Search results for: elderly care physicians

Authors: Florence A. Undiyaundeye, Aniashie Akpanke

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Early identification of developmental disorders in infants and toddlers is critical for the well being of children. It is also an integral function of the primary care medical provider and the early care given in the home or crèche. This paper is focused at providing information on special need infants and toddlers and strategies to support them in developmental concern to cope with the challenges in and out of the classroom and to interact with their peers without stigmatization and inferiority complex. The target children are from birth through three years of age. There is a strong recommendation for developmental surveillance to be incorporated at every well child preventive care program in training and practical stage of formal school settings. The paper posits that any concerns raised during surveillance should be promptly addressed with standardized developmental screening by appropriate health service providers. In addition screening tests should be administered regularly at age 9+, 19+ and 30 months of these infants. The paper also establishes that the early identification of these developmental challenges of the infants and toddlers should lead to further developmental and medical evaluation, diagnosis and treatment, including early developmental school intervention, control and teaching and learning integration and inclusion for proper career build up. Children diagnosed with developmental disorders should be identified as children with special needs so that management is initiated and its underlying etiology may also drive a range of treatment of the child, to parents. Conselling and school integration as applicable to the child’s specific need and care for sustenance in societal functioning.

Keywords: care, special need, support, infants and toddlers, management and developmental disorders

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Authors: Ellina Zipman

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This research investigates the place of music education in aged care facilities through the implementation of a program of regular piano lessons for residents. Using a qualitative case study methodology, the research explores aged care residents’ experiences in learning to play the piano. Since the aged care homes are unlikely places for formal learning and since older adults, especially in residential care, are not considered likely candidates for learning, this research opens the door for innovative and transformative thinking about where and to whom educational programs can be delivered. By addressing the educational needs of residents in aged care facilities, this research fills the gap in the literature. The research took place in Australia in two of Melbourne’s residential aged care facilities, engaging two residents (a nonagenarian female and an octogenarian male) to participate in 12-months weekly individual piano lessons. The data was collected through video recording of lessons, observations, interviews, emails, and a reflective journal. Data analysis was done using Nvivo and hard copy analysis with identifications of themes. The case studies revealed that passion for music was a major driver in participants’ motivation to engage in a long-term piano lessons program. This participation led to experiences of positive emotions, positive attitude, successes and challenges, the exercise of control, maintaining and building new relationships, improved self-confidence through autonomy and independent skills development, and discovering new identities through finding a new purpose and new roles in life. Speaking through participants’ voices, this research project demonstrates the importance of music education for older adults and hopes to influence transformation in the residential aged care sector.

Keywords: adult music education, quality of life, passion, positive ageing, wellbeing

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Authors: Stephanie Zuba-Bates

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Purpose: This qualitative research study explored the lived experience of people with functional movement disorder (FMD) including how it impacts their quality of life and participation in life activities. It aims to educate health care professionals about FMD from the perspective of those living with the disorder. Background: Functional movement disorder is characterized by abnormal motor movements including tremors, abnormal gait, paresis, and dystonia with no known underlying pathophysiological cause. Current research estimates that FMD may account for 2-20% of clients seen by neurologists. Getting a diagnosis of FMD is typically long and difficult. In addition, many healthcare professionals are unfamiliar with the disorder which may delay treatment. People living with FMD face great disruption in major areas of life including activities of daily living (ADLs), work, leisure, and community participation. OT practitioners have expertise in working with people with both physical disabilities as well as mental illness and this expertise has the potential to guide treatment and become part of the standard of care. In order for occupational therapists to provide these services, they must be aware of the disorder and must advocate for clients to be referred to OT services. In addition, referring physicians and other health professionals need to understand how having FMD impacts the daily functioning of people living with the disorder and how OT services can intervene to improve their quality of life. This study aimed to answer the following research questions: 1) What is the lived experience of individuals with FMD?; 2) How has FMD impacted their participation in major areas of life?; and, 3) What treatment have they found to be effective in improving their quality of life? Method: A naturalistic approach was used to collect qualitative data through semi-structured telephone interviews of five individuals living with FMD. Subjects were recruited from social media websites and resources for people with FMD. Data was analyzed for common themes among participants. Results: Common themes including the variability of symptoms of the disorder; challenges to receiving a diagnosis; frustrations with and distrust of health care professionals; the impact of FMD on the participant’s ability to perform daily activities; and, strategies for living with the symptoms of FMD. Conclusion: All of the participants in the study had to modify their daily activities, roles and routines as a result of the disorder. This is an area where occupational therapists may intervene to improve the quality of life of these individuals. Additionally, participants reported frustration with the medical community regarding the awareness of the disorder and how they were treated by medical professionals. Much more research and awareness of the disorder is in order.

Keywords: functional movement disorder, occupational therapy, participation, quality of life

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Authors: T. S. Beerenahally, S. Amruthavalli, C. M. Munegowda, Leelavathi, Nagarathna

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Introduction: In majority of urban India, the health system is split between different authorities being responsible for the health care of urban population. We believe that, apart from poor awareness and financial barriers to care, there are other health system barriers which affect quality and access to care for people with diabetes. In this paper, we attempted to identify health system complexity that determines access to public health system for diabetes care in KG Halli, a poor urban neighborhood in Bengaluru. The KG Halli has been a locus of a health systems research from 2009 to 2015. Methodology: The source of data is from the observational field-notes written by research team as part of urban health action research project (UHARP). Field notes included data from the community and the public primary care center. The data was generated by the community health assistants and the other research team members during regular home visits and interaction with individuals who self-reported to be diabetic over four years as part of UHARP. Results: It emerged during data analysis that the patients were not keen on utilizing primary public health center for many reasons. Patient has felt that the service provided at the center was not integrated. There was lack of availability of medicines, with a regular stock out of medicines in a year and laboratory service for investigation was limited. Many of them said that the time given by the providers was not sufficient and there was also a feeling of providers not listening to them attentively. The power dynamics played a huge role in communication. Only the consultation was available for free of cost at the public primary care center. The patient had to spend for the investigations and the major portion for medicine. Conclusion: Diabetes is a chronic disease that poses an important emerging public health concern. Most of the financial burden is borne by the family as the public facilities have failed to provide free care in India. Our study indicated various factors including individual beliefs, stigma and financial constraints affecting compliance to diabetes care.

Keywords: diabetes care, disintegrated health system, quality of care, urban health

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Authors: A. Haddick, A. Soltan

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Background: During the period of recovery from an operative obstetric procedure, a woman is not only at risk of the life-threatening complications accompanying labour but also those associated with surgery and anaesthesia. It is speculated that women in the recovery area may receive a lower standard of care over a night shift. Thus obstetric recovery room care should be evaluated regularly to ensure all women receive an equally high standard of care 24/7. Aim: The aim of this audit was to undertake an audit in the Liverpool Women’s Hospital on the care in recovery, and to ascertain the extent to which the standards were met. This audit included the full audit cycle. Method: Standards were taken from the AAGBI, RCOA, NICE and CNST guidelines. There were 12 standards including appropriate documentation of vital signs and appropriate length of stay after surgery. Notes from 100 patients were analysed from March 2011-March 2012. There were 52 day notes and 48 night notes; these were accessed to gain the relevant data. In the re audit 35 notes were accessed from March 14-September 14. Results: The Liverpool Women’s Hospital met in total 10 of these standards. 10 were met during the day shift (83%) and 0 met during the night shift. In the re audit, there was a significant improvement in the standards met at night. 9 of the standards were met during the day and 7 of the standards were met at night. Clearly there are still improvements to be made. Conclusions: In the original audit, an audit action plan was formulated. This was following discussion of the results of this audit in an MDT meeting and presentation with a consultant Obstetrician, the head of Midwifery, the head of Obstetrics theatres and a recovery nurse. This audit will be further discussed in the Liverpool Woman's Hospital in July 2015 for further implementation for improvement.

Keywords: care, recovery, room, women

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Authors: Sara Herrero Jaén, José María Santamaría García, María Lourdes Jiménez Rodríguez, Jorge Luis Gómez González, Adriana Cercas Duque, Alexandra González Aguna

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Background: Health concept has evolved throughout history. The health level is determined by the own individual perception. It is a dynamic process over time so that you can see variations from one moment to the next. In this way, knowing the health of the patients you care for, will facilitate decision making in the treatment of care. Objective: To design a technological tool that calculates the people health level in a sequential way over time. Material and Methods: Deductive methodology through text analysis, extraction and logical knowledge formalization and education with expert group. Studying time: September 2015- actually. Results: A computational tool for the use of health personnel has been designed. It has 11 variables. Each variable can be given a value from 1 to 5, with 1 being the minimum value and 5 being the maximum value. By adding the result of the 11 variables we obtain a magnitude in a certain time, the health level of the person. The health calculator allows to represent people health level at a time, establishing temporal cuts being useful to determine the evolution of the individual over time. Conclusion: The Information and Communication Technologies (ICT) allow training and help in various disciplinary areas. It is important to highlight their relevance in the field of health. Based on the health formalization, care acts can be directed towards some of the propositional elements of the concept above. The care acts will modify the people health level. The health calculator allows the prioritization and prediction of different strategies of health care in hospital units.

Keywords: calculator, care, eHealth, health

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Authors: Bindhiya Thomas, Rehana Hafeez

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Background: The Surgical Ambulatory Unit (SAU) also known as the Same Day Emergency Care (SDEC) is an established part of many hospitals providing same day emergency care service to surgical patients who would have otherwise required admission through the A&E. Prior to Covid, the SAU was functioning as a 12-hour service, but during the Covid crisis this service was transformed to a 24 hour functioning Surgical Ambulatory Assessment unit (SAAU). We studied the effects that this change brought about in-patient care in our hospital. Objective: The objective of the study was to assess the impact of a 24-hour Surgical Ambulatory Assessment unit on patient care during the time of Covid, in particular its role in freeing A&E capacity and delivering effective patient care. Methods: We collected two sets of data retrospectively. The first set was collected over a 6-week period when the SAU was functioning at the Princess Royal University Hospital. On March 23rd, 2020, the SAU was transformed into a 24-hour SAAU. Following this transformation, a second set of patient data was collected over a period of 6 weeks. A comparison was made between data collected from when the hospital had a 12-hour Surgical Ambulatory unit and later when it was transformed into a 24-hour facility. Its effects on the change in the number of patients breaching the four hour waiting period and the number of emergency surgical admissions. Results: The 24-hour Surgical Ambulatory Assessment unit brought significant reductions in the number of patients breaching the waiting period of 4 hours in A&E from 44% during the period of the 12-hour Surgical Ambulatory care facility to 0% from when the 24-hour Surgical Ambulatory Assessment Unit was established. A 28% reduction was also seen in the number of surgical patients' admissions from A&E. Conclusions: The 24-hour SAAU was found to have a profound positive impact on emergency care of surgical patients. Especially during the Covid crisis, it played a crucial role in providing not only effective and accessible patient care but also in reducing the A&E workload and admissions. It thus proved to be a strategic tool that helped to deal with the immense workload in emergency care during the Covid crisis and helped free much needed headspace at a time of uncertainty for the A&E to better configure their services. If sustained, the 24-hour SAAU could be relied on to augment the NHS emergency services in the future, especially in the event of another crisis.

Keywords: Princess Royal University Hospital, surgical ambulatory assessment unit, surgical ambulatory unit, same day emergency care

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Authors: Kristine Demilou D. Santiago

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An access to a high-quality health care system is what sets apart industrialized nations, such as the United States from other developing countries, which in this case is specifically pertaining to their older population. But what was the underrated factor in the sphere of quality healthcare rendered to elderly people in the Western context? Will this salient factor could push conviction to prorogue the existing gaps between self-denial patient-client and cheek by jowl medications? Are the natural socio-environmental approaches of caregiving the protracted remedy to healthcare disparities for aging population considering their day to day living? The conceptual framework of this model is primarily associated with addressing health and illness of human beings considering the biological, psychological and socio-environmental factors around them. The relevance of biopsychosocial formulation advancing each of the characteristics in the Biopsychosocial (BPS) model in a balance contemplation is the tumult of this study in an attempt to respond to prevailing disparities in caregiving services for old-aged patients on a day to day living. Caregiving services have been the medium path connecting between the patient and its prescribed medications. Moreover, caregivers serve as positive reinforcers in a patient’s environment. Therefore, caregivers play an important role in healthcare delivery to patients. They are considered significant people whom their acts will give an impact to a patient’s view in life. This research study intends to present the supreme importance of biopsychosocial assessment to old-aged patients with mental health illness and conditions. Biopsychosocial assessment will secure the quality of full medication to an old-aged adult suffering from a mental illness. This is because it offers a recognizably wholesome approach to medical healing of old-aged adult patients. The principle of biopsychosocial supersedes the biomedicine being offered to old-aged adults having mental illness, but it does not take away the high relevance of scientific biomedicine in healing patients. The framework presented an overlapping participation of each of its factors in its BPS model that affects in general a person’s health. The correlation between the biological (physiological), psychological (mental) and social (environment) in a person’s health condition requires equal attention according to BPS, and it always coexist with each other. Indisputably said, bio-medicine has been and is being in its unceasing endeavor to provide scientifically proven health care medications for every individual seeking medical treatments. As we grow older and eventually reach the other side of the median population, not only our physiological aspects change, our psychological and socio-environmental changes happen too. Caregiving is a salient responsibility taking place on these inevitable changes.

Keywords: biopsychosocial formulation, caregiving through natural approaches, US health care, BPS in caregiving, caregiving for aging population

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Authors: Sunethra Jayathilake, Vathsala Jayasuriya-Illesinghe, Kerstin Samarasinghe, Himani Molligoda, Rasika Perera

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In Sri Lanka, postnatal care in the state hospitals is provided by different professional categories: Midwifery trained registered nurses (MTRNs), Registered Nurses (RNs) who do not have midwifery training, doctors and midwives. Even though four professional categories provide postnatal care to mothers and newborn babies, they are not aware of their own tasks and responsibilities in postnatal care. Particularly MTRN’s role in the postnatal unit is unclear. The current study aimed to identify nurses’ (both MTRN and RNs) perception on MTRN’s tasks and responsibilities in postnatal care. This is a descriptive cross sectional study using postal survey. All nurses who were currently working in postnatal units at five selected tertiary care hospitals in the Western Province at that time were invited to participate in the study. Accordingly, the pre evaluated self-administered questionnaire was sent to 201 nurses (53 MTRNs and 148 RNs) in the study setting. The number of valid return questionnaire was 166; response rate was 83%. Respondents rated the responsibility of four professional categories: MTRN, RN, doctor and midwife whether they are 'primarily responsible', 'responsible in absence' and 'not responsible', for each of 15 postnatal (PN) tasks which were previously identified from focus group discussions with care providers during the first phase of the study. Data were analyzed using SPSS version 20; descriptive statistics were calculated. Out of the 15 PN tasks, 13 were identified as MTRNs’ primary responsibilities by 71%-93% of respondents. The respondents also considered six (6) tasks out of 15 as primary responsibility of both MTRN and RN, seven (7) tasks as primary responsibility of MTRN, RN and doctor and the remaining two (2) tasks were identified as the primary responsibility of MTRN, RN and midwife. All 15 PN tasks overlapped with other professional categories. Overlapping tasks may create role confusion leading to conflicts among professional categories which affect the quality of care they provide, eventually, threaten the safety of the client. It is recommended that an official job description for each care provider is needed to recognize their own professional boundaries for ensuring safe, quality care delivery in Sri Lanka.

Keywords: overlapping, postnatal, responsibilities, tasks

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Authors: K. L. Virupaksha Gupta

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Ayurveda offers a holistic outlook regarding skin care. Most Initial step in Ayurveda is to identify the skin type and care accordingly which is highly personalized. Though dermatologically there are various skin type classifications such Baumann skin types (based on 4 parameters i) Oily Vs Dry ii) Sensitive Vs Resistant iii) Pigmented Vs Non-Pigmented iv) Wrinkled Vs Tight (Unwrinkled) etc but Skin typing in Ayurveda is mainly determined by the prakriti (constitution) of the individual as well as the status of Doshas (Humors) which are basically of 3 types – i.e Vata Pitta and Kapha,. Difference between them is mainly attributed to the qualities of each dosha (humor). All the above said skin types can be incorporated under these three types. The skin care modalities in each of the constitution vary greatly. Skin of an individual of Vata constitution would be lustreless, having rough texture and cracks due to dryness and thus should be given warm and unctuous therapies and oil massage for lubrication and natural moisturizers for hydration. Skin of an individual of Pitta constitution would look more vascular (pinkish), delicate and sensitive with a fair complexion, unctuous and tendency for wrinkles and greying of hair at an early age and hence should be given cooling and nurturing therapies and should avoid tanning treatments. Skin of an individual of kapha constitution will have oily skin, they are delicate and look beautiful and radiant and hence these individuals would require therapies to mainly combat oily skin. Hence, the skin typing and skin care in Ayurveda is highly rational and scientific.

Keywords: Ayurveda, dermatology, Dosha, skin types

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Authors: Dona Ghosh, Zakir Husain

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In India, the increase in share of aged has generated many social and economic issues, of which health concerns is a major challenge that society must confront in coming years. Self-reported health (SRH) is a popular health measure in this regard but has been questioned in recent years due to its heavy dependence on the socioeconomic status. So, the validity of SRH, as a measure of health status during old age, is needed to be verified. This paper emphasizes on the self-reported health and related inconsistent responses among elderly in India. The objective of the study is bifurcated into two parts: firstly, to identify the socioeconomic determinants of subjective health status and its change over time; and secondly, to analyse the role of the socioeconomic components in providing inconsistent responses regarding the health status of elderly. Inconsistency in response can rise in two ways: positive response bias (if an individual has a health problem but reports his/her health as good) and negative response bias (if bad health is reported even if there is no health problem). However, in the present study, we focus only on the negative response bias of elderly individuals. To measure the inconsistencies in responses, self-reported health is compared with two types of physical health conditions – existence of chronicle ailment and physical immobility. Using NSS dataset of 60th and 71st rounds, the study found that subjective health has worsened over time in both rural and urban areas. Findings suggest that inconsistency in responses, related to chronic ailment, vary across social classes, living environments, geographical regions, age groups and education levels. On the contrary, variation in inconsistent responses regarding physical mobility is quite rare and difficult to explain by socioeconomic characteristics because most of the indicators are found to be insignificant in this regard. The findings indicate that in case of chronicle ailment, inconsistency between objective and subjective health status largely depends on socioeconomic conditions but the importance of such factors disappears for physical immobility.

Keywords: India, aging, self-reported health, inconsistent responses

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Authors: Kristin Thooft

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— Increasing pressure to manage healthcare costs has resulted in shifting care towards ambulatory settings and is driving a focus on cost transparency. There are few nurse staffing to workload models developed for ambulatory settings, less for multi-specialty clinics. Of the existing models, few have been evaluated against outcomes to understand any impact. This evaluation took place after the AWARD model for nurse staffing to workload was implemented in a multi-specialty clinic at a regional healthcare system in the Midwest. The multi-specialty clinic houses 26 medical and surgical specialty practices. The AWARD model was implemented in two specialty practices in October 2020. Donabedian’s Structure-Process-Outcome (SPO) model was used to evaluate outcomes based on changes to the structure and processes of care provided. The AWARD model defined and quantified the processes, recommended changes in the structure of day-to-day nurse staffing. Cost of care per patient visit, total visits, a total nurse performed visits used as structural and process measures, influencing the outcomes of cost of care and access to care. Independent t-tests were used to compare the difference in variables pre-and post-implementation. The SPO model was useful as an evaluation tool, providing a simple framework that is understood by a diverse care team. No statistically significant changes in the cost of care, total visits, or nurse visits were observed, but there were differences. Cost of care increased and access to care decreased. Two weeks into the post-implementation period, the multi-specialty clinic paused all non-critical patient visits due to a second surge of the COVID-19 pandemic. Clinic nursing staff was re-allocated to support the inpatient areas. This negatively impacted the ability of the Nurse Manager to utilize the AWARD model to plan daily staffing fully. The SPO framework could be used for the ongoing assessment of nurse staffing performance. Additional variables could be measured, giving a complete picture of the impact of nurse staffing. Going forward, there must be a continued focus on the outcomes of care and the value of nursing

Keywords: ambulatory, clinic, evaluation, outcomes, staffing, staffing model, staffing to workload

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Authors: Hyun-E Yeom

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Patients’ views about the cause of hypertension may influence their present and proactive behaviors to regulate high blood pressure. This study aimed to examine the internal structure underlying the causal beliefs about hypertension and the influence of causal beliefs on self-care intention and medical compliance in Korean patients with hypertension. The causal beliefs of 145 patients (M age = 57.7) were assessed using the Illness Perception Questionnaire-Revised. An exploratory factor analysis was used to identify the factor structure of the causal beliefs, and the factors’ influence on self-care intention and medication compliance was analyzed using multiple and logistic regression analyses. The four-factor structure including psychological, fate-related, risk and habitual factors was identified and the psychological factor was the most representative component of causal beliefs. The risk and fate-related factors were significant factors affecting lower intention to engage in self-care and poor compliance with medication regimens, respectively. The findings support the critical role of causal beliefs about hypertension in driving patients’ current and future self-care behaviors. This study highlights the importance of educational interventions corresponding to patients’ awareness of hypertension for improving their adherence to a healthy lifestyle and medication regimens.

Keywords: hypertension, self-care, beliefs, medication compliance

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Authors: Mei Teng Woo, Keith Davids, Jarmo Liukkonen, Jia Yi Chow, Timo Jaakkola

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Wearable garments such as tapes, compression garments, and braces could improve proprioception and reduced postural sway. The aim of this study was to examine the effects of wearable garments on postural regulation in a sample of community-dwelling elderly individuals, aged 65 years. It was hypothesized that wearable garments such as socks would provide stimulation to lower leg mechanoreceptors, and help participants achieve better postural regulation. Participants (N=63) performed a 30-s Romberg balance test protocol under four conditions (barefoot; wearing commercial socks; wearing clinical compression socks; wearing non-clinical compression socks), in a counterbalanced order, with four levels of performance difficulty: (1) standing on a stable surface with open eyes (SO); (2) a stable surface with closed eyes (SC); (3) a foam surface with open eyes (FO); and (4) a foam surface with closed eyes (FC). Centre of pressure (CoP) measurements included postural sway area (C90 area), trace length (TL) and sway velocity. Thirty-five participants (55.6%) showed positive effects of wearing the socks (responded group). In the responded group, it was revealed that socks showed significant differences in SO, SC and FO conditions for the two CoP measurements - TL and sway velocity (p < 0.05). In contrast, in the non-responded group, barefoot condition significantly decreased the TL and velocity in the SO condition. From the positive effects observed in the responded group, it is possible that wearable garments provide sensory cues that could interact with a biological cueing system to enhance performance in the postural regulation system. This study suggests that individuals respond to the socks treatments differently and future research should be undertaken to examine the factors that benefited the responded group of participants.

Keywords: community-dwelling, elderly adults, postural regulation, wearable garments

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Authors: Mannan Mridha, Mohammad S. Islam

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Innovative medical technologies offer more effective medical care, with less risk to patient and healthcare personnel. Medical technology and devices when properly used provide better data, precise monitoring and less invasive treatments and can be more targeted and often less costly. The Intensive Care Unit (ICU) equipped with patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation and life support devices is particularly prone to medical errors for various reasons. Many people in the developing countries now wonder whether their visit to hospital might harm rather than help them. This is because; clinicians in the developing countries are required to maintain an increasing workload with limited resources and absence of well-functioning safety system. A team of experts from the medical, biomedical and clinical engineering in Sweden and Bangladesh have worked together to study the incidents, adverse events at the ICU in Bangladesh. The study included both public and private hospitals to provide a better understanding for physical structure, organization and practice in operating processes of care, and the occurrence of adverse outcomes the errors, risks and accidents related to medical devices at the ICU, and to develop a ICT based support system in order to reduce hazards and errors and thus improve the quality of performance, care and cost effectiveness at the ICU. Concrete recommendations and guidelines have been made for preparing appropriate ICT related tools and methods for improving the routine for use of medical devices, reporting and analyzing of the incidents at the ICU in order to reduce the number of undetected and unsolved incidents and thus improve the patient safety.

Keywords: intensive care units, medical errors, medical devices, patient care and safety

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Authors: Kulveer Sandhu

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Background: In 1999, the Government of Canada legalized the use of cannabis for the therapeutic purpose (CTP); however, its users remain highly vulnerable to stigma and are judged by care providers and nonusers of cannabis. Findings from a literature review suggest health care providers (HCPs), including nurses in palliative care settings, lack knowledge about medical cannabis. For this reason, it is important to enhance HCPs’awarenessand knowledge of medical cannabis. Significance of the Project: Nurses are the first point of contact and spend more time with patients than other care providers; it is, therefore, important for them to be informed about CTPto provide quality and equitable care for medical cannabis users. Although nurses and other HCPs want information on CTP, the topic is rarely included in their educational curriculum. The purpose of this project is to create an evidence informed Package designed to increase knowledge among palliative care nurses about CTP. The information package will empower palliative nurses to help palliative patients make informed decisions about their treatment plan. Method: The information package will include a basic overview of the endocannabinoid system, common cannabis plants and products, and methods of consumption, as well as information to help nurses better understand consumption and harm reduction. The package will also include a set of cannabis fact sheets for nurses. Each fact sheet will comprise a high-level overview with graphics followed by a description of medical cannabis with links and references. At the end of the learning package, there are five self-reflection questions that allow nurses to examine their personal values, attitudes, and practices regarding medical cannabis. These questions will help each nurse understand their personal approach towards CTP and its users.

Keywords: medical cannabis, improve knowledge, cannabis for therapeutic purpose (CTP), patient experience, palliative care

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Authors: Beatrice Adeoye

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Studies have associated social and demographic characteristics as strong determinants of utilization of health care services; however, not much has been done to explore the dynamics of these variables in Nigeria. This empirical study explores the link between demographic factors and the future use of health care services in Nsukka, southeast Nigeria. A total of 543 respondents were selected using multi-stage sampling technique. The findings of the study showed that majority (56.9%) of the respondents were female while 43.1% were male. More of the respondents were married (50.3%) while 41.80/0 of the respondents were between ages 26-35. Testing the demographic characteristics regarding where people will prefer to go first for treatment with multiple regression, It is only Sex as a demographic variable that indicates positive association for future occurrence to where people will prefer to go first for treatment with 0.08 significance. Age and education indicates no association considering their level of significance. This result shows that sex is one of the determinant factors of where and when people will go for treatment. This is pointing out the realities regarding African society where in the family setting, it is the father that dictates the cause of action. Also to buttress these findings, cross tabulating age with who determines where and when to go for treatment, findings show that majority (58.9%) within age 26-35 said their spouses decide on where and when to go for treatment. Findings showed that patriarchy still plays an important role in the utilization of health care delivery among the people studied.

Keywords: Demographic characters, Determinant, Health Care, treatment, self-medication, symptom,

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Authors: Corbel Camille, Le Cerf Flora, Capriz Françoise, Vaillant-Ciszewicz Anne-Julie, Breaud Jean, Guerin Olivier, Corveleyn Xavier

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Background: The medical environment can generate stressful and anxiety-provoking situations for patients, particularly during painful care procedures for the older population. These stressful environments have deleterious effects on the quality of care and can even put the patient at risk and set the care team up for failure. The search for a solution is, therefore, imperative. The development of new technologies, such as virtual reality (VR), seems to be an answer to this problem. Objectives: The objective of this study is to compare the effects of virtual reality on pain and anxiety when caring for older hospitalized people with the effects of usual care. More precisely, different individual factors (age, cognitive level, individual preferences, etc.) and different virtual reality universes (personalized or non-personalized) are studied to understand the role of these factors in reducing pain and anxiety during care procedures. The aim of this study is to improve the quality of life of patients and caregivers in their work environment. Method: This mono-centered, randomized, controlled study was conducted from September 2023 to September 2024 on 120 participants recruited from the geriatric departments of the Cimiez Hospital, Nice, France. Participants are randomized into three groups: a control group, a personalized VR group and a non-personalized VR group. Each participant is followed during a painful care session. Data are collected before, during and after the care, using measures of pain (Algoplus and numerical scale) and anxiety (Hospital anxiety scale and numerical scale). Physiological assessments with an oximeter are also performed to collect both heart and respiratory rate measurements. The implementation of the care will be assessed among healthcare providers to evaluate its effects on the difficulty and fatigue associated with the care. Additionally, a questionnaire (System Usability Scale) will be administered at the conclusion of the study to determine the willingness of healthcare providers to integrate VR into their daily care practices. Result: The preliminary results indicate significant effects on anxiety (p=.001) and pain (p=<.001) following the VR intervention during care, as compared to the control group. Conclusion: The preliminary results suggest that VRI appears to be a suitable and effective method for reducing anxiety and pain among older hospitalized individuals compared with standard care. Finally, the experiences of healthcare professionals involved will also be considered to assess the impact of these interventions on working conditions and patient support.

Keywords: anxiety, care, pain, older adults, virtual reality

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Authors: Catelyn Coyle, Helena Kwakwa

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Objective: As novel and better tolerated therapies become available, effective HCV testing and care models become increasingly necessary to not only identify individuals with active infection but also link them to HCV providers for medical evaluation and treatment. Our aim is to describe an effective HCV testing and linkage to care model piloted in a network of five community health centers located in Philadelphia, PA. Methods: In October 2012, National Nursing Centers Consortium piloted a routine opt-out HCV testing model in a network of community health centers, one of which treats HCV, HIV, and co-infected patients. Key aspects of the model were medical assistant initiated testing, the use of laboratory-based reflex test technology, and electronic medical record modifications to prompt, track, report and facilitate payment of test costs. Universal testing on all adult patients was implemented at health centers serving patients at high-risk for HCV. The other sites integrated high-risk based testing, where patients meeting one or more of the CDC testing recommendation risk factors or had a history of homelessness were eligible for HCV testing. Mid-course adjustments included the integration of dual HIV testing, development of a linkage to care coordinator position to facilitate the transition of HIV and/or HCV-positive patients from primary to specialist care, and the transition to universal HCV testing across all testing sites. Results: From October 2012 to June 2015, the health centers performed 7,730 HCV tests and identified 886 (11.5%) patients with a positive HCV-antibody test. Of those with positive HCV-antibody tests, 838 (94.6%) had an HCV-RNA confirmatory test and 590 (70.4%) progressed to current HCV infection (overall prevalence=7.6%); 524 (88.8%) received their RNA-positive test result; 429 (72.7%) were referred to an HCV care specialist and 271 (45.9%) were seen by the HCV care specialist. The best linkage to care results were seen at the test and treat the site, where of the 333 patients were current HCV infection, 175 (52.6%) were seen by an HCV care specialist. Of the patients with active HCV infection, 349 (59.2%) were unaware of their HCV-positive status at the time of diagnosis. Since the integration of dual HCV/HIV testing in September 2013, 9,506 HIV tests were performed, 85 (0.9%) patients had positive HIV tests, 81 (95.3%) received their confirmed HIV test result and 77 (90.6%) were linked to HIV care. Dual HCV/HIV testing increased the number of HCV tests performed by 362 between the 9 months preceding dual testing and first 9 months after dual testing integration, representing a 23.7% increment. Conclusion: Our HCV testing model shows that integrated routine testing and linkage to care is feasible and improved detection and linkage to care in a primary care setting. We found that prevalence of current HCV infection was higher than that seen in locally in Philadelphia and nationwide. Intensive linkage services can increase the number of patients who successfully navigate the HCV treatment cascade. The linkage to care coordinator position is an important position that acts as a trusted intermediary for patients being linked to care.

Keywords: HCV, routine testing, linkage to care, community health centers

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Authors: Jessica Ding

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The field of global health is currently advocating for a resurgence in the use of traditional medicines to improve people-centered care. Healthcare policies are rapidly changing in response; in China, the increasing presence of TCM in the same spaces as biomedicine has led to a new term: integrative medicine. However, the existence of TCM as a part of integrative medicine creates a pressing paradoxical tension where TCM is both seen as a marginalized system within ‘modern’ hospitals and as a modality worth integrating. Additionally, the impact of such shifts has not been fully explored: the World Health Organization for one focuses only on three angles —practices, products, and practitioners— with regards to traditional medicines. Through ten weeks of fieldwork conducted at an urban hospital in Shanghai, China, this research expands the perspective of existing strategies by looking at integrative care through a fourth lens: patients and families. The understanding of self-care, health-seeking behavior, and non-professional caregiving structures are critical to grasping the significance of traditional medicine for people-centered care. Indeed, those individual and informal health care expectations align with the very spaces and needs that traditional medicine has filled before such ideas of integration. It specifically looks at this issue via three processes that operationalize experiences of care: (1) how aspects of TCM are valued within integrative medicine, (2) how negotiations of care occur between patients and doctors, and (3) how 'good quality' caregiving presents in integrative clinical spaces. This research hopes to lend insight into how culturally embedded traditions, bureaucratic and institutional rationalities, and social patterns of health-seeking behavior influence care to shape illness experiences at the intersection of two medical modalities. This analysis of patients’ clinical and illness experiences serves to enrich the narratives of integrative medical care’s ability to provide patient-centered care to determine how international policies are realized at the individual level. This anthropological study of the integration of Traditional Chinese medicine in local contexts can reveal the extent to which global strategies, as promoted by the WHO and the Chinese government actually align with the expectations and perspectives of patients receiving care. Ultimately, this ethnographic analysis of a local Chinese context hopes to inform global policies regarding the future use and integration of traditional medicines.

Keywords: emergent systems, global health, integrative medicine, traditional Chinese medicine, TCM

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Authors: Saradiya Mukherjee

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Background: Indian Muslims, compared to their counterparts in other religions, generally do not fare well on many yardsticks related to socio-economic progress and the same is true with maternal health care utilization. Due to low age at marriage a major percentage of child birth is ascribed to young (15-24 years) Muslim mothers in, which pose serious concerns on the maternal health care of Young Married Muslim women (YMMW). A thorough search of past literature on Muslim women’s health and health care reveals that studies in India have mainly focused on religious differences in fertility levels and contraceptive use while the research on the determinants of maternal health care utilization among Muslim women are lacking in India. Data and Methods: Retrieving data from the National Family Health Survey -3 (2005-06) this study attempts to assess the level of utilization and factors effecting three key maternal health indicators (full ANC, safe delivery and PNC) among YMMW (15-24 years) in India. The key socio-economic and demographic variables taken as independent or predictor variables in the study was guided by existing literature particularly for India. Bi-variate analysis and chi square test was applied and variables which were found to be significant were further included in binary logistic regression. Results: The findings of the study reveal abysmally low levels of utilization for all three indicators i.e. full ANC, safe delivery and PNC of maternal health care included in the study. Mother’s education, mass media exposure, women’s autonomy, birth order, economic status wanted status of child and region of residence were found to be significant variables effecting maternal health care utilization among YMMW. Multivariate analysis reveals that no mass media exposure, lower autonomy, education, poor economic background, higher birth order and unintended pregnancy are some of the reasons behind low maternal health care utilization. Conclusion: Considering the low level of safe maternal health care utilization and its proximate determinants among YMMW the study suggests educating Muslim girls, promoting family planning use, involving media and collaboration between religious leader and health care system could be some important policy level interventions to address the unmet need of maternity services among YMMW.

Keywords: young Muslim women, religion, socio-economic condition, antenatal care, delivery, post natal care

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Authors: K. Malak, A. Nourah, S.Liyakathunisa

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Nowadays, healthcare services are facing many challenges since they are becoming more complex and more needed. Every detail of a patient’s interactions with health care providers is maintained in Electronic Health Records (ECR) and Healthcare information systems (HIS). However, most of the existing systems are often focused on documenting what happens in manual health care process, rather than providing the highest quality patient care. Healthcare business processes and stakeholders can no longer rely on manual processes, to provide better patient care and efficient utilization of resources, Healthcare processes must be automated wherever it is possible. In this research, a detail survey and analysis is performed on the existing health care systems in Saudi Arabia, and an automated smart medical healthcare business process model is proposed. The business process management methods and rules are followed in discovering, collecting information, analysis, redesign, implementation and performance improvement analysis in terms of time and cost. From the simulation results, it is evident that our proposed smart medical records system can improve the quality of the service by reducing the time and cost and increasing efficiency

Keywords: business process management, electronic health records, efficiency, cost, time

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Authors: A. Dali-Ali, F. Agag, H. Beldjilali, A. Oukebdane, K. Meddeber, R. Dali-Yahia, N. Midoun

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The ability of Acinetobacter baumannii to develop multiple resistances towards to the majority of antibiotics explains the therapeutic difficulties encountered in severe infections. Furthermore, its persistence in the humid or dry environment promotes cross-contamination in intensive care units. The aim of our study was to describe the epidemiological and bacterial resistance profiles of hospital-acquired infections caused by Acinetobacter baumannii in the intensive care unit of our teaching hospital. During the study period (June 3, 2012 to December 31, 2013), 305 patients having duration of hospitalization equal or more than 48 hours were included in the study. Among these, 36 had developed, at least, one health-care associated infection caused by Acinetobacter baumannii. The rate of infected patients was equal to 11.8% (36/305). The rate of cumulative incidence of hospital-acquired pneumonia was the highest (9.2%) followed by central venous catheter infection (1.3%). Analysis of the various antibiotic resistance profile shows that 93.8% of the strains were resistant to imipenem. The nosocomial infection control committee set up a special program not only to reduce the high rates of incidence of these infections but also to descrease the rate of imipenem resistance.

Keywords: Acinetobacer baumannii, epidemiological profile, hospital acquired infections, intensive care unit

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Authors: M. Aljumaan, F. Alkhadra, A. Aldajani, M. Alarfaj, A. Alawami, Y. Aljamaan

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Introduction: The internet has been widely available with 18 million users in Saudi Arabia alone. It was shown that 58% of Saudis are using the internet as a source of health-related information which may contribute to overcrowding of the Emergency Room (ER). Not many studies have been conducted to show the effect of online searching for health related information (HRI) and its role in influencing internet users to visit various health care facilities. So the main objective is to determine a correlation between HRI website use and health care facility visits in Saudi Arabia. Methodology: By conducting a cross sectional study and distributing a questionnaire, a total number of 1095 people were included in the study. Demographic data was collected as well as questions including the use of HRI websites, type of websites used, the reason behind the internet search, which health care facility it lead them to visit and whether seeking health information on the internet influenced their attitude towards visiting health care facilities. The survey was distributed using an internet survey applications. The data was then put on an excel sheet and analyzed with the help of a biostatician for making a correlation. Results: We found 91.4% of our population have used the internet for medical information using mainly General medical websites (77.8%), Forums (34.2%), Social Media (21.6%), and government websites (21.6%). We also found that 66.9% have used the internet for medical information to diagnose and treat their medical conditions on their own while 34.7% did so due to the inability to have a close referral and 29.5% due to their lack of time. Searching for health related information online caused 62.5% of people to visit health care facilities. Outpatient clinics were most visited at 77.9% followed by the ER (27.9%). The remaining 37.5% do not visit because using HRI websites reassure them of their condition. Conclusion: In conclusion, there may be a correlation between health information website use and health care facility visits. However, to avoid potentially inaccurate medical information, we believe doctors have an important role in educating their patients and the public on where to obtain the correct information & advertise the sites that are regulated by health care officials.

Keywords: ER visits, health related information, internet, medical websites

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Authors: Chaliya Wamaloon, Malee Chaisaena, Nusara Prasertsri

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Informal caregivers providing home-based palliative and end-of-life (EOL) care to people with advanced cancer is needed, however, there has not been develop caregiver skills for the EOL in cancer patients. The aim of this research was to study the model development of caregiver skills for the EOL in cancer patients. Mixed methods research was conducted in 3 phases. All subjects were in Ubon Rathchathani Cancer Hospital including 30 EOL cancer patient caregivers, 30 EOL cancer patients, and 111 health care professionals who provided care for the EOL cancer patients and 30 EOL target participants who had been trained to be cancer patient caregivers. The research tools were questionnaires, semi structured interviews, and caregiver skills questionnaires. Data were analyzed by using percentage, mean, standard deviation, pair t-test, and content analysis. The result from this study showed the model development of caregiver skills for cancer patients consisted of 9 domains skills: 1. monitoring, 2. interpreting, 3. making decisions, 4. taking action, 5. making adjustments, 6. providing hands-on care, 7. accessing resources, 8. working together with the ill patients, and 9. navigating the healthcare system. The model composed of skills development curriculum for cancer patient caregivers, Manual of palliative care for caregivers, diary of health care records for cancer patients, and the evaluation model of development of caregiver skills for EOL cancer patients. The results of the evaluation in the development model of caregiver skills for EOL cancer patients showed that the caregivers were satisfied with the model of development for caregiver skills at a high level. The comparison of the caregiver skills before and after obtaining the development of caregivers skills revealed that it improved at a statistically significant level (p < 0.05).

Keywords: caregiver, caregiver skills, cancer patients, end of life

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Authors: K. Shiba, T. Kaburagi, Y. Kurihara

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With global aging, people who require care, such as people with dementia (PwD), are increasing within many developed countries. And PwDs may wander and unconsciously set foot outdoors, it may lead serious accidents, such as, traffic accidents. Here, round-the-clock monitoring by caregivers is necessary, which can be a burden for the caregivers. Therefore, an automatic wandering detection system is required when an elderly person wanders outdoors, in which case the detection system transmits a ‘moving’ followed by an ‘absence’ state. In this paper, we focus on the transition from the ‘resting’ to the ‘absence’ state, via the ‘moving’ state as one of the wandering transitions. To capture the transition of the three states, our method based on the hidden Markov model (HMM) is built. Using our method, the restraint where the ‘resting’ state and ‘absence’ state cannot be transmitted to each other is applied. To validate our method, we conducted the experiment with 10 subjects. Our results show that the method can classify three states with 0.92 accuracy.

Keywords: wander, microwave Doppler sensor, respiratory frequency band, the state transition, hidden Markov model (HMM).

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Authors: Chia-Chen Hsieh, Fei-Hsiu Hsiao

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Objective: To examine the effects of supportive care interventions on depressive symptoms in patients with lung cancer. Methods: The databases of Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and Chinese Electronic Periodical Services (CEPS) were searched from their inception until September 2015. We included the studies with randomized controlled trial design that compared standard care with supportive care interventions using psychotherapeutic or exercises approach. The standardized mean differences (SMD) (Cohen’s d) were calculated to estimate the treatment effects. The Cochrane Risk of Bias Tool was used for quality assessment and subgroup analysis was conducted to identify possible sources of heterogeneity. Results: A total of 1472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = -0.74 with 95% CI = -1.07 to -0.41), and the effect was maintained at the 4th, 8th, and 12th weeks of follow-up. Either psychotherapy combined with psychoeducation or exercise alone produced significant improvements in depressive symptoms, while psychoeducation alone did not. The greater improvements in depressive symptoms occurred in lung cancer patients with severe depressive symptoms at baseline, total duration of interventions of less than ten weeks, and intervention provided through face-to-face delivery. Conclusions: Psychotherapy combined with psychoeducation can help patients manage the causes of depressive symptoms, including both symptom distress and psychological trauma due to lung cancer. Exercise can target the impaired respiratory function that is a cause of depressive symptoms in lung cancer patients.

Keywords: supportive care intervention, depressive symptoms, lung cancer, meta-analysis

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Authors: Akram Farhadi, Mahshid Froughan, Farahnaz Mohammadi, Maryam Rassouli, Maryam Noroozian, Leila Sadeghmoghaddam

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Background: The caregivers’ assessment of their own caregiving is considered the most important concept in exploring their experiences and has a major role in care outcomes. The rising number of people with dementia and their need for care makes family caregiving really important matter to consider and evaluate. Objectives: This study was conducted with the aim to naturalize and validate the Persian version of the Revised Caregiving Appraisal Scale (RCAS) in family caregivers of older adults with dementia. Patients and Method: In this cross-sectional methodological study, the Revised Caregiving Appraisal Scale (RCAS) was translated using International Quality of Life Assessment (IQOLA) protocol, and then a panel of experts examined its face and content validities. To ensure construct validity, the translated Revised Caregiving Appraisal Scale (RCAS) was completed by 236 family caregivers, and factor construct of the scale was assessed with 5 initial factors using confirmatory factor analysis. Internal consistency was found using Cronbach's alpha, and test-retest using intraclass correlation coefficient. Confirmatory factor analysis was performed in LISREL-8.8 software in Windows®. Results: Participating caregivers' mean age was 53.5±13.13 years. Content and face validities of the scale were confirmed according to the views expressed by family caregivers and panel of experts. The confirmatory factor analysis (CFA) results showed appropriate values for all fitness indices (RMSEA=0.046, df/X2=2.428, CFI=0.98, AGFI=0.84, GFI=0.9), and the 5-factor model was confirmed with 27 items. Overall Cronbach's alpha was reported 0.894, and test retest showed overall ICC=0.94. Conclusion: The Persian version of RCAS is a valid and reliable tool for family caregivers' assessment of their caregiving of older adults with dementia, and can be useful in assessing family caregiving interventions.

Keywords: psychometric, family caregivers, reliability and validity, elderly, dementia, self-appraisal

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Authors: Angela T. H. Kwan, Saman Arfaie, Joseph Therriault, Zahra Azizi, Firoza Z. Lussier, Cecile Tissot, Mira Chamoun, Gleb Bezgin, Stijn Servaes, Jenna Stevenon, Nesrine Rahmouni, Vanessa Pallen, Serge Gauthier, Pedro Rosa-Neto

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Alzheimer’s disease (AD) can be detected in living people using in vivo biomarkers of amyloid-β (Aβ) and tau, even in the absence of cognitive impairment during the preclinical phase. [¹⁸F]-MK-6420 is a high affinity positron emission tomography (PET) tracer that quantifies tau neurofibrillary tangles, but its ability to predict cognitive changes associated with early AD symptoms, such as memory decline, is unclear. Here, we assess the prognostic accuracy of baseline [18F]-MK-6420 tau PET for predicting longitudinal memory decline in asymptomatic elderly individuals. In a longitudinal observational study, we evaluated a cohort of cognitively normal elderly participants (n = 111) from the Translational Biomarkers in Aging and Dementia (TRIAD) study (data collected between October 2017 and July 2020, with a follow-up period of 12 months). All participants underwent tau PET with [¹⁸F]-MK-6420 and Aβ PET with [¹⁸F]-AZD-4694. The exclusion criteria included the presence of head trauma, stroke, or other neurological disorders. There were 111 eligible participants who were chosen based on the availability of Aβ PET, tau PET, magnetic resonance imaging (MRI), and APOEε4 genotyping. Among these participants, the mean (SD) age was 70.1 (8.6) years; 20 (18%) were tau PET positive, and 71 of 111 (63.9%) were women. A significant association between baseline Braak I-II [¹⁸F]-MK-6240 SUVR positivity and change in composite memory score was observed at the 12-month follow-up, after correcting for age, sex, and years of education (Logical Memory and RAVLT, standardized beta = -0.52 (-0.82-0.21), p < 0.001, for dichotomized tau PET and -1.22 (-1.84-(-0.61)), p < 0.0001, for continuous tau PET). Moderate cognitive decline was observed for A+T+ over the follow-up period, whereas no significant change was observed for A-T+, A+T-, and A-T-, though it should be noted that the A-T+ group was small.Our results indicate that baseline tau neurofibrillary tangle pathology is associated with longitudinal changes in memory function, supporting the use of [¹⁸F]-MK-6420 PET to predict the likelihood of asymptomatic elderly individuals experiencing future memory decline. Overall, [¹⁸F]-MK-6420 PET is a promising tool for predicting memory decline in older adults without cognitive impairment at baseline. This is of critical relevance as the field is shifting towards a biological model of AD defined by the aggregation of pathologic tau. Therefore, early detection of tau pathology using [¹⁸F]-MK-6420 PET provides us with the hope that living patients with AD may be diagnosed during the preclinical phase before it is too late.

Keywords: alzheimer’s disease, braak I-II, in vivo biomarkers, memory, PET, tau

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Authors: Forhana Rahman Noor, Shafia Jannat Khanam

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The image of old age in Bangladesh is associated with graying of hair, wrinkling of skin, with poor physical health, and decreased ability to work. The common expression “bura hoechi”, to be aged, means to be limited in terms of performing economically productive activities, known as ‘work’. For ‘old-old’ age, there is a saying, “uthan akhon onek dure”, which literally means “even the courtyard is like a very distant place (for an old person).” Traditionally, Bengali society had a structure caring the life of older people. It was common in the joint families of Bangladeshi culture. The situation has been changing. Complexities of the societies with growing rapid urbanization are influencing the traditional respects and caring structure of the elderly persons and facing social challenges. Bangladesh is projected to have 10 percent of its population of age 60 years and above in the year 2025. The ageing process is expected to accelerate in the next century, mainly because the large cohorts born in 1950s and 1960s respectively will be joining the ranks of 60 years and over during this period. The decline in mortality, particularly at young ages, also means that a higher proportion of the large cohorts will survive to old age. The country does not have enough policy or strategy to face this upcoming challenge for the aged persons which needs immediate attention.

Keywords: ageing, gender, dimension, elderly population, Bangladesh

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