Mid-Term Review of the Care Group Model Used in Five Pilot Districts in Zimbabwe

Stunting has remained the nutrition condition of public health concern affecting one in three children under the five years Zimbabwe.Causes of stunting are multiple and poor infant and young child feeding(IYCF)practices are among the top factors associated with stunting.IYCF indicators in Zimbabwe are not performing very well with 61%of children 0 to 5 months being exclusively breastfed,and only 7%of children 6 to 23 months receiving minimum acceptable diet(MAD).The care group approach been piloted in 5 districts to promote and influence behaviour change towards uptake of optimal IYCF practices.The paper assesses progress made in the implementation of the approach after six months of implementation.Results show that implementation of the care group approach,with appropriate coordination structures at community level,yields considerable improvement in health,IYCF,and water and sanitation hygiene(WASH)behaviours and practices.Community level initiatives like income generating activities,food production,and cooking demonstrations are proving to be the sustainability pillars for the care group approach.Conclusively,with proper leadership and coordination,care groups help to affect behaviour change in improving the health,nutrition and caring practices for children.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

Improving Infant and Maternal Health through CenteringPregnancy: A Comparison of Maternal Health Indicators and Infant Outcomes between Women Receiving Group versus Traditional Prenatal Care

Background: Despite efforts to increase participation in prenatal care, outcomes for women and infants in the United States remain below global and national health targets. CenteringPregnancy, a model of group prenatal care, incorporates practices consistent with national and international guidelines while allowing for greater freedom in providing content tailored to the specific needs of women receiving care. Objective: To determine whether the CenteringPregnancy model improves maternal and neonatal health indicators such as prenatal care attendance, smoking cessation, weight gain during pregnancy, gestational age at delivery, mode of delivery, and initiation and continuation of breastfeeding. Methods: A retrospective study was conducted including all pregnant women participating in CenteringPregnancy at two prenatal clinic sites in southwest Michigan from January 2010 to April 2012 (n = 173). A comparison group of women receiving traditional care from certified nurse-midwives was created using propensity scores to match for age, race, and insurance status (n = 170). A chart review was performed to analyze maternal and neonatal health indicators including attendance at prenatal visits, gestational age at delivery, baseline maternal weight and weight gain during pregnancy, smoking cessation, infant birth weight, mode of delivery (vaginal birth vs. cesarean section), and rates of breastfeeding. Results: There were no significant differences in pre-pregnancy weight, amount of weight gained during pregnancy, prenatal care attendance, gestational age at delivery, mode of delivery or infant birth weight. The CenteringPregnancy group had significantly higher rates of smoking cessation during pregnancy, as well as higher rates of breastfeeding initiation and continuation. Conclusions: This study provides support for the benefits of CenteringPregnancy in improving rates of smoking cessation during pregnancy which is important to both maternal and infant health. Additionally, in this population CenteringPregnancy resulted in improved rates of breastfeeding initiation and continuation, providing benefits to both infants and mothers.

Meanings Given to Professional Care: Focus Group Results

Background: Many studies have focused on exploring the concept of care from patient and nurse perspectives, but knowledge is limited regarding student perceptions. Objective: To explore the meanings given to the concept of professional care from the perspective of graduate students in nursing and pastoral care. Research design: A qualitative study was employed with the formation of six focus groups. Data were analyzed via a thematic content analysis of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Seven main themes and forty-four subthemes were identified. Major themes included reverence and respect for the dignity and value of human life, bonding, sensitive to self and other, communication, competence, willfulness and deep caring. Discussion: Different levels of intentionality, professional comportment and caring consciousness were revealed in the discussions. Findings also lend support to major beliefs and values in Watson’s Human Caring Theory. Conclusion: The focus groups generated valuable detail of complex experiences behind student’s perceptions, attitudes, beliefs and actions. Focus group methodology can enhance holistic nursing practice by providing opportunities to explore and clarify holistic care values, create opportunities for self-awareness and transformative learning in education, clinical practice, administration and research.

Impact of Relaxation and Group Psycho-Education on Health Outcomes Using Integrated Care Models and Quality Improvement

The purpose of this Integrated Care Practice Change and Quality Improvement (ICPCQI) initiative was to evaluate the impact of wellness and relaxation and group psycho-education on health out-comes in an integrated care setting. Individuals diagnosed with mental illness and a co-occurring chronic medical condition participated in the ICPCQI initiatives which were run by peer support and wellness experts in an integrated care setting over the one-year project implementation period. Evaluation of outcome measures revealed an overall decline of 8.3% (p < 0.0001) and 7.3% (p < 0.0001) in the average systolic and diastolic blood pressure respectively. There was a 12.3% (p = 0.02) reduction on the average PHQ-9 scores. GAD-7 (p = 0.9) scores had a mean reduction of 1.5%. These preliminary results suggest that the evidence-based ICPCQI initiatives positively impact health outcomes among individuals with mental illness and chronic medical conditions.

Student’s Perception of Missed Care: Focus Group Results

Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perceived as threatening quality care. Objective: To explore graduate nursing and pastoral care student’s perceptions of missed care in Norway. Research design: A qualitative study was employed with the formation of six focus groups. Data was analyzed via a thematic content of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Five major themes and thirty subthemes were identified. Major themes included labor constraints, organizational contraints, professional constraints, communication constaints and emotional strain. Discussion: Findings of this study resonate with other research as well as with studies on missed nursing care. Findings also lend support to the definition of missed nursing care actions as required care that is omitted, either in part or whole, or delayed. Conclusion: The findings from this study extend understanding of what barriers health professionals perceive as inhibiting them from offering quality care. The focus groups provided a valuable flora for discussion regarding what participants perceived as missed.

Continuity of Care during Care Transition: Nurses’ Experiences and Challenges

The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience continuity during care transition of older patients from hospital to municipal health care? How would nurses describe an optimal care transition? Nurses have a pivotal role during care transitions of older patients. More knowledge about their experiences is necessary to develop favorable improvements for this important period in the older patient’s treatment and care. The study has a qualitative explorative design with follow-up focus group interviews. Nurses (N = 30) working in hospital (n = 16) and municipal (n = 14) health care were organized in five mixed focus groups during the period October-January 2014/2015. The focus groups met twice, answering the research questions following a previously circulated semi-structured interview guide. The interview analysis was inspired by content analysis. The analysis resulted in the themes “Administrative demands challenge terms for collaboration” and “Essentials for nursing determine optimal care transitions for older patients”. Administrative demands may prevent nurses’ professional dialogue and collaboration across health care levels. Older patients’ best interests should be ensured through a collaborative relationship between hospital and municipal nurses, to form continuous care across health care levels. Clinical practice should be aware of essentials for nursing, which could influence and facilitate a more individualized and continuous transition for older patients.

Challenges and facilitators for patient and public involvement in England;focus groups with senior nurses

The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly quoted patient-centred services. Limited evidence exists about the implementation of PPI policies and strategies within organisations;three studies only have explored health professionals’ perceptions of PPI. Although nurses’ positive support for patient and public involvement has been noted, comparatively little is known about senior nurses’ experiences of embedding PPI. A national consultation utilising three focus groups aimed to explore senior nurses’ perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Nurses’ perceptions on patient and public involvement, challenges and facilitators for its implementation were discussed. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Limited resources, patient representation and recruitment, complexities of implementing PPI and national policy changes were challenging. Commissioning limitations, lack of feedback on patient experience, limited staff awareness, negative attitudes, management of patients and public expectations constituted further challenges. Nursing role characteristics and informal involvement activities, PPI policy and cultural change, commissioning PPI competencies, related service frameworks, providing feedback on patient experiences to staff and recognition of involvement benefits were recognised as facilitators. Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. However, recognition of existing nursing role characteristics and potential delivery problems created by expanded nursing roles, informal PPI practice and internal organisational sharing of patient feedback may bring an “emerging productive partnership” with nurses enabling and contributing to effective PPI.

群智创新时代下社区居家养老服务交互设计研究

目的解决目前养老中因服务组织参与度不高及智能交互产品利用率低下而导致的养老服务质量欠佳的问题。方法通过对当前社区居家养老服务现状进行分析,结合群智创新的发展及特点,分析养老服务设计的群智创新过程,提出了群智创新时代下基于用户的养老服务新组织,借助KANO模型原理对养老服务需求项目进行群体用户分析,并对分析数据结果进行优先顺序排序,获得老年用户群体对养老服务设计的真实需求情况。结果构建了以用户为中心的社区居家养老服务设计框架,并结合服务设计工具进行智能交互界面设计。结论对交互设计界面的测评显示,老年人对其满意度极高,该养老服务新模式有别于传统养老模式,顺应当今群智创新时代下大数据、互联网、云平台等科技的发展需求,在提高养老服务满意度的同时,使养老服务质量达到最优的效果。

“Care That Respects Individuality” Provided to Elderly People with Dementia as Perceived by Japanese Dementia Carers Qualified

The objective of this study was to clarify the contents of “care that respects individuality” provided to elderly people with dementia living in group homes as perceived by dementia carers qualified. We interviewed 21 dementia carers qualified working at group homes in Prefecture A about the practical contents of and their thoughts on “care that respects individuality”. The data obtained from the interviews were analyzed using the modified grounded theory approach (M-GTA). As a result, 14 concepts regarding the contents of “care that respects individuality” provided to elderly people with dementia living in group homes as perceived by dementia carers qualified were generated in the following 4 categories: “placing emphasis on the individual”, “respecting feelings”, “eliciting strengths”, and “close mutual relationship”.

Understanding organizational context and heart failure management in long term care homes in Ontario, Canada

Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.

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.

“临床营养”团体标准在提高神经重症患者肠内营养治疗全流程管理达标率中的应用

目的提高神经重症患者肠内营养治疗全流程管理达标率。方法对照中国医院协会中国《医院质量安全管理》“第2-29部分患者服务临床营养”团体标准中肠内营养标准条款,对神经创伤重症科住院患者肠内营养治疗全流程管理达标情况进行调查,通过现状调查、原因解析,制订针对性方策,从组建肠内营养治疗全流程管理“医-护-营-康”多学科团队、构建基于“知-信-行”理论的肠内营养治疗培训闭环管理模式、建立以肠内营养治疗数据精准分析为基础的质量改进体系3方面予以改进。结果科室肠内营养治疗全流程管理达标率由改善前33.9%上升至改善后62.5%。结论开展“临床营养”团体标准实践可有效提高神经重症患者肠内营养治疗全流程管理达标率,规范肠内营养治疗操作流程,减少并发症,保障患者安全。

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

高龄产妇参与全球群组化保健的感受与体验的质性研究

目的深入了解高龄产妇对全球群组化保健(GCG)的体验与感知,进而为增强高龄产妇参与GCG的积极性和降低孕期并发症提供参考建议。方法采用质性研究中的现象学研究方法,对福建省妇幼保健院11例参与过GCG的高龄产妇进行半结构式访谈,运用Colaizzi七步法对访谈资料进行整理与分析,提炼主题。结果高龄产妇对GCG的感受和体验可归纳为3个主题:产妇赋能、愉悦的产前护理和对GCG的建议。结论高龄产妇对GCG的整体满意度较高,认为GCG有效提升了她们的孕期知识、自我效能感和安全感。为使GCG更加完善,医护团队应考虑进一步调整其内容流程。未来的研究可以探索GCG在其他孕妇群体中的潜在益处。

基于DRG的重症医学科病例费用结构比较分析及分组效能研究

目的探讨重症医学科(ICU)病例的住院费用构成及疾病诊断相关分组(DRG)分组效能。方法回顾性分析2019年1月1日至2022年12月31日在西安交通大学第一附属医院治疗的11378例ICU患者的入组情况,筛选出例数排名前10位的病组,分析该10组的费用结构;并采用变异系数评价ICU的前10位病组及全院相同病组。结果外科ICU的三个病组,主要费用构成为药费及耗材费,平均占总费用的69.82%。其余病组费用构成主要集中在药费及诊断费。前10位病组的分组效果较好(变异系数<1),但在相同DRG中,ICU出院患者组住院费用的变异系数普遍低于全院出院患者组,因此,对于相同DRG组,ICU出院患者单独评价时组内住院费用的同质性更高。结论建议进一步细化ICU相关分组,或建立切实可行的ICU患者补偿付费机制。在满足医保控费需要的同时,达到合理付费的目的。

The Role of Mutual Support Groups for the Control of Diabetes in a Mexican City: Achievements and Limitations from the Patients’ Perspective

Background: Mutual Support Groups (MSG) provides to the patient, the ability to effective self-management behaviors, such as taking prescribed medications, following diet and exercise regimens, self-monitoring, and coping emotionally with the rigors of living with diabetes. Physicians, nurses and health promoters from public primary Health Care Centers (HCC) are responsible for providing follow-up care through MSGs. However, although the MSG program has been carried out, in the last decade Mexico presents the most alarming statistics in the prevalence and complications of Diabetes Mellitus type II (DM-II), suggesting a low impact of MSG in the strategy to support the effective control of the disease. Objetive: The aim of this work was to assess whether knowledge or benefits of effective management to control of DM-II, also to identify strengths and limitations of MSGs, in six different Health Care Centers (HCC), in San Luis Potosi, Mexico. This research provides an overview of patients’ perception, and significant issues that demand to adjust MGSs strategies, with the goal of exceed the expectations of current health statistics. Methods: A qualitative evaluation was carried out, with an ethnographic approach design. The study included 28 diabetic persons, (21 women and 7 men from ruraland urban carecenters). Semi-structured interviews, non-participant observation, and structured content analysis were used. Results: Support groups give patients a way to address emotional issues, and learn about their disease and self-care, although some patients consider participation an inconvenient obligation. Support group users mention barriers such as lack of continuity in support group activities, inconvenient meeting times, and the difficulty of commuting to attend group sessions. They also mention that overworked health care workers find it difficult to provide leadership to keep the group going. These issues have multiple implications for the success of strategies to control the disease. Conclusions: This study shows the need to apply a participatory model to disease support group strategies to reorganize their actions in such a way as to meet the needs and requirements of patients and to ensure their participation and help them control their disease.

互联网+微信群组健康教育对HDP患者产后自我管理能力及血压控制效果

目的:分析互联网+微信群组健康教育在妊娠期高血压(HDP)患者产后管理中的应用效果。方法:选取2022年4月-2023年3月于本院分娩的HDP患者92例,随机数字表法分为对照组46例(常规干预)和观察组46例(互联网+微信群组健康教育)。比较两组产后血压控制情况、自我管理能力、并发症发生情况及生活质量。结果:干预1、3个月时血压控制情况观察组(舒张压87.67±6.89、80.39±5.56,收缩压128.63±10.06、117.47±10.22)mmHg均优于对照组(91.36±8.66、84.37±7.61,133.54±11.29、124.26±10.66)mmHg,干预3个月时观察组自我管理行为测评量表情绪管理(22.56±3.68分)、饮食管理(36.34±2.41分)、用药管理(17.87±3.56分)、工作与休息管理(21.21±1.35分)评分及SF-36各维度评分均高于对照组高(20.44±4.45分、33.48±5.51分、16.38±2.44分、20.34±2.36分)(均P<0.05);干预期间观察组与对照组并发症发生率(2.2%、15.2%)未见差异(P>0.05)。结论:采用互联网+微信群组健康教育可增强HDP患者产后自我管理能力,有效控制血压,利于产后恢复与生活质量改善。

群体烧伤院内紧急救援护士核心能力评价指标体系的构建

目的 构建群体烧伤院内紧急救援护士核心能力评价指标体系。方法 基于文献回顾,参考护士核心能力框架,在整体理论的指导下结合本院参与群体烧伤救治工作的实践经验,拟定评价指标初稿,2023年12月1日-2024年2月1日采用德尔菲法进行两轮专家函询,结合层次分析法计算各指标权重。结果 两轮函询问卷回收率为100%,专家权威系数为0.889,专家意见协调系数分别为0.244、0.254(P<0.05),最终形成包括烧伤专科知识、烧伤护理实践能力、应急能力、多学科协作能力、评判性思维能力5项一级指标、15项二级指标和48项三级指标的群体烧伤院内紧急救援护士核心能力评价指标体系。结论 该研究构建的群体烧伤院内紧急救援护士核心能力评价指标体系,专家意见统一,为评估紧急救援护士能力提供工具,同时为进一步优化院内紧急救援护士培训模式、建立院内紧急救援护士梯队提供参考。

门诊患者膝关节腔注射治疗中应用专科护理小组多学科合作模式的效果分析

目的:分析在门诊患者膝关节腔注射治疗中应用专科护理小组多学科合作模式的效果。方法:选取2020年6月—2021年3月于苏北人民医院门诊注射室行膝关节腔注射治疗的260例患者作为研究对象,将2020年6—10月的130例患者设为对照组,2020年11月—2021年3月的130例患者设为观察组。对照组实施常规护理,观察组建立专科护理小组并实施多学科合作模式。比较两组护理效果。结果:观察组穿刺失败、穿刺部位感染、疼痛加剧、残肢血运障碍及并发症总发生率高于对照组,差异有统计学意义(P<0.05)。观察组满意率高于对照组,差异有统计学意义(P=0.043)。结论:门诊患者膝关节腔注射治疗中建立专科护理小组的效果显著,能够降低并发症发生率,提高患者满意度,值得临床应用并予以推广。