagaram, India
| | - Shaily B Surti
- Department of Community Medicine, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India
| | - Deepa Bhat
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Manoranjan Ranjit
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Godi Sudhakar
- Department of Human Genetics, Andhra University, Visakhapatnam, India
| | - Jatin Sarmah
- Department of Biotechnology, Bodoland University, Kokrajhar, India
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Sulaiman NM, Alyahya E. Congenital Insensitivity to Pain with Anhidrosis: A Case Report. Cureus 2023; 15:e48294. [PMID: 38058353 PMCID: PMC10696640 DOI: 10.7759/cureus.48294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
Hereditary sensory and autonomic neuropathy type 4 (HSAN4), or congenital insensitivity to pain with anhidrosis (CIPA), is a rare autosomal recessive disorder caused by mutations in the NTRK1 gene, resulting in pain insensitivity, anhidrosis, and temperature dysregulation. This report focuses on oral manifestations in an 11-year-old girl with CIPA, highlighting the need for early intervention and comprehensive care. The patient had a history of recurrent oral injuries and an unexplained fever, with a confirmed HSAN4 diagnosis through genetic analysis. Clinical features included pain insensitivity, anhidrosis, and intellectual disability. Dental history revealed emergency care, suboptimal oral hygiene, early tooth loss, and infections. Extra-oral examination showed nail-biting and injuries, while intra-oral assessment revealed ulcers and scars. Radiographic evaluation indicated mandibular alveolar bone thinning and periapical lesions in the lower incisors. This case emphasizes the complex challenges of CIPA, including pain insensitivity, recurring fever episodes, and self-inflicted injuries. Early diagnosis and specific dental care are vital to prevent orofacial trauma, necessitating a proactive interdisciplinary approach for comprehensive care.
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Affiliation(s)
- Noura M Sulaiman
- Pediatric Dentistry, Prince Sultan Military Medical City, Riyadh, SAU
| | - Eram Alyahya
- Pediatric Dentistry, Prince Sultan Military Medical City, Riyadh, SAU
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Barzi A, Kim AJ, Liang CK, West H, Wong D, Wright C, Nathwani N, Vasko CM, Chung V, Rubinson DA, Sachs T. Pancreatic Adenocarcinoma: Real World Evidence of Care Delivery in AccessHope Data. J Pers Med 2023; 13:1377. [PMID: 37763145 PMCID: PMC10532778 DOI: 10.3390/jpm13091377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/02/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Pancreatic adenocarcinoma is an aggressive disease and the delivery of comprehensive care to individuals with this cancer is critical to achieve appropriate outcomes. The identification of gaps in care delivery facilitates the design of interventions to optimize care delivery and improve outcomes in this population. METHODS AccessHope™ is a growing organization that connects oncology subspecialists with treating providers through contracts with self-insured employers. Data from 94 pancreatic adenocarcinoma cases (August 2019-December 2022) in the AccessHope dataset were used to describe gaps in care delivery. RESULTS In all but 6% of cases, the subspecialist provided guideline-concordant recommendations anticipated to improve outcomes. Gaps in care were more pronounced in patients with non-metastatic pancreatic cancer. There was a significant deficiency in germline testing regardless of the stage, with only 59% of cases having completed testing. Only 20% of cases were receiving palliative care or other allied support services. There was no difference in observed care gaps between patients receiving care in the community setting vs. those receiving care in the academic setting. CONCLUSIONS There are significant gaps in the care delivered to patients with pancreatic adenocarcinoma. A concurrent subspecialist review has the opportunity to identify and address these gaps in a timely manner.
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Affiliation(s)
- Afsaneh Barzi
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA;
| | - Angela J. Kim
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
| | - Crystal K. Liang
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
| | - Howard West
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA;
| | - D. Wong
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA;
| | - Carol Wright
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
| | - Nitya Nathwani
- Department of Hematology and Hematopoietic Stem Cell Transplant, City of Hope, Duarte, CA 91011, USA;
| | - Catherine M. Vasko
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
| | - Vincent Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA;
| | | | - Todd Sachs
- AccessHope, Duarte, CA 91010, USA; (A.J.K.); (C.K.L.); (H.W.); (C.W.); (C.M.V.); (T.S.)
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Chaudhary MH, Dev S, Kumari A, Kanwal K, Jadav DN, Rasool S, Tayyab Saleem M, Bhagat R, Prachi F, Puri P, Kashif M, Varrassi G, Khatri M, Kumar S, Mohamad T. Holistic Approaches to Arrhythmia Management: Combining Medication, Ablation, and Device Interventions. Cureus 2023; 15:e45958. [PMID: 37900386 PMCID: PMC10600027 DOI: 10.7759/cureus.45958] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
This narrative review investigates the severe health issue of arrhythmias, which affects millions of people worldwide. A multifaceted strategy incorporating medicine, catheter ablation, and advanced device interventions is necessary to manage these disorders effectively. Medication is the cornerstone, and as antiarrhythmic medications develop, their efficacy and side effects are reduced. Success depends on having individualized treatment strategies that consider patient profiles and arrhythmia type. Catheter ablation, a minimally invasive surgery that targets and removes faulty heart electrical circuits, has become a potent therapy when drugs are ineffective. Technological developments, including high-resolution mapping systems and customized catheters, improve precision. Pacemakers and implantable cardioverter-defibrillators (ICDs) are two examples of implantable cardiac devices essential to managing all types of arrhythmias. Pacemakers provide a regular heartbeat when the body's natural pacing mechanism fails. At the same time, ICDs, with cutting-edge algorithms, can identify and stop life-threatening arrhythmias and offer high-risk patients vital protection. As device technology advances, smaller, more durable devices become available, improving patient comfort and lowering the need for replacements. The seamless fusion of these three strategies is where holistic arrhythmia management shines. Even for difficult instances, customized combination therapy combining medicine, ablation, and device interventions offers complete solutions. Healthcare providers must collaborate for this integrated strategy to deliver personalized, efficient, and holistic care. In conclusion, the management of arrhythmias has developed into a dynamic, synergistic discipline where drugs, catheter ablation, and devices all work in concert to deliver comprehensive care. For those with arrhythmias, a patient-centered strategy that considers their particular patient features and best integrates different modalities can significantly enhance their quality of life. The effectiveness and accessibility of holistic arrhythmia management could be further improved because of ongoing developments in these fields, which is encouraging for patients and medical professionals.
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Affiliation(s)
| | - Shah Dev
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Ankeeta Kumari
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Kainat Kanwal
- Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | | | - Sohaib Rasool
- Medicine, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | | | - Ridhi Bhagat
- Internal Medicine, Teerthanker Mahaveer Medical College and Reseach Center, Moradabad , IND
| | - Fnu Prachi
- Medicine, Guru Teg Bahadur Hospital, Delhi, IND
| | - Piyush Puri
- Internal Medicine, Adesh Institute of Medical Science and Research, Bathinda, IND
| | - Maham Kashif
- Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
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12
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Jayakumar P, Mills Z, Triana B, Moxham J, Olmstead T, Wallace S, Bozic K, Koenig K. A Model for Evaluating Total Costs of Care and Cost Savings of Specialty Condition-Based Care for Hip and Knee Osteoarthritis in an Integrated Practice Unit. Value Health 2023; 26:1363-1371. [PMID: 37236394 DOI: 10.1016/j.jval.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The viability of specialty condition-based care via integrated practice units (IPUs) requires a comprehensive understanding of total costs of care. Our primary objective was to introduce a model to evaluate costs and potential costs savings using time-driven activity-based costing comparing IPU-based nonoperative management with traditional nonoperative management and IPU-based operative management with traditional operative management for hip and knee osteoarthritis (OA). Secondarily, we assess drivers of incremental cost differences between IPU-based care and traditional care. Finally, we model potential cost savings through diverting patients from traditional operative management to IPU-based nonoperative management. METHODS We developed a model to evaluate costs using time-driven activity-based costing for hip and knee OA care pathways within a musculoskeletal IPU compared with traditional care. We identified differences in costs and drivers of cost differences and developed a model to demonstrate potential cost savings through diverting patients from operative intervention. RESULTS Weighted average costs of IPU-based nonoperative management were lower than traditional nonoperative management and lower in IPU-based operative management than traditional operative management. Key drivers of incremental cost savings included care led by surgeons in partnership with associate providers, modified physical therapy programs with self-management, and judicious use of intra-articular injections. Substantial savings were modeled by diverting patients toward IPU-based nonoperative management. CONCLUSIONS Costing models involving musculoskeletal IPUs demonstrate favorable costs and cost savings compared with traditional management of hip or knee OA. More effective team-based care and utilization of evidence-based nonoperative strategies can drive the financial viability of these innovative care models.
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Affiliation(s)
- Prakash Jayakumar
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA.
| | - Zachary Mills
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA
| | | | - Jamie Moxham
- Department of Analytics and Health Economics. Ascension Seton. Austin, TX, USA
| | - Todd Olmstead
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, USA
| | - Scott Wallace
- Value Institute for Health and Care. University of Texas at Austin, Austin, TX, USA
| | - Kevin Bozic
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA
| | - Karl Koenig
- Department of Surgery and Perioperative Care. University of Texas at Austin, Dell Medical School. Austin, TX, USA
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13
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Shanbhag NM, Aljawamis DF, Araki M, Abdelbari NA. Multidisciplinary Checklist for Safe Transitions to Home Total Parenteral Nutrition From Hospital-Based Palliative Care: A Case Study From Al Ain, Abu Dhabi. Cureus 2023; 15:e43350. [PMID: 37577268 PMCID: PMC10421964 DOI: 10.7759/cureus.43350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/15/2023] Open
Abstract
We present a complex case of a multimorbid elderly patient admitted with septic shock, suspected to be secondary to aspiration pneumonia, who subsequently developed an intestinal obstruction due to an ileocecal junction mass. Despite conservative management, the patient's clinical status deteriorated and required comprehensive palliative care. This case highlights the challenges in managing patients with multimorbidities, the importance of a multidisciplinary approach, and the central role of palliative care in the setting of advanced disease. We demonstrate the effectiveness of the above method to safely transit an elderly male with a recent diagnosis of colon cancer with malignant intestinal obstruction, initiated on total parenteral nutrition (TPN). This study emphasizes the successful implementation of an innovative, multidisciplinary checklist for managing elderly palliative care patients on home total parenteral nutrition (HTPN) in Al Ain, Abu Dhabi. The collaborative approach adopted by the multidisciplinary team (MDT), coupled with comprehensive staff training, patient and caregiver education, and ongoing monitoring and support, facilitated the seamless integration of HTPN into the patient's care plan. The positive outcomes observed in this case underscore the potential of such tailored interventions to bridge the existing gap in HTPN implementation within the region, thus improving the quality of life and overall well-being of elderly patients requiring specialized nutrition support.
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Affiliation(s)
- Nandan M Shanbhag
- Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
- Internal Medicine, United Arab Emirates University, Al Ain, ARE
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14
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Walker BM, Donnell CC. Does dental rehabilitation under general anaesthetic contribute to the development of temporomandibular disorders in children and adolescents? A scoping review. J Oral Rehabil 2023. [PMID: 37247258 DOI: 10.1111/joor.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 02/04/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) have multiple aetiological factors. Although some evidence suggests invasive and lengthy dental procedures may contribute toward TMD development, there is a relative paucity in the literature regarding an association between elements of paediatric dental general anaesthesia (pDGA) and TMDs. This review aims to consider the impact of dental rehabilitation (and its constituent elements) performed under general anaesthesia on the development of TMDs in childhood and adolescence and identify theories and/or gaps in knowledge which may benefit from future research. METHODS Due to the need to preliminarily examine the nature and extent of the current evidence base, a scoping review approach was chosen. The review was conducted based on the framework provided by the methodological working group of the Joanna Briggs Institute (JBI) for conducting systematic scoping reviews. Electronic databases MEDLINE, Embase, Scopus, Web of Science and Cochrane Library were searched as well as the grey literature using OpenGrey, Nexis, Ethos, Google Scholar and ProQuest, with eligible studies uploaded onto Zotero (Mac Version 5.0.96.2). RESULTS A total of 810 records were identified. After removing duplicates and those not available in English, 260 were identified for title and abstract screening. Seventy-six records underwent full text review of which only one met the broad inclusion criteria. The most common reasons for exclusion were no specific relation to general anaesthesia, not specifically relating to dental treatment and only being concerned with TMD management. The included study found that while development of TMDs following dental rehabilitation under GA did occur in children, whether the problems caused by treatment were exacerbated by other elements of the pDGA process remains unknown. CONCLUSION This review has confirmed a distinct paucity of research in this field. While there is no current tangible scientific evidence that common and routine dental procedures lead to TMD, the literature shows that alterations to any one or a combination of critical factors can contribute to TMD development, which may be collectively exacerbated by iatrogenic macrotrauma during the pDGA process. We have highlighted elements of pre-, peri- and post-operative pDGA, alongside biopsychosocial factors, which may contribute to TMD development in childhood and adolescence and may benefit from future research.
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Affiliation(s)
- Benjamin M Walker
- Specialty Doctor in Oral and Maxillofacial Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Christopher C Donnell
- Specialty Registrar in Paediatric Dentistry, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals NHS Foundation Trust; Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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15
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Teela L, Haverman L, Burgess C, Buckova P, Vandenabeele K, Golan G, Rooney G, Torres-Ortuño A. The results of a survey about psychosocial care throughout Europe. Haemophilia 2023; 29:917-920. [PMID: 36847729 DOI: 10.1111/hae.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Lorynn Teela
- Amsterdam UMC Location University, of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam UMC Location University, of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
| | - Christina Burgess
- Haemophilia and Bleeding Disorders Counselling Association, A Charity Providing Psychological Support to the Bleeding Disorder Community, Cambridge, UK
| | - Petra Buckova
- University Hospital Brno, Brno, Jihomoravsky, the Czech Republic
| | - Karen Vandenabeele
- Haemophilia Centre, University Hospital Leuven, Leuven, Flanders, Belgium
| | - Gaby Golan
- Sheba Medical Center, Tel Aviv Medical University, Tel Aviv, Israel
| | - Gloria Rooney
- Senior Medical Social Worker at The National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Ana Torres-Ortuño
- Department of Psychiatry and Social Psychology, Faculty of Medicine, Haemophilia Association of Murcia, University of Murcia, Murcia, Spain
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16
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van Wijngaarden MT(M, van Asselt DZB(D, Grol SM(, Scherpbier-de Haan ND(N, Fluit CRMG(L. Components and Outcomes in Under- and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review. Int J Integr Care 2023; 23:7. [PMID: 37091493 PMCID: PMC10120600 DOI: 10.5334/ijic.6959] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction The ageing society requires physicians who can deliver integrated care, but it is unclear how they should be prepared for doing so. This scoping review aims to create an overview of educational programmes that prepare (future) physicians to deliver integrated care while addressing components and outcomes of the interventions. Method We included papers from five databases that contained: (1) integrated care (2) education programme (3) medical students (4) elderly, or synonyms. We divided the WHO definition of integrated care into ten components for the concept of 'integrated care'. Data were collected with a charting template, and template analysis was used to formulate themes. Results We found 17 educational programmes in different learning settings. All programmes addressed several components of the WHO definition. The programmes primarily focused on care for individual patients (micro-level), and the outcomes suggested that experiencing the complexity of care is key. Conclusion This review revealed the limited evidence on educational programmes about integrated care for the elderly. Our findings suggest that educational programmes on integrated care should not be limited to the micro-level, and that students should obtain adaptive expertise by experiencing complexity. Future research should contain an explicit description and definition of integrated care.
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Affiliation(s)
| | | | - S. M. (sietske) Grol
- Radboud University Medical Center, Corporate Staff Strategy Development, Nijmegen, the Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | | | - C. R. M. G. (Lia) Fluit
- Radboud University Medical Center, Radboudumc Health Academy, Research on Learning and Education, Nijmegen, the Netherlands
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17
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Matthie NS. The management of chronic pain in sickle cell disease: an interview with Nadine Matthie. Pain Manag 2023; 13:71-75. [PMID: 36718836 DOI: 10.2217/pmt-2022-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Nadine Matthie, PhD, RN, CNL is an Assistant Professor in the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, GA, USA. As a nurse scientist, she has conducted behavioral research to investigate pain and self-management in adults living with sickle cell disease, and address chronic, non vaso-occlusive pain in this population. Dr Matthie is developing non pharmacological, patient-centered, self-management strategies that incorporate virtual reality and biopsychosocial approaches to help manage chronic pain and reduce the burden of sickle cell; thereby, facilitating new, personalized approaches to management of chronic pain conditions in the home setting. Her research has been published in several national and international peer-reviewed sources for various disciplines, including nursing, medicine, music therapy and psychology.
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Affiliation(s)
- Nadine S Matthie
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
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18
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Hulbert ML, Manwani D, Meier ER, Alvarez OA, Brown RC, Callaghan MU, Campbell AD, Coates TD, Frei-Jones MJ, Hankins JS, Heeney MM, Hsu LL, Lebensburger JD, Quinn CT, Shah N, Smith-Whitley K, Thornburg C, Kanter J. Consensus definition of essential, optimal, and suggested components of a pediatric sickle cell disease center. Pediatr Blood Cancer 2023; 70:e29961. [PMID: 36094289 DOI: 10.1002/pbc.29961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 12/25/2022]
Abstract
Sickle cell disease (SCD) requires coordinated, specialized medical care for optimal outcomes. There are no United States (US) guidelines that define a pediatric comprehensive SCD program. We report a modified Delphi consensus-seeking process to determine essential, optimal, and suggested elements of a comprehensive pediatric SCD center. Nineteen pediatric SCD specialists participated from the US. Consensus was predefined as 2/3 agreement on each element's categorization. Twenty-six elements were considered essential (required for guideline-based SCD care), 10 were optimal (recommended but not required), and five were suggested. This work lays the foundation for a formal recognition process of pediatric comprehensive SCD centers.
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Affiliation(s)
- Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Deepa Manwani
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, New York, New York, USA
| | - Emily Riehm Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Ofelia A Alvarez
- Division of Pediatric Hematology/Oncology, University of Miami School of Medicine, Miami, Florida, USA
| | - R Clark Brown
- Division of Pediatric Hematology/Oncology, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael U Callaghan
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Andrew D Campbell
- Division of Pediatric Hematology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Thomas D Coates
- Cancer and Blood Disease Institute, Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Melissa J Frei-Jones
- Division of Pediatric Hematology/Oncology, University of Texas School of Medicine-San Antonio, San Antonio, Texas, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Matthew M Heeney
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis L Hsu
- Division of Pediatric Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles T Quinn
- Division of Pediatric Hematology/Oncology, Cincinnati Children's Hospital Medical Center and, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nirmish Shah
- Divisions of Pediatric Hematology Oncology and Hematology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kim Smith-Whitley
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Global Blood Therapeutics, San Francisco, California, USA
| | - Courtney Thornburg
- Division of Pediatric Hematology/Oncology, Rady Children's Hospital/Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Julie Kanter
- Division of Hematology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Nyatela A, Nqakala S, Singh L, Johnson T, Gumede S. Self-care can be an alternative to expand access to universal health care: What policy makers, governments and implementers can consider for South Africa. Front Reprod Health 2022; 4:1073246. [PMID: 36545492 PMCID: PMC9760858 DOI: 10.3389/frph.2022.1073246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
As a result of collaboration amongst the various decision-makers in the field of healthcare, there has been an improvement in the access to healthcare and living conditions globally. Nonetheless, poorer communities continue to benefit the least from public investment. To bridge the gap, self-care can be a viable alternative as it allows individuals and communities to reduce their dependence on government healthcare solutions. Barriers to self-care do exist. Some of these are cost effectiveness, usability of self-care instruments, differentiated strategies and linkage to care. In identifying these obstacles, it is also worthwhile to investigate how they can be mitigated. To encourage sustained self-care in the HIV continuum, contextual factors as well as the manner in which individuals and communities engage with self-care must be considered. In South Africa, multiple variables come into play: literacy levels, cultural influences, socio-economic conditions and access to resources are some of these. Evidence demonstrates how self-care can be promoted by various stakeholders re-strategising to tweak and in some cases totally change existing structures. This paper explores some of the transformations, like at a governmental level where the supply of HIV self-testing kits is increased, at a production level where instructions for use are reformatting, in communities where sports programmes fulfil the dual purpose of developing sport skills and providing HIV education concurrently, and at an individual level where greater awareness invites greater participation in self-care. While self-care is a promising proposal, it is not a replacement for traditional health-care practices, but a complementary approach.
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Affiliation(s)
- Athini Nyatela
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Correspondence: Athini Nyatela
| | - Sizwe Nqakala
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leanne Singh
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Taylor Johnson
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siphamandla Gumede
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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20
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Zappalà G, Crnić T, Tominz K, Ramseier CA. Students' opinions on tutor-supported comprehensive care training in clinical dental education. Swiss Dent J 2022; 132:838-847. [PMID: 36069698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Tutor-supported comprehensive care training at the University of Bern School of Dental Medicine (SDM) has been used for many years. Therefore, the aim of this study was to evaluate dental students' opinions on tutor-supported training to identify key aspects of future course organisation that are important for students to achieve the minimum requirements for their graduation. A digital survey was developed and distributed among all fourth- and fifth-year dental students enrolled in the SDM in 2014 and 2016. A total of 28 (41.2%) and 21 (36.2%) students participated in the survey in 2014 and 2016, respectively. The average age of all respondents was 25.8 (±4.0) years. The proportion of females was 75% with no differences between groups, neither among classes nor years of the survey. The students felt well prepared following the bachelor's degree pre-clinical programme and a two-week introduction immediately preceding the clinical course. During clinical training, the students' experiences with their assigned tutors were positive even though waiting times for tutors during patient care as well as organisational efforts to manage attestations and logbooks were mentioned. For each discipline, patient assignment (ρ=0.54, p<0.0001) and frequently meeting with their tutors (ρ=0.56, p<0.0001) revealed the highest correlation with 1) achieving minimum requirements and 2) improving treatment planning skills in both fourth- and fifth-year dental students. In conclusion, tutor-supported comprehensive care training is well accepted by dental students while focusing on both patient assignment and frequent discussions with tutors may help students to better achieve minimum requirements in clinical dental education.
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Affiliation(s)
- Graziano Zappalà
- Department of Periodontology, School of Dental Medicine, University of Bern, Switzerland
- These authors contributed equally to the manuscript
| | - Tin Crnić
- Independent researcher, Mainz, Germany
- These authors contributed equally to the manuscript
| | - Katarina Tominz
- Department of Periodontology, School of Dental Medicine, University of Bern, Switzerland
| | - Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Switzerland
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21
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Sridevi P, Sharma Y, Balakrishna SL, Babu BV. Sickle cell disease treatment and management in India: a systematic review of interventional studies. Trans R Soc Trop Med Hyg 2022; 116:1101-1111. [PMID: 36227060 DOI: 10.1093/trstmh/trac095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/14/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Sickle cell disease (SCD) affects approximately 5% of the world's population, and India has been the second highest country in the numbers of predicted SCD births. Despite the high burden in India, there is no state-led public health programme, and very few interventions dealing with the treatment and management of SCD are available. This review highlights the dearth of SCD-related interventions, and demonstrates that these interventions effectively improve patients' conditions and are feasible to implement in India. We systematically searched three databases-PubMed/Medline, Google Scholar and Web of Science-for articles from India on SCD-related interventions. The PRISMA guidelines were followed during this review. We included 22 studies, of which 19 dealt with specific therapeutic interventions, and 3 with comprehensive SCD care. Hydroxyurea therapy was the main therapy in 15 studies and is efficacious. Three studies demonstrated the feasibility of comprehensive care in resource-limited settings. The low number of SCD-related intervention studies does not match the huge burden of SCD in India. Governments of endemic countries should consider the findings of available interventions and include them in their countries' programmes. Comprehensive care is feasible in India and other low-resource settings, from screening to treatment and psychosocial support.
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Affiliation(s)
- Parikipandla Sridevi
- D epartment of Biot echnology, Indira Gandhi National Tribal University, Amarkantak, India
| | - Yogita Sharma
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
| | - Sunnam L Balakrishna
- D epartment of Biot echnology, Indira Gandhi National Tribal University, Amarkantak, India.,Department of Biochemistry & Molecular Biology, Central University of Kerala, Periye, India
| | - Bontha V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
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22
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Richardson EV, Fifolt M, Barstow EA, Motl RW. Models and materials for exercise promotion in comprehensive multiple sclerosis care: completion of the 'exercise in medicine' development process. Disabil Rehabil 2022; 44:7475-7483. [PMID: 34802341 DOI: 10.1080/09638288.2021.1998662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Health care providers have highlighted the need for tools and resources that support promotion of exercise behavior within comprehensive multiple sclerosis (MS) care. This study involved a final quality improvement evaluation of exercise promotion models and materials for inclusion within this setting. METHODS AND MATERIALS Our research team distributed a paper-based survey containing Likert scales, open answer questions, and copies of the models for editing. We distributed this survey among health care providers across the United States. We conducted a novel mixed-methods analysis evaluating quantitative, qualitative, and creative data. RESULTS We received completed surveys from 13 health care providers who strongly rated the clarity and applicability of the models and materials, and reported that no major improvements were necessary. The minor improvements were specific per comprehensive MS care center. The feedback indicated that the "Exercise in Medicine" models and materials are guides such that the processes should be integrated into real world practice by amending roles and responsibilities with the team members and structure per comprehensive MS care center. CONCLUSION This paper presents finalized models and materials for exercise promotion within comprehensive MS care that are ready to be tested for feasibility and efficacy in a clinical trial.IMPLICATIONS FOR REHABILITATIONHealth care providers require support to promote exercise within the context of comprehensive MS care.The practice models in this article provide guides regarding how to promote exercise in this context.Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers.These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique.
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Affiliation(s)
- Emma V Richardson
- School of Sport and Exercise Sciences, St John's Campus, Worcester University, Worcester, UK
| | - Matthew Fifolt
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Barstow
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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23
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Michel HK, Boyle B, David J, Donegan A, Drobnic B, Kren C, Maltz RM, McKillop HN, McNicol M, Oates M, Dotson JL. The Pediatric Inflammatory Bowel Disease Medical Home: A Proposed Model. Inflamm Bowel Dis 2022; 28:1420-1429. [PMID: 34562013 DOI: 10.1093/ibd/izab238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 12/09/2022]
Abstract
Care for patients with inflammatory bowel disease (IBD) can be complex and costly. Care delivery models to address these challenges and improve care quality are essential. The patient-centered medical home (PCMH), which was developed in the primary care setting, has recently been applied successfully to the adult IBD population. Following the tenets of the PCMH, this specialty medical home (SMH) emphasizes team-based care that is accessible, comprehensive, patient/family-centered, coordinated, compassionate, and continuous and has demonstrated improved patient outcomes. Children and young adults with IBD have equally complex care needs, with additional challenges not faced by the adult population such as growth, physical and psychosocial development, and transition of care from pediatric to adult providers. Thus, we advocate that the components of the PCMH are equally-if not more-important in caring for the pediatric patient population. In this article, we review what is known about the application of the PCMH model in adult IBD care, describe care delivery within the Center for Pediatric and Adolescent IBD at Nationwide Children's Hospital as an example of a pediatric IBD medical home, and propose a research agenda to further the development and dissemination of comprehensive care delivery for children and adolescents with IBD.
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Affiliation(s)
- Hilary K Michel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Brendan Boyle
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jennie David
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy Donegan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Barb Drobnic
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Courtney Kren
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ross M Maltz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA.,The Center for Microbial Pathogenesis, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hannah N McKillop
- Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA.,Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Megan McNicol
- Department of Pharmacy, Nationwide Children's Hospital, Columbus OH, USA
| | - Melanie Oates
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer L Dotson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA.,The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
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Abstract
BACKGROUND Spina bifida is a congenital neural tube defect that affects the spine and spinal cord, as well as the brain in many cases, with life-long health-related consequences. In most cases, the term spina bifida refers to open myelomeningocele but includes a spectrum of dysraphic conditions. Early recognition and comprehensive care improve long-term health, well-being, and quality of life and decrease the use of emergency services and hospitalizations over the lifespan. Current evidence-based care guidelines are comprehensive, but they are not easily interpreted in busy primary care settings. The development of a periodicity schedule serves to simplify the current spina bifida guidelines into a document that is easy to use by all practitioners and families.
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Affiliation(s)
- Jessica Y Chaney
- School of Nursing, Oregon Health & Science University, Portland, Oregon.,Institute of Developmental Disability, Oregon Health & Science University, Portland, Oregon
| | - Asma A Taha
- School of Nursing, Oregon Health & Science University, Portland, Oregon.,Institute of Developmental Disability, Oregon Health & Science University, Portland, Oregon
| | - Joseph D Pinter
- Institute of Developmental Disability, Oregon Health & Science University, Portland, Oregon.,School of Medicine, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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25
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Babalola O, Goudge J, Levin J, Brown C, Griffiths F. Assessing the Utility of a Quality-of-Care Assessment Tool Used in Assessing Comprehensive Care Services Provided by Community Health Workers in South Africa. Front Public Health 2022; 10:868252. [PMID: 35651863 PMCID: PMC9149253 DOI: 10.3389/fpubh.2022.868252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Few studies exist on the tools for assessing quality-of-care of community health worker (CHW) who provide comprehensive care, and for available tools, evidence on the utility is scanty. We aimed to assess the utility components of a previously-reported quality-of-care assessment tool developed for summative assessment in South Africa. Methods In two provinces, we used ratings by 21 CHWs and three team leaders in two primary health care facilities per province regarding whether the tool covered everything that happens during their household visits and whether they were happy to be assessed using the tool (acceptability and face validity), to derive agreement index (≥85%, otherwise the tool had to be revised). A panel of six experts quantitatively validated 11 items of the tool (content validity). Content validity index (CVI), of individual items (I-CVI) or entire scale (S-CVI), should be >80% (excellent). For the inter-rater reliability (IRR), we determined agreement between paired observers' assigned quality-of-care messages and communication scores during 18 CHW household visits (nine households per site). Bland and Altman plots and multilevel model analysis, for clustered data, were used to assess IRR. Results In all four CHW and team leader sites, agreement index was ≥85%, except for whether they were happy to be assessed using the tool, where it was <85% in one facility. The I-CVI of the 11 items in the tool ranged between 0.83 and 1.00. For the S-CVI, all six experts agreed on relevancy (universal agreement) in eight of 11 items (0.72) whereas the average of I-CVIs, was 0.95. The Bland-Altman plot limit of agreements between paired observes were −0.18 to 0.44 and −0.30 to 0.44 (messages score); and −0.22 to 0.45 and −0.28 to 0.40 (communication score). Multilevel modeling revealed an estimated reliability of 0.77 (messages score) and 0.14 (communication score). Conclusion The quality-of-care assessment tool has a high face and content validity. IRR was substantial for quality-of-care messages but not for communication score. This suggests that the tool may only be useful in the formative assessment of CHWs. Such assessment can provide the basis for reflection and discussion on CHW performance and lead to change.
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Affiliation(s)
- Olukemi Babalola
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Levin
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celia Brown
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, United Kingdom
| | - Frances Griffiths
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, United Kingdom
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26
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Zerden LD, Guan T, Shurer J, Kreitzer L, Book E. Social work, Parkinson's disease care, and COVID-19. Soc Work Health Care 2022; 61:139-157. [PMID: 35481456 DOI: 10.1080/00981389.2022.2069902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2023]
Abstract
Parkinson's Disease is a neurological disease affecting over 10 million people worldwide. Interdisciplinary teams provide integrated care to people with Parkinson's Disease, including care for non-motor symptoms such as anxiety and depression, and many of these teams include social workers. This study sought to learn more about (a) clinical social work utilization across the continuum of care of PWP and their family care partners and (b) how patterns in utilization and service provision have shifted during the pandemic. This mixed method study identifies the breadth of roles performed by social workers in the comprehensive care of people with Parkinson's Disease (PWP). Findings underscore the important roles social workers play in providing comprehensive care for PWP and their families and their contributions to interdisciplinary teams providing holistic, integrated care, particularly during COVID-19 and into the future.
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Affiliation(s)
- Lisa D Zerden
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ting Guan
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- University of Syracuse, Falk College, Syracuse, NY, USA
| | - Jessica Shurer
- Parkinson's Foundation Center of Excellence, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda Kreitzer
- Faculty of Social Work, University of Calgary, Edmonton, Alberta, Canada
| | - Elaine Book
- Parkinson's Foundation Center of Excellence, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Thaker P, Colah RB, Patel J, Raicha B, Mistry A, Mehta V, Italia Y, Desai S, Dave K, Shanmugam R, Ghosh K, Mukherjee MB. Newborn Screening for Sickle Cell Disease Among Tribal Populations in the States of Gujarat and Madhya Pradesh in India: Evaluation and Outcome Over 6 Years. Front Med (Lausanne) 2022; 8:731884. [PMID: 35242766 PMCID: PMC8885810 DOI: 10.3389/fmed.2021.731884] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Sickle cell disease (SCD) poses considerable public health problems in India. This study was undertaken to understand the clinical course of SCD among children identified during newborn screening programmes in Gujarat and Madhya Pradesh where the frequency of the HbS gene is high. A total of 8,916 newborn babies 8,411 from Gujarat and 505 from Madhya Pradesh were screened over 6 years (2010–2016) using HPLC and the diagnosis was confirmed by molecular analysis in a subset. A total of 128 babies (122 Gujarat, 6 Madhya Pradesh) were identified with sickle cell disease, of whom 87 (69 HbSS, 18 HbS-β thalassemia) from Gujarat were followed for 0.5–6.6 years. Acute painful events, severe anemia and fever with infections were the major complications and 23 babies required hospitalization. Severe to moderate clinical presentation was found in 13.8% babies with SCD whereas, 86.2% babies had a milder presentation. Presence of ameliorating factors (α-thalassemia and Xmn 1 polymorphism) did not have a discernible effect on the clinical severity. Parents of babies with SCD were educated and counseled for home care. Distribution of mobile phones to 44 families having babies with SCD was beneficial as it allowed regular contact with patients and their families. Genetic counseling to the affected families has increased the awareness and acceptance for prenatal diagnosis and 18 couples opted for prenatal diagnosis in subsequent pregnancies. SCD is not always mild among tribal groups in India. Therefore, facilities for early diagnosis and prophylactic treatment in the tertiary care centers should be made available. The difficulties in regular follow up of the babies in remote rural areas have also been highlighted.
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Affiliation(s)
- Pallavi Thaker
- Department of Haematogenetics, Indian Council of Medical Research (ICMR)-National Institute of Immunohaematology, Mumbai, India
| | - Roshan B Colah
- Department of Haematogenetics, Indian Council of Medical Research (ICMR)-National Institute of Immunohaematology, Mumbai, India
| | | | | | | | | | | | - Shrey Desai
- Society for Education Welfare and Action (SEWA) Rural Kendra, Jhagadia, India
| | - Kapilkumar Dave
- Society for Education Welfare and Action (SEWA) Rural Kendra, Jhagadia, India
| | - Rajasubramaniam Shanmugam
- Department of Genetic Disorders, Indian Council of Medical Research (ICMR)-National Institute for Research in Tribal Health, Jabalpur, India
| | - Kanjaksha Ghosh
- Department of Haematogenetics, Indian Council of Medical Research (ICMR)-National Institute of Immunohaematology, Mumbai, India
| | - Malay B Mukherjee
- Department of Haematogenetics, Indian Council of Medical Research (ICMR)-National Institute of Immunohaematology, Mumbai, India
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28
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Enin K, Parikh A, Kallogjeri D, Naunheim MR, Huston MN. Correlation Between a Diagnosis of Anxiety or Depression and Initial VHI-10 Scores in Benign Dysphonia. Otolaryngol Head Neck Surg 2022; 167:725-730. [PMID: 35104179 DOI: 10.1177/01945998221074994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Anxiety and depression have demonstrated a positive correlation with vocal handicap among patients with benign causes of dysphonia. Our objective is to explore differences in initial Vocal Handicap Index-10 (VHI-10) scores between patients with a mental health history of anxiety or depression and those without. STUDY DESIGN Retrospective cohort study. SETTING Demographic data, diagnoses, and initial VHI-10 scores were collected for patients presenting with dysphonia to 2 tertiary laryngology clinics. METHODS A Kruskal-Wallis test and subsequent Mann-Whitney U test for pairwise comparisons were used to compare distribution of VHI-10 scores among patients with anxiety, depression, anxiety and depression, and no such conditions. Bonferroni correction was used to control for multiple comparisons. Robust regression was used for multivariable analysis. RESULTS A total of 620 cases of benign dysphonia were analyzed. Forty-two percent of the patient cohort had a preexisting diagnosis of anxiety (n = 121, 20%), depression (n = 64, 10%), or anxiety and depression (n = 74, 12%). VHI-10 scores were higher in patients with depression than in those without anxiety or depression (median difference, 4 [95% CI, 1-8]; P = .005) but did not differ significantly among the other groups. The effects of depression and anxiety status on initial VHI-10 scores among the causes of benign dysphonia varied. CONCLUSIONS Patients with a history of depression who presented with dysphonia had worse vocal handicap than those without anxiety/depression history. Future studies may clarify how optimization of anxiety and depression can affect patient-reported vocal handicap.
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Affiliation(s)
- Kwasi Enin
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ayush Parikh
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Ilori T, Awoonidanla KT, Adetunji AA. The contribution of family physicians to primary health care: Experiences from southwest Nigeria. Afr J Prim Health Care Fam Med 2021; 13:e1-e3. [PMID: 34931520 PMCID: PMC8689366 DOI: 10.4102/phcfm.v13i1.3218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022] Open
Abstract
Although an emerging speciality in Africa, family medicine contributes significantly to African health systems. Leadership from family physicians can enable the delivery of high-quality primary health care that is accessible, comprehensive, coordinated, continuous and person-centred. This short report chronicles how family physicians from a university teaching hospital in Ibadan, Nigeria, adopted a health post located in a home for persons with mild physical and mental disabilities and changed it into a hub of comprehensive, holistic and person-centred care for residents and staff of the home, as well as individuals and families in the neighbouring communities and its environs. The Department of Family Medicine of the University College Hospital, Ibadan, with the aid of a benefactor, reorganised a modest health facility to include the services of family medicine senior registrars (undergoing training-related rotations) with supervision by consultant family physicians. Family physicians led the primary health care team that provided both facility-based care and community outreach services. This report demonstrates how family physicians can improve the quality of primary health care and outcomes such as health equity in the community served.
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Affiliation(s)
- Temitope Ilori
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria; and, Department of Family Medicine, University College Hospital, Ibadan.
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30
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Schmalstieg-Bahr K, Popert UW, Scherer M. The Role of General Practice in Complex Health Care Systems. Front Med (Lausanne) 2021; 8:680695. [PMID: 34901044 PMCID: PMC8655229 DOI: 10.3389/fmed.2021.680695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
According to the WHO, in a complex system, "there are so many interacting parts that it is difficult (…), to predict the behavior of the system based on knowledge of its component parts. "In countries without general practitioner (GP)-gatekeeping, the number of possible interactions and therefore the complexity increases. Patients may consult any doctor without contacting their GP. Family medicine core values, e.g., comprehensive care, and core tasks, e.g., care coordination, might be harder to implement and maintain. How are GPs perceived and how do they perceive themselves if no GP-gatekeeping exists? Does the absence of any GP-gatekeeping influence family medicine core values? A PubMed and Cochrane search was performed. The results are summarized in form of a narrative review. Four perspectives regarding the GP's role were identified. The GPs' self-perception regarding family medicine core values and tasks is independent of their function as gatekeepers, but they appreciate this role. Patient satisfaction is also independent of the health care system. Depending on the acquisition of income, specialists have different opinions of GP-gatekeeping. Policymakers want GPs to play a central role within the health care system, but do not commit to full gatekeeping. The GPs and policymakers emphasize the importance of family medicine specialty training. Further international studies are needed to determine if family medicine core values and tasks can be better accomplished by GP-gatekeeping. Specialty training should be mandatory in all countries to enable GPs to fulfill these values and tasks and to act as coordinators and/or gatekeepers.
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Affiliation(s)
| | - Uwe Wolfgang Popert
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Eppendorf, Hamburg, Germany
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31
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López-Tarrida ÁDC, de Diego-Cordero R, Lima-Rodríguez JS. Spirituality in a Doctor's Practice: What Are the Issues? J Clin Med 2021; 10:5612. [PMID: 34884314 DOI: 10.3390/jcm10235612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: It is becoming increasingly important to address the spiritual dimension in the integral care of the people in order to adequately assist them in the processes of their illness and healing. Considering the spiritual dimension has an ethical basis because it attends to the values and spiritual needs of the person in clinical decision-making, as well as helping them cope with their illness. Doctors, although sensitive to this fact, approach spiritual care in clinical practice with little rigour due to certain facts, factors, and boundaries that are assessed in this review. Objective: To find out how doctors approach the spiritual dimension, describing its characteristics, the factors that influence it, and the limitations they encounter. Methodology: We conducted a review of the scientific literature to date in the PubMed, Scopus, and CINAHL databases of randomised and non-randomised controlled trials, observational studies, and qualitative studies written in Spanish, English, and Portuguese on the spiritual approach adopted by doctors in clinical practice. This review consisted of several phases: (i) the exclusion of duplicate records; (ii) the reading of titles and abstracts; (iii) the assessment of full articles and their methodological quality using the guidelines of the international Equator Network. Results: A total of 1414 publications were identified in the search, 373 of which were excluded for being off-topic or repeated in databases. Of the remaining 1041, 962 were excluded because they did not meet the inclusion criteria. After initial screening, 79 articles were selected, from which 17 were collected after reading the full text. A total of 8 studies were eligible for inclusion. There were three qualitative studies and five cross-sectional observational studies with sufficient methodological quality. The results showed the perspectives and principal characteristics identified by doctors in their approach to the spiritual dimension, with lack of training, a lack of time, and fear in addressing this dimension in the clinic the main findings. Conclusions: Although more and more scientific research is demonstrating the benefits of spiritual care in clinical practice and physicians are aware of it, efforts are needed to achieve true holistic care in which specific training in spiritual care plays a key role.
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32
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Cheng SL, Li YR, Huang N, Yu CJ, Wang HC, Lin MC, Chiu KC, Hsu WH, Chen CZ, Sheu CC, Perng DW, Lin SH, Yang TM, Lin CB, Kor CT, Lin CH. Effectiveness of Nationwide COPD Pay-for-Performance Program on COPD Exacerbations in Taiwan. Int J Chron Obstruct Pulmon Dis 2021; 16:2869-2881. [PMID: 34703221 PMCID: PMC8539057 DOI: 10.2147/copd.s329454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It has also imposed a substantial economic and social burden on the health care system. In Taiwan, a nationwide COPD pay-for-performance (P4P) program was designed to improve the quality of COPD-related care by introducing financial incentives for health care providers and employing a multidisciplinary team to deliver guideline-based, integrated care for patients with COPD, reducing adverse outcomes, especially COPD exacerbation. However, the results of a survey of the effectiveness of the pay-for-performance program in COPD management were inconclusive. To address this knowledge gap, this study evaluated the effectiveness of the COPD P4P program in Taiwan. Methods This retrospective cohort study used data from Taiwan’s National Health Insurance claims database and nationwide COPD P4P enrollment program records from June 2016 to December 2018. Patients with COPD were classified into P4P and non-P4P groups. Patients in the P4P group were matched at a ratio of 1:1 based on age, gender, region, accreditation level, Charlson Comorbidity Index (CCI), and inhaled medication prescription type to create the non-P4P group. A difference-in-difference analysis was used to evaluate the influence of the P4P program on the likelihood of COPD exacerbation, namely COPD-related emergency department (ED) visit, intensive care unit (ICU) admission, or hospitalization. Results The final sample of 14,288 patients comprised 7144 in each of the P4P and non-P4P groups. The prevalence of COPD-related ED visits, ICU admissions, and hospitalizations was higher in the P4P group than in the non-P4P group 1 year before enrollment. After enrollment, the P4P group exhibited a greater decrease in the prevalence of COPD-related ED visits and hospitalizations than the non-P4P group (ED visit: −2.98%, p<0.05, 95% confidence interval [CI]: −0.277 to −0.086; hospitalization: −1.62%, p<0.05, 95% CI: −0.232 to −0.020), whereas no significant difference was observed between the groups in terms of the changes in the prevalence of COPD-related ICU admissions. Conclusion The COPD P4P program exerted a positive net effect on reducing the likelihood of COPD exacerbation, namely COPD-related ED visits and hospitalizations. Future studies should examine the long-term cost-effectiveness of the COPD P4P program.
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Affiliation(s)
- Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 220, Taiwan.,Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli, Taoyuan, 320, Taiwan
| | - Yi-Rong Li
- Changhua Christian Hospital, Thoracic Medicine Research Center, Changhua, 500, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan
| | - Kuo-Chin Chiu
- Division of Chest, Department of Internal Medicine, Poh-Ai Hospital, Luodong, 265, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chiung-Zuei Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, 701, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Sheng-Hao Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, 613, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Ching-Hsiung Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan.,Department of Recreation and Holistic Wellness, MingDao University, Changhua, 523, Taiwan
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Timmer MA, Blokzijl J, Schutgens REG, Veenhof C, Pisters MF. Coordinating physiotherapy care for persons with haemophilia. Haemophilia 2021; 27:1051-1061. [PMID: 34492151 PMCID: PMC9292005 DOI: 10.1111/hae.14404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 01/12/2023]
Abstract
Introduction Physiotherapy is highly recommended for persons with haemophilia (PWH), to regain functioning after bleeding and to maintain functioning when dealing with haemophilic arthropathy. However, many PWH live too far from their Haemophilia Comprehensive Care Centre (HCCC) to receive regular treatment at their HCCC. Physiotherapists in primary care may have limited experience with a rare disease like haemophilia. Aim To explore experiences of stakeholders with primary care physiotherapy for PWH and develop recommendations to optimize physiotherapy care coordination. Methods A RAND approach was used, consisting of a Delphi procedure with e‐mailed questionnaires and a consensus meeting. Included stakeholders were PWH, physiotherapists from HCCC's and primary care physiotherapists. HCCC physiotherapists approached patients from their centre and primary care physiotherapists from their network to fill in the questionnaires. Purposive sampling was used to select participants from the survey sample for the consensus meeting. Results Ninety‐six primary care physiotherapists, 54 PWH and eight HCCC physiotherapists completed the questionnaire. Subsequently, four PWH, three primary care physiotherapists and four HCCC physiotherapists participated in the consensus meeting. The questionnaires yielded 33 recommendations, merged into a final list of 20 recommendations based on the consensus meeting. The final rank‐order consists of 13 recommendations prioritized by at least one stakeholder. Conclusion Commitment to a formal network is considered not feasible for a rare disease like haemophilia. Development of a practice guideline, easy‐accessible information and contact details, two‐way and open communication between HCCC and primary care and criteria to refer back to the HCCC are recommended.
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Affiliation(s)
- Merel A Timmer
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht University, The Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, UMC Utrecht Brain Centre, Utrecht University, The Netherlands
| | - Johan Blokzijl
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht University, The Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, UMC Utrecht Brain Centre, Utrecht University, The Netherlands
| | - Roger E G Schutgens
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, UMC Utrecht Brain Centre, Utrecht University, The Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, The Netherlands
| | - Martijn F Pisters
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centres, The Netherlands
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Pan Y, Ni L, Fang S, Zhang J, Fan W, Shen F. Effect of comprehensive care on the negative emotions and life quality in parturients with postpartum depression and gestational hypertension. Am J Transl Res 2021; 13:7228-7234. [PMID: 34306486 PMCID: PMC8290703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the efficacy of comprehensive care during the nursing process of parturients with gestational hypertension and postpartum depression. METHODS This prospective study recruited 70 patients with gestational hypertension concurrent with postpartum depression, and the patients were randomly divided into a control group (35 patients received routine care) and an observation group (35 patients, treated by comprehensive care). Indicators including psychological condition, life quality, thyroid function, the incidence of eclampsia, and nursing satisfaction were recorded and compared before intervention (at the diagnosis of postpartum depression) and after intervention (three months after delivery) in the two groups. RESULTS The Hamilton Anxiety (HAMA) Scale and Hamilton Depression (HAMD) Scale scores were decreased in both groups after care intervention. Scores of Quality of Life Comprehensive Assessment Questionnaire (GQOLI-74) in all dimensions were higher after intervention than those of before intervention, and improvement was greater in the observation group (P<0.05). The levels of thyroid-stimulating hormone, free triiodothyronine and free thyroxine after the intervention were higher than those before the intervention in the two groups, and the increase in the observation group was greater significant than that in the control group (P<0.05). The incidence of postpartum eclampsia in the observation group was lower than that of the control group, and the nursing satisfaction of patients in the observation group was higher than that of the control group (both P<0.05). CONCLUSION Comprehensive care effectively relieved the abnormal psychological condition, promoted thyroid function, reduced the risk of postpartum eclampsia and improved the quality of life in patients with gestational hypertension and postpartum depression.
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Affiliation(s)
- Yuanzhen Pan
- The Postpartum Care Center, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of MedicineSuzhou 215028, Jiangsu Province, China
| | - Liping Ni
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow UniversitySuzhou, Jiangsu Province, China
| | - Suimei Fang
- The Postpartum Care Center, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of MedicineSuzhou 215028, Jiangsu Province, China
| | - Jie Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow UniversitySuzhou, Jiangsu Province, China
| | - Wen Fan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow UniversitySuzhou, Jiangsu Province, China
| | - Fangrong Shen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow UniversitySuzhou, Jiangsu Province, China
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Ohta R, Ueno A, Kitayuguchi J, Moriwaki Y, Otani J, Sano C. Comprehensive Care through Family Medicine: Improving the Sustainability of Aging Societies. Geriatrics (Basel) 2021; 6:geriatrics6020059. [PMID: 34199871 PMCID: PMC8293036 DOI: 10.3390/geriatrics6020059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Comprehensive care through family medicine can enhance the approach to multimorbidity, interprofessional collaboration, and community care, and make medical care more sustainable for older people. This study investigated the effect of implementing family medicine and the comprehensiveness of medical care in one of the most rural communities. This implementation research used medical care data from April 2015 to March 2020. Patients' diagnoses were categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10). In 2016, family medicine was implemented in only one general hospital in Unnan. The comprehensiveness rate improved in all ICD-10 disease categories during the study period, especially in the following categories-infections; neoplasms; endocrine, nutritional, and metabolic diseases; mental disorders; nervous system; circulatory system; respiratory system; digestive system; skin and subcutaneous tissue; musculoskeletal system and connective tissue; and the genitourinary system. Implementing family medicine in rural Japanese communities can improve the comprehensiveness of medical care and resolve the issue of fragmentation of care by improving interprofessional collaboration and community care. It can be a solution for the aging of both patient and healthcare professionals. Future research can investigate the relationship between family medicine and patient health outcomes for improved healthcare sustainability.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, Unnan 699-1221, Shimane, Japan; (Y.M.); (J.O.)
- Correspondence: ; Tel.: +81-90-5060-5330
| | - Akinori Ueno
- Unnan Public Health Center, Unnan 699-1311, Shimane, Japan;
| | - Jun Kitayuguchi
- Physical Education and Medicine Research Center Unnan, Unnan 699-1105, Shimane, Japan;
| | - Yoshihiro Moriwaki
- Community Care, Unnan City Hospital, Unnan 699-1221, Shimane, Japan; (Y.M.); (J.O.)
| | - Jun Otani
- Community Care, Unnan City Hospital, Unnan 699-1221, Shimane, Japan; (Y.M.); (J.O.)
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan;
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Lawson HJO, Nortey DNN. Core Values of Family Physicians and General Practitioners in the African Context. Front Med (Lausanne) 2021; 8:667144. [PMID: 34136504 PMCID: PMC8200572 DOI: 10.3389/fmed.2021.667144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/05/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction: Family Medicine is a growing specialty in the medical world. While it is expected that the specialty should have its own unique and established core values and tasks, the breath of the practice in several countries of the world has made this a daunting task. Core values and Tasks have far reaching effects on professions. They guide development of curricula, methods of instruction, standards of performance and even the culture of the profession. We aimed to explore the core value system of Family Physicians and General Practitioners practicing in Africa. Methods: Using the Delphi technique, a purposive selection of African Family Medicine practitioners in academia, public service, private practice and clinical training across Central, East, North, South and West Africa was conducted. Participants were asked to select five core values from an alphabetically collated global list of 29 core values in an online survey. The five most selected core values were collated and sent out in the second round to the participants to rank in order of importance. Results: Practitioners from nine African countries in three out of the five United Nations subregions of Africa completed the study. The first round of the study saw participation of a team of nineteen experts who selected the following five core values-Comprehensive care, Continuity of Care, Collaborative Care, Patient centered care, and Life-long learning. Discussion/Conclusion: The core values selected were not very different from global literature. These core values should guide the development of curricula, standardization of training methods and creation of benchmarks for standards of practice for the specialty in Africa.
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Affiliation(s)
- Henry J O Lawson
- Department of Community Health, University of Ghana, Accra, Ghana
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Kubielas G. Project of the Health Policy Program: Access to Vessels in Renal Replacement Therapy - Fistula First/Catheter Last. Pol Przegl Chir 2021; 92:1-8. [PMID: 32759399 DOI: 10.5604/01.3001.0013.7956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The number of patients with end-stage renal failure (ESRF) that require inclusion in the renal replacement therapy program (RRT) is steadily increasing. This fact caused an increase in vascular operations involving the production of vascular access. According to the current guidelines, the best and safest option for a patient with chronic kidney disease (CKD) is the early creation of arteriovenous fistula (AVF). An efficient vascular access to haemodialysis determines the procedure and directly affects the quality of life of a patient with CKD. AIM The aim of this paper is to present the author's project of the health policy program "Vascular access in renal replacement therapy - fistula first/catheter last", the essence of which is to assess the practical effectiveness and develop an optimal model of CKD patient care organization qualified for the chronic RRT program. MATERIAL AND METHODS The target population of the program consists of all patients diagnosed with CKD, qualified for the RRT program. The basic measures of the program's effectiveness include: (1) reduction in the number of re-hospitalizations related to vascular access, (2) reduction in the number of complications associated with haemofiltration surgery, (3) reduction in general mortality among patients undergoing dialysis in a 12-month perspective, (4) increasing knowledge in the field of self-care and self-care of arteriovenous anastomosis, and (5) creating a register of vascular access in Poland. CONCLUSIONS To sum up, health policy programme "Vascular access in renal replacement therapy - fistula first/catheter last" covering health care services provided in the scope and on the conditions specified in the regulations issued on the basis of article 31d of the Act of 27 August 2004 on health care benefits financed from public funds, is to check whether planned changes in the organization and delivery of services will improve the situation of patients with CKD eligible for chronic RRT and whether it will be effective the point of view of the health care system.
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Affiliation(s)
- Grzegorz Kubielas
- Narodowy Fundusz Zdrowia, Centrala w Warszawie, Departament Świadczeń Opieki Zdrowotnej, WarszawaUniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Katedra Pielęgniarstwa Klinicznego, Wrocław
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Park SE. Ten-year follow-up of patient-centered comprehensive care using case completion curriculum. J Dent Educ 2021; 85:1408-1414. [PMID: 33794004 DOI: 10.1002/jdd.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/17/2021] [Accepted: 03/20/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the patient-based comprehensive model in the student teaching practice at Harvard School of Dental Medicine (HSDM) as a result of the case completion curriculum. The patient-centered assessment system was implemented in 2009 as a clinical reform in clinical education to redirect predoctoral clinical learning from a student requirement-driven assessment system to a patient-centered treatment delivery model. METHODS The sample for the 10-year retrospective cohort study consisted of the graduating classes of 2010 through 2019 at HSDM and all data regarding case completion and student feedback were obtained from the Office of Dental Education. RESULTS The average number of completed cases by the predoctoral graduating class has risen from 22.8 in 2010 to 33.26 in 2019, and as a result, the number of completed cases required for graduation has been adjusted twice, from 15 to 20 in 2012, and from 20 to 25 including two pediatric cases in 2018. CONCLUSION The redesigned clinical component of the curriculum can contribute to improved efforts in providing a patient-based comprehensive care environment and in helping broaden student learning experience in the predoctoral dental education program.
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Affiliation(s)
- Sang E Park
- Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
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Sheshadri V, Shabeer P, Santhirapala V, Jayaram A, Krishnamurti L, Menon N. Mortality in sickle cell disease: A population-based study in an aboriginal community in the Gudalur Valley, Nilgiris, Tamil Nadu, India. Pediatr Blood Cancer 2021; 68:e28875. [PMID: 33381914 DOI: 10.1002/pbc.28875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sickle cell disease (SCD), the most common monogenic disorder, affects more than 300 000 births annually, with 44 000 in India. Although the clinical phenotype of SCD is considered to be milder in aboriginal populations in India, there is a paucity of data on outcomes. To determine the severity of SCD in this population, we studied mortality rates and causes of mortality in a longitudinal cohort of patients with SCD in a remote aboriginal community in India receiving community-based comprehensive care. PROCEDURES Causes of death were analyzed in this cohort from January 2008 to December 2018. Details were collected from hospital records and in case of deaths at home by utilizing the WHO verbal autopsy questionnaire. RESULTS The cohort consisted of 157 patients belonging to the Paniya, Betta Kurumba, Kattunyakan, and Mullu Kurumba tribes. During the study period, there were 22 deaths, all from the Paniya tribe. Twelve deaths (54.5%) occurred in the hospital and the remaining at home (45.5%), reflecting a crude mortality rate of 140 per 1000 population. Twenty-five percent of deaths occurred in the 6-18 age group. There were no deaths in the 0-5 age group. The median age of death was 25 years, which was 30 years less than in the non-SCD aboriginal population. The leading causes of death were acute chest syndrome, anemia, and sepsis among the SCD patients and stroke and suicides in the non-SCD aboriginal population. CONCLUSION SCD is a severe disease among the Gudalur Valley's aboriginal population with a significant risk of premature mortality.
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Affiliation(s)
- Veena Sheshadri
- ASHWINI Gudalur Adivasi Hospital, Gudalur, Tamil Nadu, India
| | | | - Vatshalan Santhirapala
- Program in Global Surgery and Social Change, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
| | - Anusha Jayaram
- Program in Global Surgery and Social Change, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nandakumar Menon
- ASHWINI Gudalur Adivasi Hospital, and Sickle Disease Centre, Gudalur, Tamil Nadu, India
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Frota AX, Vieira MC, Soares CCS, da Silva PS, da Silva GMS, Mendes FDSNS, Mazzoli-Rocha F, Veloso HH, da Costa AD, Lamas CDC, Valete-Rosalino CM, Gonçalves TR, Costa HS, Rodrigues LF, Mediano MFF. Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges. Rev Soc Bras Med Trop 2021; 54:e07892020. [PMID: 33533821 PMCID: PMC7849325 DOI: 10.1590/0037-8682-0789-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022] Open
Abstract
Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.
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Affiliation(s)
- Aline Xavier Frota
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Marcelo Carvalho Vieira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | - Paula Simplício da Silva
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | | | - Flavia Mazzoli-Rocha
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Henrique Horta Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Ananda Dutra da Costa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Cristiane da Cruz Lamas
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
- Instituto Nacional de Cardiologia, Departamento de Pesquisa e Educação, Rio de Janeiro, RJ, Brasil
| | - Claudia Maria Valete-Rosalino
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de Janeiro, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brasil
- Conselho Nacional de Desenvolvimento Científico e Tecnológico, Programa de Produtividade em Pesquisa, Brasília, DF, Brasil
| | - Tatiana Rehder Gonçalves
- Universidade Federal do Rio de Janeiro, Instituto de Medicina Social, Rio de Janeiro, RJ, Brasil
| | - Henrique Silveira Costa
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Luiz Fernando Rodrigues
- Instituto Nacional de Cardiologia, Departamento de Pesquisa e Educação, Rio de Janeiro, RJ, Brasil
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Ciências Fisiológicas, Rio de Janeiro, RJ, Brasil
| | - Mauro Felippe Felix Mediano
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
- Instituto Nacional de Cardiologia, Departamento de Pesquisa e Educação, Rio de Janeiro, RJ, Brasil
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Abstract
Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients' quality of life.
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Affiliation(s)
- Deborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France.,Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy Institute, Lyon, France
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Collette N, Güell E, Fariñas O, Pascual A. Art Therapy in a Palliative Care Unit: Symptom Relief and Perceived Helpfulness in Patients and Their Relatives. J Pain Symptom Manage 2021; 61:103-111. [PMID: 32739559 DOI: 10.1016/j.jpainsymman.2020.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
CONTEXT Creative arts therapies aim to expand conventional palliative care interventions by making clinical care more holistic. OBJECTIVES The objective of the present study was to evaluate the benefits of an art therapy intervention in a tertiary hospital palliative care unit, directly in adult cancer inpatients and indirectly in their relatives. METHODS We evaluated the intensity of pain, anxiety, depression, and well-being using the Edmonton Symptom Assessment Scale before and after the first, third, and fifth art therapy sessions. After the third and fifth sessions, perceived helpfulness was assessed via a questionnaire developed by the palliative care team, combining open-ended questions and a checklist. We categorized the narrative data into three predetermined types: generally helpful (some positive experience), helpfulness related to a dyadic relationship (patient-art therapist), and helpfulness related to a triadic relationship (patient-image-art therapist). RESULTS We observed a significant reduction in anxiety, depression, and pain as well as a significant increase in well-being at each of the time points evaluated. Ninety-eight percent of the patients considered the art therapy helpful, which could be categorized as generally helpful in 54.8%, related to a triadic relationship in 32.9%, and to a dyadic relationship in 12.3%. Relatives gave similar opinions regarding the effects on patients and, in addition, reported an indirect helpful effect for themselves. The most frequently selected experiences from the checklist were feeling calm, being entertained, and expressing and communicating emotions. CONCLUSION This art therapy intervention was beneficial in reducing symptom intensity. Almost all the participants directly or indirectly involved in the creative art process considered it helpful. They reported a wide variety of sensory, emotional, cognitive, and spiritual experiences.
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Affiliation(s)
- Nadia Collette
- Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Unidad de Cuidados Paliativos, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ernest Güell
- Unidad de Cuidados Paliativos, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Fariñas
- Unidad de Cuidados Paliativos, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Pascual
- Unidad de Cuidados Paliativos, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Tellez M, Meraner M, Lim S, Brandon R, Ismail A. An innovative approach to assess comprehensive care: Temple University's patient wellness report. J Dent Educ 2020; 85:652-659. [PMID: 33368251 DOI: 10.1002/jdd.12521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/12/2002] [Accepted: 12/01/2002] [Indexed: 11/11/2022]
Abstract
PURPOSE The transition from a paper-based to an all-electronic patient health record took a major step forward in 2018, with the implementation of an electronic health record that supports the School's patient-centered comprehensive care model and facilitates outcomes assessment. The Patient Wellness Report (PWR) summarizes findings of the patient assessment, and it does so automatically by locating data already entered in axiUm forms. This study aimed to describe the PWR implementation procedures and to examine outcomes and characteristics among patients with completed treatment plans during an 18-month period. METHODS Outcome data were extracted from axiUm for patients aged ≥16 years who completed comprehensive care treatment plans. Each PWR contained 14 metrics related to "dimensions" of wellness (quality of life, general health factors, oral hygiene, caries risk, and degree of periodontal inflammation and pocketing), each of which is rated on a 3-point scale based on best available scientific evidence. RESULTS A total of 2074 patients completed planned procedures between July 2018 and January 2020, and met the study eligibility criteria. Improvement of several conditions was observed between baseline and follow-up in caries lesions (21%), blood pressure (9%), and periodontal pocket (3.2%). A majority of patients rated in good condition at baseline had their scores unchanged at follow-up in the following areas: dental anxiety (92%), speaking (88%), smoking (87%), and alcohol consumption (79%). CONCLUSION Improvements in dental caries and blood pressure metrics were easily monitored using the PWR. In addition, disparities exist in improvement of patient outcomes by race/ethnicity.
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Affiliation(s)
- Marisol Tellez
- Department of Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Mark Meraner
- Department of Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Sungwoo Lim
- Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Ryan Brandon
- Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Amid Ismail
- Department of Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
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44
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Somé NH, Devlin RA, Mehta N, Zaric GS, Sarma S. Stirring the pot: Switching from blended fee-for-service to blended capitation models of physician remuneration. Health Econ 2020; 29:1435-1455. [PMID: 32812685 DOI: 10.1002/hec.4145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 05/25/2023]
Abstract
In Canada's most populous province, Ontario, family physicians may choose between the blended fee-for-service (Family Health Group [FHG]) and blended capitation (Family Health Organization [FHO] payment models). Both models incentivize physicians to provide after-hours (AH) and comprehensive care, but FHO physicians receive a capitation payment per enrolled patient adjusted for age and sex, plus a reduced fee-for-service while FHG physicians are paid by fee-for-service. We develop a theoretical model of physician labor supply with multitasking to predict their behavior under FHG and FHO, and estimable equations are derived to test the predictions empirically. Using health administrative data from 2006 to 2014 and a two-stage estimation strategy, we study the impact of switching from FHG to FHO on the production of a capitated basket of services, after-hours services and nonincentivized services. Our results reveal that switching from the FHG to FHO reduces the production of capitated services to enrolled patients and services to nonenrolled patients by 15% and 5% per annum and increases the production of after-hours and nonincentivized services by 8% and 15% per annum.
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Affiliation(s)
- Nibene H Somé
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nirav Mehta
- Department of Economics, University of Western Ontario, London, Ontario, Canada
| | - Gregory S Zaric
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada
- Ivey School of Business, University of Western Ontario, London, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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45
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Agou SH, Imam AY. Development of a novel integrated educational relative-unit value system to assess dental students' clinical performance. J Dent Educ 2020; 85:166-175. [PMID: 32978788 DOI: 10.1002/jdd.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE The use of relative unit values (RUVs) to assess students' clinical productivity is common in dental education. However, there are large variations on how RUVs are defined, developed, validated, and reported across institutions. This study described the development of a novel educational RUV system. METHODS A preparatory phase of literature review and methodological gap analysis, followed by initial conception, pilot testing, and a 2-round modified Delphi process were conducted. Panelists reviewed the procedure list, nomenclature, purpose of development, basis of calculation of RUVs, and the relative weights of different dental procedures. Also, their perception of the usefulness, fairness, and practicality of the system was assessed. Agreement was set at 80%. RESULTS Eight published educational RUV systems were identified. These data guided the initial conception of the novel Integrated Educational RUVs (IERUVs). Five experts reviewed the system and it was piloted for a full educational cycle. Feedback from faculty and students was used to adjust over- or under-estimated RUVs, with deconstruction of multi-step procedures. Fifteen experts participated in the second Delphi round (71% response rate). Consensus was reached for 105 procedural RUVs. A total of 93% of the panelists agreed the system was useful, while 71% perceived it as fair and practical. CONCLUSION(S) Content validity of the new educational RUV was established. The system provides a promising tool for assessing dental students' clinical performance, as it provides a unified base unit to assess clinical productivity, clinical competence, and comprehensive care cases. Longitudinal evaluations in different contexts are needed to confirm IERUVs validity.
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Affiliation(s)
- Shoroog Hassan Agou
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Yahya Imam
- Department of Prosthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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46
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Thielen FW, Houwing ME, Cnossen MH, Al Hadithy-Irgiztseva IA, Hazelzet JA, Groot CAUD, de Pagter APJ, Blommestein HM. Cost of health care for paediatric patients with sickle cell disease: An analysis of resource use and costs in a European country. Pediatr Blood Cancer 2020; 67:e28588. [PMID: 32672889 DOI: 10.1002/pbc.28588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND While multiple studies have examined the cost of health care for one aspect of sickle cell disease care, few have focussed on the overall cost of comprehensive care for sickle cell disease. METHODS We conducted a retrospective cohort study of children with sickle cell disease treated in a comprehensive care centre from 1 January 2015 to 31 December 2016. Health care utilisation of included patients was based upon data from two main sources. The clinical practice guideline was used to determine the expected resource use of routine comprehensive care (planned elective care), and the financial claims database was used to estimate real-world resource use associated with acute and inpatient care (additional care). RESULTS A total of 125 children with sickle cell disease were analysed. Expenditures for these patients averaged €5049 [standard deviation (SD) €1634] per child per year. Total yearly costs per patient varied considerably, ranging from €669 to €84 010, and less than 15% of patients were responsible for 50% of the health care costs. The majority (37%) of costs was associated with inpatient hospital care, which increased by age group, 27% with diagnostics, 19% with treatment, 11% with outpatients' visits and 6% with emergency care. CONCLUSION We have described real-world resource use and expenditures for children with sickle cell disease in a European comprehensive care centre. It seems that costs of a comprehensive approach with effective management in the outpatient setting is favourable when compared to episodic health care.
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Affiliation(s)
- Frederick W Thielen
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Maite E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ilona A Al Hadithy-Irgiztseva
- Department of Control and Compliance, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.,Institute for Medical Technology Assessment, Rotterdam, The Netherlands
| | - Anne P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.,Leiden University Medical Center-Willem Alexander Children's Hospital, Leiden, The Netherlands
| | - Hedwig M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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47
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Lapena C, Borràs E, Digon C, Aznar R, Del Val Garcia JL, Castelblanco E, Garaikoetxea A, Laguna V. Effectiveness of a comprehensive care protocol in patients with new diagnoses of type 2 diabetes mellitus and associated comorbidities in primary care: study protocol of a quasi-experimental trial. BMJ Open 2020; 10:e033725. [PMID: 32580980 PMCID: PMC7312326 DOI: 10.1136/bmjopen-2019-033725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic disease in the Spanish population. Typically, T2DM is associated with other chronic conditions. Intensive medication at the time of diagnosis has proven effective in reducing cardiovascular risk, improving glycaemic control and preventing T2DM complications. However, it has not yet been demonstrated that a comprehensive and intensive health education protocol at the time of diagnosis has the benefits described previously. Currently, there is great variability in the practices of primary care nurses regarding health education at the time of disease diagnosis.We aimed to evaluate the effectiveness of a systematic protocol with a comprehensive care programme in people with newly diagnosed T2DM with associated comorbidities. METHODS AND ANALYSIS A multicentre quasi-experimental design comparing a group of individuals taking part in the intervention (intervention group (IG)) with a similar group receiving standard diabetes care (comparison group (CG)) is planned. The intervention will take place during the 3 months after study enrolment. Data will be collected at baseline and at 3, 6 and 12 months. Ten primary care centres in Barcelona city will be selected for participation: 5 for the IG and 5 for the CG. The IG will include five structured individual visits postdiagnosis with the primary care nurse, during which aspects of diabetes education will be discussed with the patient and his/her family. The results will be measured in terms of health-related quality of life and the change in main outcomes (glycated haemoglobin and weight). ETHICS AND DISSEMINATION The study fully met the requirements of the Ethical Committee of Clinical Investigation of the IDIAP Jordi Gol (approval code: P13/118). Patients will be informed that their data are confidential, and they have the right to withdraw at any time without penalty. Dissemination will include publishing the findings in peer-reviewed journals and sharing our findings at scientific conferences. TRIAL REGISTRATION NUMBER NCT03990857; Pre-results.
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Affiliation(s)
- Carolina Lapena
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Spain
| | - Enriqueta Borràs
- Gerència Territorial de Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Clarisa Digon
- Centre d'Atenció Primària Sagrera, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Rosa Aznar
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Jose Luis Del Val Garcia
- Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Spain
- Unidad de Evaluación, Sistemas de Información y Calidad, Institut Català de la Salut, Barcelona, Spain
| | - Esmeralda Castelblanco
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau) & Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Ana Garaikoetxea
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Vicencia Laguna
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
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48
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Wu C, Zou G, Chen M, Wan L, Kielmann K, McCormack B. Perceived challenges in delivering comprehensive care for patients following stroke: a qualitative study of stroke care providers in Guangdong Province, China. Disabil Rehabil 2020; 44:59-67. [PMID: 32343635 DOI: 10.1080/09638288.2020.1755896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To understand the challenges in delivering comprehensive care for patients recovering from stroke in Guangdong Province, China.Methods: A cross-sectional qualitative study was conducted in two tertiary hospitals with different socio-economic characteristics in Guangdong Province, Southern China. Interviews were conducted with 16 stroke care providers including doctors, nurses, rehabilitation therapists and care workers. The interviews were audiotaped, transcribed and translated from Mandarin to English. Thematic analysis was used to draw out descriptive and analytical themes relating to care providers' experiences of existing routine stroke care services and the perceptions of challenges in delivering comprehensive stroke care.Results: The interviews with stroke care providers highlighted three key factors that hinder the capacity of the two hospitals to deliver comprehensive stroke care. First, expertise and knowledge regarding stroke and stroke care are lacking among both providers and patients; second, stroke care systems are not fully integrated, with inadequate coordination of the stroke team and inconsistency in care following discharge of stroke patients; third, stroke patients have insufficient social support.Conclusions: While comprehensive stroke care has become a priority in China, our study highlights some important gaps in the current provision of stroke care.IMPLICATIONS FOR REHABILITATIONComprehensive integrated stroke care is essential to maximize the effectiveness of stroke services and in China it needs to be further improved.Multidisciplinary stroke care systems should strengthen collaborations across all relevant disciplines and should include a clear role for registered nurses.Follow-up care after discharge needs more engagement with family caregivers.
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Affiliation(s)
- Chanchan Wu
- School of Nursing, Sun Yat-sen University, Guangzhou, China.,School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Guanyang Zou
- School of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Minjie Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Lihong Wan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Brendan McCormack
- Division of Nursing, School of Health Sciences, Queen Margaret University, Edinburgh, UK
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49
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Page D. Setting the scene: Historical overview of challenges and what led to advances in comprehensive care in developed countries, the Canadian experience. Haemophilia 2020; 26 Suppl 3:4-5. [PMID: 32356349 DOI: 10.1111/hae.13885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The history of the development of comprehensive care for hemophilia and other inherited bleeding disorders in Canada has been long and full of challenges. From limited in-patient treatment with plasma and cryoprecipitate in a few major centres in the 1950s and 1960s, a network of Hemophilia Treatment Centres (HTCs) offering multi-disciplinary comprehensive care, home infusion and prophylaxis was established across the country by the late 1970s and early 1980s, only to be shaken by the widespread contamination of factor concentrates with HIV and HCV in the 1970s and 1980s. In recent years the mission of HTCs has expanded to better serve people with von Willebrand disease, rare factor deficiencies and other rare bleeding disorders, and more fully recognize the needs of women with bleeding disorders. In 2020, challenges remain, notably maintaining the resources and expertise in HTCs and gaining access to the latest innovations in treatments.
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Affiliation(s)
- David Page
- Health Policy, Canadian Hemophilia Society, Montreal, QC, Canada
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50
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Nkya S, Mtei L, Soka D, Mdai V, Mwakale PB, Mrosso P, Mchoropa I, Rwezaula S, Azayo M, Ulenga N, Ngido M, Cox SE, D'Mello BS, Masanja H, Kabadi GS, Mbuya F, Mmbando B, Daniel Y, Streetly A, Killewo J, Tluway F, Lyimo M, Makani J. Newborn screening for sickle cell disease: an innovative pilot program to improve child survival in Dar es Salaam, Tanzania. Int Health 2020; 11:589-595. [PMID: 31145786 DOI: 10.1093/inthealth/ihz028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 02/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a recognized cause of childhood mortality. Tanzania has the fifth highest incidence of SCD (with an estimated 11 000 SCD annual births) worldwide. Although newborn screening (NBS) for SCD and comprehensive healthcare have been shown to reduce under-5 mortality by up to 94% in high-income countries such as the USA, no country in Africa has maintained NBS for SCD as a national health program. The aims of this program were to establish and evaluate NBS-SCD as a health intervention in Tanzania and to determine the birth prevalence of SCD. METHODS Muhimbili University of Health and Allied Sciences conducted NBS for SCD from January 2015 to November 2016. Dried blood spot samples were collected and tested for SCD using isoelectric focusing. RESULTS Screening was conducted on 3981 newborns. Thirty-one (0.8%) babies had SCD, 505 (12.6%) had sickle cell trait and 26 (0.7%) had other hemoglobinopathies. Twenty-eight (90.3%) of the 31 newborns with SCD were enrolled for comprehensive healthcare. CONCLUSIONS This is the first report on NBS as a health program for SCD in Tanzania. The SCD birth prevalence of 8 per 1000 births is of public health significance. It is therefore important to conduct NBS for SCD with enrollment into a comprehensive care program.
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Affiliation(s)
- Siana Nkya
- Dar es Salaam University College of Education, Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lillian Mtei
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deogratias Soka
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vera Mdai
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Promise B Mwakale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Mrosso
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Issa Mchoropa
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Delloite and Touche, Dar es Salaam, Tanzania
| | - Stella Rwezaula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Melkiory Ngido
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Delloite and Touche, Dar es Salaam, Tanzania
| | - Sharon E Cox
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Graduate School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan.,Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Brenda S D'Mello
- Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), Dar es Salaam, Tanzania
| | | | - Gregory S Kabadi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Frederick Mbuya
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Mmbando
- Dar es Salaam University College of Education, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Yvonne Daniel
- Public Health England, NHS Sickle Cell and Thalassemia Screening Programme and National Healthcare Public Health Division, London, UK
| | - Allison Streetly
- Public Health England, NHS Sickle Cell and Thalassemia Screening Programme and National Healthcare Public Health Division, London, UK
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Furahini Tluway
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Magdalena Lyimo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,National Blood Transfusion service, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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