Influences of Horticultural Therapy and Functional Recovery Training at a Day-Care Center for the Elderly and Text Mining of Care Records by AI

Background: In Japan, due to the COVID-19 pandemic, various behavioral restrictions were implemented from March 2020, resulting in an increased number of elderly people with reduced participation in care and rehabilitation. As a result, the decline in motor and cognitive functions became more pronounced. Purpose: The study examined how activities combining passive horticultural therapy, which is always introduced, with active functional recovery training, which is used in the functional recovery training of patients with hemiplegia, influence the behavior of elder people using the facility. Methods: 36 elder people with care need 1 or 2 who regularly used the day-care facilities after the pandemic ended and who agreed to participate in the study was included. The assessment data were every three months from December 2021 to December 2023 after the COVID-19 pandemic, the MMSE and Moca-J, TMIG-Index, and GDS15. AI-based text mining was used to compare changes in visit reports before and after the introduction of the Posture Chart and Red Code, and the relationship between the language used. Results: The results of MMSE and Moca-J were both significantly higher in Group B and C than in Group A. TIMG assessment, was significantly higher in Group B and C than in Group A, and Group C was significantly higher than Group B. The GDS, an assessment of depression in old age, tended to be significantly higher in Group A than in Groups B and C. In the “Co-Occurrence Network Analysis” shown after the introduction of the latest functional recovery training equipment such as the Red Cord, its results showed a high association between the words Bathing and CARE and words such as POSTURE, Red-Code, and AI, App, which are used in functional training and rehabilitation, and their analysis. Conclusion: At day-care facilities specializing in functional recovery training and rehabilitation, a combination of horticultural therapy and the latest functional training equipment found to help maintain the physical and mental health of elderly people certified as requiring nursing care. Since this is a short-term study following behavioral restrictions, long-term research should continue to study the effects of adding functional training, handled by rehabilitation professionals, to horticultural therapy.

Assessment of Breast Cancer Prevention Practices among Women Attending Primary Health Care in Abha City, Aseer Region, Saudi Arabia

Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.

Envita’s Precision Cancer Care: 35-Fold Improvement in Response Rates

New clinical approaches are imperative beyond the widely adopted National Comprehensive Cancer Network (NCCN) guidelines, utilized by prominent cancer institutions. Cancer is the leading cause of death among individuals younger than 85 years within the United States. Despite significant technological advances, including the expenditure of hundreds of billions, treatment outcomes and overall survival have not notably improved for most types of advanced cancer over the last several decades. Over the past 24 years, Envita Medical Centers has pioneered a unique form of personalized treatment approach for late-stage and refractory cancer patients, introducing groundbreaking innovations in the field. Our integrated algorithm utilizes advanced genomics, transcriptomics, and highly tailored immunotherapy, resulting in remarkable outcome improvements. This study presents Envita’s innovative personalized treatment algorithms and examines the response outcomes of 199 late-stage cancer patients treated at Envita Medical Centers over a two-year period. Compared to standard of care and palliative chemotherapy, Envita’s treatment demonstrated a remarkable 35-fold improvement in overall response rates (Figure 1). Moreover, 88% of the patients, the majority presenting with Stage 3 or 4 cancer, experienced a 43-fold improvement in quality of life with minimal side effects, as compared to standard of care chemotherapy and palliative care. This revolutionary success is attributed to Envita’s personalized therapeutic algorithms, which incorporate customized immunotherapy. Envita’s precision care approach has also achieved a 100% better response rate compared to over 65 global chemotherapy clinical trials with more than 2700 patients. The results from this study suggest that a wider utilization of Envita’s personalized approach can significantly benefit patients with late-stage and refractory cancer.

U. S. Academic Medical Centers Under the Managed Health Care Environment

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U. S. health care system through their missions of conducting cutting-edge biomedical researeh, pursuing clinical and technological innovations, Providing state-of-the-art medical care and producing highly qUalified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical sciTo survive the threats of managed care in the health care environment, acadendc medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 1h8 CEOs in all the academic medical centers in the U. S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

Family Centered Care versus Child Centered Care: The Malawi Context

Family Centered care is a model that is practiced and encouraged in child health care. It considers family as partners and collaborators in care of children. It aims at involving family in all aspects of child care. Family centered care also mentions involvement of child. However, emphasis is given more on family than child and does not take into account the older child’s capacity for independent decision making and right to privacy. As such, child’s needs are missed out. With child centered care, children are involved and supported at all levels of care based on their age and developmental stage. This paper aims to stress the importance of involving children within family centered care. Involving children in their care, makes them feel less threatened by the health care professional and their self esteem is promoted. Currently, no studies have been identified in Malawi that demonstrates full partnership between the family, child and the nurse. Furthermore, Family Centered Care and Child Centered Care as models are not fully practiced. It is therefore important to practice both family and child centered care in child health care if the needs of both family and children are to be addressed concurrently.

Practical Experience of Establishing German Standard Level 1 Perinatal Center in Chongqing Health Care for Women and Children

Germany,as a western developed country,has an advanced medical level,especially in the health care of very immature premature infants.We trace the medical history of perinatology to understand the development of perinatal centers in Germany.After analyzing the classification and function,hierarchical management and quality control systems of German perinatal centers,we established a German standard level 1 perinatal center in the Chongqing Health Center for Women and Children(CHCWC).During more than two years of practice,we changed concepts,continuously updated clinical knowledge and skills,developed a series o f high-quality work processes and supervision systems and introduced advanced medical equipment.We believe that the experience of establishing a German standard level 1 perinatal center and perinatal center network in Chongqing is worthy of being promoted to the Chinese maternal and child health care system.

Study of the Conditions Surrounding Fatigue That Are Common to Medical Professionals Working in Emergency and Critical Care Centers in Japan

This study aimed to clarify the conditions surrounding fatigue that are common to medical professionals working in emergency and critical care centers in Japan. Semi-structured interviews were conducted with eight professionals ranging from doctors, nurses and pharmacists to clinical engineering technologists and radiation technologists. Their narratives were analyzed using the qualitative descriptive approach to determine fatigue common to all professionals and the reasons behind it. The five categories that emerged as the reasons for fatigue common to the subjects were [playing one’s role in treatment and procedures for emergency and critical patients], [accommodating the patient’s background and coming to terms with the outcome], [difficulties in liaising with other professionals], [feeling pressure as a responsible professional in emergency care] and [loss of sense of time caused by variable working hours]. The results revealed that fatigue common to all of the subjects was related to dealing with patients, coordinating with other professionals, having professional responsibilities and the working environment. This study suggests that arrangements to improve the working environment, ensure adequate staffing, and provide mental health support for the well-being of medical professionals working in emergency and critical care centers are necessary.

Job Satisfaction and Mental Health among Physicians in Primary Health Care Centers in Kuwait

Objectives: To measure the level of job satisfaction among primary health care physicians Ministry of Health (MOH) Primary Healthcare Center (PHC) physicians, to evaluate the physicians’ mental health, and to assess their associated factors. Study Setting: Kuwait Ministry of Health, Primary Care Centers. Study Design: Cross-sectional study. Data Collection: The study was conducted from July to September, 2017. Of 746 questionnaires distributed to all PHC physicians in the MOH, 417 questionnaires were completed. Information was collected on socio-demographic characteristics, work and health-related factors, job satisfaction (using the Warr-Cook-Wall job satisfaction scale), and mental health (using General Health Questionnaire). Principal Findings: Of participants, 40.8% were male, and 24.9% were Kuwaitis. Median overall job satisfaction was 71.4%. There were significant differences in overall job satisfaction with the physician rank (p = 0.008) and governorate (p = 0.05). The GPs were moderately satisfied with work surroundings;work freedom;recognition;degree of responsibility;salary;opportunity to use abilities;attention given to suggestions;relationship with hospital physicians, colleagues, and fellow workers;relations between management and workers;working hours;and the amount of variety in their job, but more satisfied with their immediate supervisors. Conclusions: Job satisfaction of PHC physicians is critical for the improvement of health systems. This study showed that GPs (General Practitioners) were more satisfied overall than previously reported studies done in Kuwait. They were moderately satisfied with their salary and the amount of variety in work.

Earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province, Iran: A case study

Objective: To study earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province. Methods: This is a descriptive-analytical survey based on the quantitative and qualitative characteristics of Tiran and Karvan County Health Care Centers(HCCs). Twenty quantitative and qualitative indicators were derived from the studied HCCs and analyzed using the strengths, weaknesses, opportunities and threats analysis technique. The top crisis management strategies were identified and a number of strategies and solutions were proposed. Results: The HCC utilities such as water, electricity, gas, and heating and cooling systems were in average condition, whereas the facilities of the majority of HCCs were in vulnerable-to-average condition. In addition, they sustained relatively high degree of instability which calls for reassessment and effective policies to minimize weaknesses and eliminate threats using strengths and opportunities. Conclusions: It is recommended that the condition of Tiran and Karvan County HCCs be enhanced by distributing new HCCs based on the population density, expanding the road network and creating vast, wide-open spaces to enable field hospital construction in times of crisis.

Quality-Oriented Climate and Service Quality Among Healthcare Providers： Evidence From a Rehabilitation Center in Italy

The importance of quality in service provision is widely recognized in health service research. However, a limited number of studies have investigated antecedents of quality in healthcare service provision. This article tries to shed further light on this under-researched field. Specifically, the aim of this study is to verify the relationship between the quality-oriented climate and service quality as perceived by employees. The study was conducted in a private non-profit Rehabilitation Centre in Italy using a questionnaire administered to all healthcare workers. The questions focused on perceptions of quality-oriented climate （priorization of quality care, social cooperation, and exchange）, four different connotations of the quality in healthcare provision （provision of high quality service, adequacy of time spent with patients, freedom in clinical decisions, and continuing relationships with patients）, as well as on respondents＇ background. Of the 248 healthcare workers, 183 completed the questionnaire. Hierarchical regression analysis was used to study the relationship between quality-oriented climate and outcome variables （quality in healthcare provision）. The results suggest that a quality-oriented climate does explain service quality in Healthcare settings： When an organization has implemented a quality-oriented climate, the service care provided by healtheare workers can determine an increase for three of the four investigated aspects of quality service provision （quality of care, freedom to make clinical decisions to meet patients＇ needs, and continuing relationships with patients）. The paper demonstrates that the offer of quality services involves in a different way the various healthcare professionals and/or management staff. This research provides interesting findings for healthcare manager in Health Service settings regarding the management of a quality-oriented process of service provision.

People-Centered Care: Concept Analysis

Purpose: This study aims to clarify the definition, attributes, antecedents, and consequences of the concept of people-centered care (PCC). Method: Rogers and Knafl’s evolutionary method was used to analyze the concept of People-centered care. The cords such as “Attributes,” “Antecedent,” and “Consequences” were extracted on the coding sheet. The extracted contents of each of the “Attributes,” “Antecedent,” and “Consequences” from the created coding sheets were summarized as codes, and similar codes were categorized. Result: We included 33 studies in the analysis. As a result of the analysis, we identified four attributes (the subject is people, approaches to improving and enhancing health issues, relationships as a basis for partnership building, and behavioral attitudes for building partnerships), four antecedents (changes in social conditions, increasing people’s ownership of their health, health issues in modern society, and care in a variety of settings), and three consequences (achieving goals set by the people themselves, self-transformations of both people and healthcare providers, and social transformations). Discussion: Based on the analysis results, PCC was defined as “an initiative in which people step forward and partner with health care providers to improve and enhance health issues in individuals and communities.” In various social and individual changes, the realization of PCC is expected to result in the achievement of goals set by the people themselves together with health care providers and the transformation of individuals and society.

Challenges for Nurses in Providing Patient-Centered Care in Rural Primary Health Care Clinics in Nigeria

Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.

Factors Influencing Patient-Centered Care in the Primary Health Care Settings: The Impact of the Pandemic Crisis and Nurses’ Experience

Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.

以家庭为中心的赋能健康教育模式在剖宫产初产妇早期母乳喂养中的应用

目的探讨以家庭为中心的赋能健康教育模式在剖宫产初产妇早期母乳喂养中的应用效果。方法选取2021年11月-2022年1月在我院计划行剖宫产的初产妇及其照顾者93例作为对照组,采用常规健康教育宣教方法,宣教对象主要为初产妇本人;选取2022年3-7月在我院计划行剖宫产的初产妇及其照顾者98例作为观察组,在对照组基础上实施以家庭为中心的赋能健康教育模式。比较2组初产妇及其照顾者干预前后母乳喂养知识情况;干预前后初产妇婴儿喂养态度、母乳喂养家庭支持;干预后初产妇泌乳Ⅱ期启动时间和出院时纯母乳喂养率。结果干预前2组初产妇及照顾者各指标比较,差异均无统计学意义(P>0.05);干预后,观察组初产妇及其照顾者母乳喂养知识,以及初产妇婴儿喂养态度、母乳喂养家庭支持、泌乳Ⅱ期启动时间和出院时纯母乳喂养率方面均优于对照组(P<0.05)。结论以家庭为中心的赋能健康教育模式能提高产妇及照顾者的母乳喂养知识,提升婴儿喂养态度及母乳喂养家庭支持,缩短泌乳Ⅱ期启动时间,提高产妇出院时纯母乳喂养率。

基于SERVQUAL模型的基层医疗卫生服务质量评价研究

目的:在县域医共体的建设背景下,评价社区卫生服务中心服务质量及影响因素,提出基层医疗卫生服务质量改善对策。方法:运用SERVQUAL模型,从社区卫生服务中心服务质量的有形性、可靠性、响应性、信任性、移情性方面,形成问卷条目;通过多因素二分类logistic回归探索筛查服务质量差距的影响因素;借助IPA象限图呈现居民对社区卫生服务中心的SERVQUAL模型各维度服务质量重要性的分布情况。结果:问卷各项条目的服务质量差距均为负值,服务保证性和移情性维度的服务质量差距得分最高,分别为-0.47±0.59分和-0.47±0.65分;服务有形性维度的服务质量差距得分最低,为-0.40±0.55分。年龄、收入情况和慢病年限是服务质量差距的影响因素。结论:当前基层医疗卫生服务质量与居民的期望之间存在一定差距,基层医疗卫生服务机构应重视对低年龄、高收入和慢病病程较长的居民的服务需求。

根因分析法3C护理对消毒供应中心护理质控成效的影响

目的探讨消毒供应中心在开展护理管理过程中运用根因分析法3C护理模式对降低护理缺陷事件发生率以及质控成效的影响。方法福建省立医院消毒供应中心2022年6月1日开始运用根因分析法进行3C护理,分析实施前后各1年(2021年6月—2023年6月)消毒供应中心护理管理工作质量。结果评估实施前后各护理管理质量,实施后环境管理(93.01±3.11)分、安全管理(94.15±1.86)分、物品管理(92.11±1.86)分、检查管理(93.46±1.58)分,均明显高于管理前的(82.14±2.34)分、(81.45±1.86)分、(83.45±1.45)分、(80.05±2.34)分(P<0.05)。随机抽选两观察时间段患者500例,实施后护理缺陷事件发生率为0.20%,低于实施前的5.00%(P<0.05)。实施后院内感染率为1.00%,低于实施前的9.40%(P<0.05)。实施后对消毒供应中心护理工作满意度为98.00%,高于实施前的92.00%(P<0.05)。结论消毒供应中心在开展日常护理管理过程中将根因分析法3C护理进行运用,可以降低护理缺陷事件发生率,提升质量控制效果,对于提升消毒供应中心护理工作质量有重要作用。

以家庭为中心的产科护理模式在预防产后抑郁症中的应用研究进展

产后抑郁症是一种育龄期妇女生产过程中的特发性精神障碍疾病。对产妇而言,在生理、心理、社会、文化等因素的影响下出现负面情绪,极易导致产后抑郁症的发生。以家庭为中心的产科护理模式是将产科护理技术、家庭社会支持与产妇积极配合有机结合,给予产妇身心整体照顾,不但能预防产妇产后抑郁症,维持母婴健康,也能帮助建立健全其家庭功能,促进家庭和睦。文章综述了以家庭为中心的产科护理模式的应用现状、阻碍因素,并从家庭支持、医护人员培养、社会支持、照护方式等方面提出展望,旨在增进国内家庭对产后抑郁症的认识及对以家庭为中心的产科护理模式的了解,从而为提升产妇心理健康水平助力。

药师参与下的标本评估对万古霉素血药浓度解读的改善性研究

目的评价由药师参与下的血液标本质量评估对万古霉素血药浓度解读的影响。方法回顾性收集2022年1月—12月在武汉市第一医院使用万古霉素抗感染治疗并监测血药浓度的患者资料。以不合格标本分布类型及占比、科室分布、再评估不合格标本复查前后结果差值、血药浓度分布等作为观察指标。结果共纳入92例患者,177个血液标本,涉及20个科室,最终进入谷浓度监测环节的有162个。59个(36.42%)标本合格且浓度达窗(10~20 mg/L),浓度不足10 mg/L占22.84%(37/162个),高于20 mg/L占30.86%(50/162个)。合格标本共115个(64.97%)。不合格标本共62个(占35.03%),初评估不合格15个(8.47%),再评估不合格47个(26.55%)。对再评估不合格的标本在规范宣教后进行复测,其中有44个前后浓度结果具有显著差异(P<0.05),其中“给药后采血”的情况,复测前后差值最大(-16.5 mg/L)。结论以标本为中心的管理模式下,在分析前和分析后分别对标本做合理评估,使得万古霉素TDM数据的可靠性大大提升,临床应用价值得到充分发挥。

以家庭为中心的出院准备计划对先天性消化道畸形患儿出院准备度的影响

目的探讨以家庭为中心的出院准备计划对先天性消化道畸形患儿出院准备度的影响。方法采用类实验设计,上海交通大学医学院附属新华医院儿外科收治的先天性消化道畸形患儿按住院时间顺序分为对照组和干预组,每组33例。对照组,入院时发放居家康复知识图文手册,住院期间由责任护士承担患儿的所有护理任务,出院时给予常规宣教;干预组,实施以家庭为中心的出院准备计划,基本原则是通过授权父母参与共同照护患儿。向患儿父母发放相关问卷进行调查,比较2组的出院准备度、出院指导质量评价及父母的焦虑状况。结果出院时,干预组的出院准备度总分及除期望得到的支持维度以外的其他维度得分、出院指导质量评价得分均高于对照组(P<0.05);出院时及居家照护后2周,干预组患儿父母的焦虑水平均显著低于对照组(P<0.01)。结论对先天性消化道畸形患儿实施以家庭为中心的出院准备计划,可有效提高出院准备度并缓解父母的焦虑情绪,有助于患儿与父母顺利应对出院早期的困境。

“我的健康我做主”:宏观叙事医学视域下医患交流患者争取权力言语行为研究

近年来,中国医患冲突问题引起世界范围内的关注,从本质上改进医患交流质量刻不容缓。从广义叙事医学视角出发,结合社会语言学领域对语言与权力关系的探究,聚焦患者的主体性,致力于探讨医院情境医患交流过程中患者是否以及如何通过话语来展开权力协商。采用交际民族志方法对辅助生殖医学领域内的医患交流进行实地考察,收集田野笔记医患会话录音材料。在扎根理论的指导下对数据进行了编码分析。研究发现:患者在交流中采纳了七类言语行为来“争取权力”:“寻求诊疗建议”“寻求医疗信息”“确认行动指导”“提供信息”“参与决策”“建立关系”以及“维护隐私权”。每一类言语行为都具有多样化的表现形式,在医院特定场景中呈现出不同的分布特征。关注医患交流中的患者视角,丰富对患者主体性的考察,是对“以患者为中心”的交流模式的具体化补充和发展。