Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework

As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.

The construction and practice of humanistic care teaching model based on 5C care theory

Objective:To construct a scientific and feasible teaching mode based on 5C caring theory and evaluate it,so as to provide a reference basis for future study about nursing humanistic quality education.Methods:Based on the 5C caring theory,the teaching design and teaching content were revising and implementing in the intervention group.Before and after the implementation of the course,a questionnaire survey was conducted using the Caring Ability Inventory(CAI).The results of the surveys were collected,and the data were statistically analysis using SPSS.Results:After the implementation of the course,the cognitive dimension,patience dimension,and humanistic caring ability scores of the nursing students in the intervention group improved compared with those before the implementation of the course(P<0.05).There were no significant difference in the control group(P>0.05).Conclusion:The humanistic caring teaching model based on 5C caring theory has a positive effect on improving nursing students'humanistic caring ability.In the future nursing teaching,the modules with the characteristics of humanistic caring ability can be increased,and carry out the educational reform throughout the humanistic caring ability.Actively guiding nursing students to establish the awareness of humanistic caring,so as to lay a solid foundation for high-quality clinical nursing work.

Analysis of the Application Effect of Family Collaborative Care Model on Elderly Patients with Type 2 Diabetes Mellitus and the Situation of Self-Care Ability

Objective: To study the application effect of the family collaborative care model on elderly patients with type 2 diabetes mellitus and its influence on self-care ability. Methods: The elderly type 2 diabetes mellitus patients (400 cases) treated in our hospital between March 2020 and July 2023 were divided into two groups by randomized grouping method;the control group received the conventional nursing program, while the observation group received the family collaborative nursing model. Blood glucose level, self-care ability, and quality of life were compared between the groups. Results: The blood glucose level of the observation group was lower than that of the control group (P < 0.05). The self- care ability and quality of life scores of the observation group were higher than those of the control group (P < 0.05). Conclusion: The family collaborative care model for elderly patients with type 2 diabetes mellitus can promote their self- care ability, improve the effect of glycemic control, and improve their quality of life, and is suitable for further promotion and application.

Analysis of the Effect of Integrated Extended Care Model in Improving the Quality of Life of Elderly Patients with Type 2 Diabetes Mellitus

Objective: To analyze the impact of an integrated extended care model on improving the quality of life of elderly patients with Type 2 Diabetes Mellitus (T2DM). Methods: A total of 176 patients admitted to the hospital from March 2015 to February 2018 were selected and randomly assigned to an observation group and a control group, with 88 patients each. The control group implemented conventional nursing interventions, and the observation group carried out an integrated extended-care model. The level of glycemic control, quality of life, and daily medication adherence between both groups were compared. Results: The observation group showed significant improvement in the level of glycemic control, and their fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin levels were significantly lower as compared with those in the study group (P < 0.05). The quality of life of the patients in the observation group was higher than that of the control group (P < 0.05). The observation group had a higher compliance score (95.48 ± 7.45) than the control group (81.31 ± 8.72) (t = 8.909, P < 0.05). Conclusion: The integrated extended care model allows patients to receive comprehensive and individualized nursing services after discharge, which improves the effect of drug therapy and the quality of life of patients.

Physiology and health assessment,risk balance,and model for endstage liver disease scores:Postoperative outcome of liver transplantation

BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.

个性化护理联合CICARE沟通模式在耳鼻喉门诊患者中的应用

目的:探讨个性化护理联合CICARE沟通模式在耳鼻喉门诊患者中的应用效果。方法:采用便利取样法将2022年6月1日~2023年12月31日就诊于耳鼻喉门诊的256例患者作为研究对象,将2022年6月1日~2023年1月31日就诊的128例作为对照组,将2023年2月1日~12月31日就诊的128例作为实验组;对照组给予常规耳鼻喉门诊护理,实验组给予个性化护理联合CICARE沟通模式;比较两组护理前后护理质量、护理满意度。结果:护理后,实验组有形性感知、可靠性感知、响应性感知、保证性感知评分均高于对照组(P<0.05,P<0.01),两组移情性感知比较差异无统计学意义(P>0.05);护理后,实验组服务态度、沟通能力、就诊秩序、专业素质、护理安全、护理满意度总分均高于对照组(P<0.05,P<0.01)。结论:将个性化护理联合CICARE沟通模式应用于耳鼻喉门诊患者中,能够提高护理质量和护理满意度。

Development of the Transitional Care Model for nursing care in China's Mainland:A literature review

Background:The Transitional Care Model(TCM)for nursing care has yet to be implemented in China despite its success in Western countries.However,rapid social changes have demanded an upgrade in the quality of nursing care;in 2010,the Chinese government has acknowledged the need to implement the TCM in China.Objective:This study has the following objectives:(1)perform a thorough review of the literature regarding the development and implementation of the TCM in China's Mainland within the past 5 years;(2)provide a comprehensive discussion of the current status,problems,and strategies related to the implementation of the TCM in China's Mainland;and(3)suggest strategies pertaining to the future of the TCM in China.Design:The current pertinent literature is systematically reviewed.Data sources:Systematic and manual searches in computerized databases for relevant studies regarding the TCM led to the inclusion of 26 papers in this review.Review methods:Abstracts that satisfied the inclusion criteria were reviewed independently by the two authors of this manuscript,and discrepancies were resolved through discussion.The same reviewers independently assessed the paper in its entirety for selected abstracts.Results:The present English literature reviewrevealed a paucity of updated information about the development and implementation of the TCM in China's Mainland.Nevertheless,the dramatic growth of the TCM in the past 5 years has had a vital impact within the society and in nursing development.This review also revealed numerous issues regarding the focus of the TCM.Overall implications for practiceandrecommendations for future researchare discussed.Conclusion:Despite the potential of this nursing model to have a successful and beneficial impact in China's Mainland,it remains an under-researched topic.Further research on education and training as well as premium policies for nurses under the TCM are needed.

Development of a prediction model for enteral feeding intolerance in intensive care unit patients:A prospective cohort study

BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.

The efficacy of the seamless transfer of care model to apply for the patients with cerebral apoplexy in China

Purpose:To evaluate the efficacy of the Seamless Transfer of Care Model(STCM)to improve readmission occurrence of patients withstroke.Methods:The sample was comprised of fifty-nine subjects with stroke who were hospitalized in the geriatric and neurology departments of a large university hospital in China.Subjects were allocated to an STCM group(n=30)or a routine care(control)group(n=29).Results:Compared with the control group,the STCM group had a higher quality of life(p<0.05),higher compliance(p<0.05)and a lower readmission rate(p<0.05).Conclusion:Based on our results,the application of the STCM in Chinese stroke patients can improve quality of life and compliance,and reduce readmission rate.

Chronic care model in the diabetes pay-for-performance program in Taiwan:Benefits,challenges and future directions

In this review,we discuss the chronic care model(CCM)in relation to the diabetes pay-for-performance(P4P)program in Taiwan.We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan,mapping them onto the 6 components of the CCM.For each CCM component,the following three topics are described:the definition of the CCM component,the general activities implemented related to this component,and practical and empirical practices based on hospital or local government cases.We then conclude by describing the possible successful features of this P4P program and its challenges and future directions.We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives(i.e.,shared care network),physician-led P4P and the implementation of activities based on the CCM components.However,due to the low rate of P4P program coverage,approximately 50%of patients with diabetes cannot enjoy the benefits of CCMrelated activities or receive necessary examinations.In addition,most of these CCM-related activities are not allotted an adequate amount of incentives,and these activities are mainly implemented in hospitals,which compared with primary care providers,are unable to execute these activities flexibly.All of these issues,as well as insufficient implementation of the e-CCM model,could hinder the advanced improvement of diabetes care in Taiwan.

Shared Decision-Making after Implementation of the Chronic Care Model (CCM)—An Evaluative Approach

Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.

Using Roy’s Model to Evaluate the Care Given to Postpartum Women Following Caesarean Delivery

Background: To evaluate the care given using Roy’s Adaptation Model. Materials and Methods: A pretest-posttest experimental model with a control group. Study population comprised postpartum women (N = 134;65 in the experimental group, 69 in the control group) who had caesarean full-term delivery in a Turkish maternity hospital between September 2009 and February 2011. Data were collected from the experimental group during seven home visits and from the control group at the end of the 6th week postpartum. Results: Percentage, chi-square, arithmetic mean, standard deviation, and the McNamer test were used to evaluate data establishing 36 nursing diagnoses: Physiological requirements (22), Self requirements (7), Role Function requirements (4), and Interdependence Mode requirements (3). It was determined that the care given during the postpartum period using Roy’s Adaptation Model resolved or prevented the majority of postpartum problems. The difference between most diagnoses was found to be statistically significant (p p < 0.001) during the last week of data collection. Conclusion: The care given in the postpartum period using Roy’s Adaptation Model resolved or prevented postpartum problems.

Retrospective analysis of hepatitis C infected patients treated through an integrated care model

AIM To determine if our health system's integrated model reflects sustained virologic response(SVR) outcomes similar to those in clinical trial data, maximizes adherence, and averts drug interactions.METHODS Subjects with chronic hepatitis C had their medical records reviewed from November 1st, 2014 through March 1st, 2016. Patients eligible for treatment were entered into an integrated care model therapy algorithm. The primary outcome was SVR12 based on intention to treat(ITT) analysis. Inclusion criteria consisted of both treatment na?ve and experienced patients over the age of 18 who were at least twelve weeks post-therapy completion with any genotype(GT) or METAVIR score. Secondary outcomes included adherence, adverse events, and number of drug interaction interventions.RESULTS At the time of analysis, 133 patients had reached twelve weeks post therapy with ITT. In the ITT analysis 70 patients were GT 1a, 26 GT 1b, 23 could not be differentiated between GT 1a or 1b, 8 GT 2, 4 GT 3, and 2 patients with multiple genotypes. The ITT treatment regimens consisted of 97 sofosbuvir(SOF)/ledipasvir(LDV), 8 SOF/LDV and ribavirin(RBV), 7 SOFand Simeprevir(SMV), 6 3D and RBV, 1 3D, 11 SOF and RBV, and 1 SOF, peg interferon alpha, and RBV. The overall SVR12 rate was 93% in the ITT analysis with a total of 6 patients relapsing. In patients with cirrhosis, 89% obtained SVR12. All 33 patients who were previous treatment failures achieved SVR12. Drug-drug interactions were identified in 56.4% of our patient population, 69 of which required interventions made by the pharmacist. The most common side effects were fatigue(41.4%), headache(28.6%), nausea(18.1%), and diarrhea(8.3%). No serious adverse effects were reported.CONCLUSION Dean Health System's integrated care model successfully managed patients being treated for hepatitis C virus(HCV). The integrated care model demonstrates high SVR rates amongst patients with different levels of fibrosis, genotypes, and HCV treatment history.

Remote nursing training model combined with proceduralization in the intensive care unit dealing with patients with COVID-19

The shortage of personal protective equipment and lack of proper nursing training have been endangering health care workers dealing with coronavirus disease 2019(COVID-19).In our treatment center,the implementation of a holistic care model of time-sharing management for severe and critical COVID-19 patients has further aggravated the shortage of intensive care unit(ICU)professional nurses.Therefore,we developed a short-term specialized and targeted nursing training program to help ICU nurses to cope with stress and become more efficient,thus reducing the number of nurses required in the ICU.In order to avoid possible human-to-human spread,small teaching classes and remote training were applied.The procedural training mode included four steps:preparation,plan,implementation,and evaluation.An evaluation was conducted throughout the process of nursing training.In this study,we documented and shared experiences in transitioning from traditional face-to-face programs to remote combined with proceduralization nursing training mode from our daily work experiences during the COVID-19 pandemic,which has shown to be helpful for nurses working in the ICU.

Evaluating Improvement in the Care of Depressed Elderly Patients: An Empirical Approach to the WHO Patient Safety Model

Depression among the elderly is a public health issue. This paper demonstrates the value of patient safety research for future strategies in this area. The aim of the present study was to analyse the relationship between the World Health Organization (WHO) Patient Safety (PS) Model and empirical research on depressed elderly patients’ experiences of quality and safe care. The research question was: Which patients’ experiences could be linked to quality and safe care as recommended by the WHO? We adopted an implementation approach as the starting point for this interdisciplinary project. A total of 29 individual narrative-based, in-depth interviews were performed to explore patients’ experiences and two healthcare teams participated in the focus group interviews. Interpretation of the results revealed that the 23 components of the PS model were linked to elderly patients’ experiences of quality and that safe care was not achieved. There was evidence of low quality and lack of safe care due to psychological distress, stress and fatigue, the absence of involvement in decision-making, misdiagnosis, sleep problems as a result of harm from medical error and a poor physical state. Patients’ experiences of loneliness gave rise to suicidal thoughts. In conclusion, quality improvement is necessary in all components of the WHO PS model. We recommend structural, process and outcome improvements, more specifically: active involvement, shared decision-making and increased self-management.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Predictive modeling in neurocritical care using causal artificial intelligence

Artificial intelligence(AI)and digital twin models of various systems have long been used in industry to test products quickly and efficiently.Use of digital twins in clinical medicine caught attention with the development of Archimedes,an AI model of diabetes,in 2003.More recently,AI models have been applied to the fields of cardiology,endocrinology,and undergraduate medical education.The use of digital twins and AI thus far has focused mainly on chronic disease management,their application in the field of critical care medicine remains much less explored.In neurocritical care,current AI technology focuses on interpreting electroencephalography,monitoring intracranial pressure,and prognosticating outcomes.AI models have been developed to interpret electroencephalograms by helping to annotate the tracings,detecting seizures,and identifying brain activation in unresponsive patients.In this mini-review we describe the challenges and opportunities in building an actionable AI model pertinent to neurocritical care that can be used to educate the newer generation of clinicians and augment clinical decision making.

Adapting chronic care models for diabetes care delivery in low-and-middle-income countries:A review

A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.

Why Do We Care for Old Parents? Evolutionary Genetic Model of Elderly Caring

From the standpoint of evolution, caring for old parents may be maladaptive, because they have ceased reproduction, so that the benefit for inclusive fitness may not be expected. Then why do we care for old parents? In this study, the evolution of care for the elderly was examined, by using an evolutionary genetic model, in which pleiotropic constraints between behaviors expressed in different social contexts among family members were assumed. It was suggested that establishing a solid relationship with parents during infancy should be selectively favorable, even though old parents have to be cared for in the future, but that caring for old parents may be excluded from the population if this behavior imposes high costs on reproduction of the younger generation. Despite the diminishing numbers of individuals within the population, care for the elderly may not be readily selected against, but at the same time this may not contribute to the rate of increase in population size. The significance of discussing the behavior of elderly caring from the standpoint of evolutionary genetics was emphasized.

Evaluating health care financing in a highly decentralized Beveridge model

The Finnish health care system is financed in a highly decentralized manner. In the tax-financed Beveridge model each municipality is responseble for financing and organizing health care services for its residents. This paper examined the annual incidence and treatment costs of three cost-intensive DRG-groups, and all DRG-groups together. The objective was to estimate municipal level predictions on the incidence of new illness cases and their associated costs, and to analyze whether there was greater uncertainty in anticipated specialized health care costs in municipalities with smaller populations. The dataset comprised of longitudinal hospital utilization and discharge data from Hospital Discharge Registers. The expected annual variation of illness cases and costs was assessed with respect to 95% confidence intervals estimated for each morbidity group and municipality. The results indicated that the costs of the selected morbidity groups fluctuated in a completely uncontrollable manner in municipalities with small populations. As the median size of Finnish municipalities is less than 6000, the inability to anticipate periodic health care costs constitutes an extensive financial problem and calls for the establishment of larger regional units and funding pools.