Corroborative Activities and Recognition Between Community Comprehensive Care Unit’s Nurses and Care Managers in Supporting Discharge of Elderly from Hospital - A Secondary Publication

Objective: The purpose of this study was to clarify the collaborative activities and mutual recognition between community comprehensive care unit nurses (Ns) and care managers (CM) in supporting the discharge of the elderly from the hospital. Methods: A total of 300 nurses working in community comprehensive care wards and 360 care managers working in B City in A Prefecture were surveyed using an anonymous self-administered questionnaire. Results: The highest percentage of responses regarding necessary collaborative activities with multiple professions in supporting hospital discharge were the same for Ns and CMs. The items regarding practice with the highest percentages were “relationship as a team” for Ns, and “user-centered awareness” for CM. While these professionals were willing to share information about their patients’ lives after discharge, the percentage of those explaining their expertise was low. It is thought that collaborative activities focusing on these aspects would lead to more appropriate discharge support.

Effect of medical care linkage-continuous management mode in patients with posterior circulation cerebral infarction undergoing endovascular interventional therapy

BACKGROUND Acute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction(PCCI).PCCI affects the structure of the posterior circulation brain,because posterior part of the brain,which has more complex anatomical structures and more prone to posterior circulation vascular variation.Therefore,improving the prognosis of PCCI patients is necessary.AIM To explore the effect of medical care linkage-continuous management mode(MCLMM)on endovascular interventional therapy(EIT)for PCCI.METHODS Sixty-nine patients with PCCI who received EIT and conventional nursing intervention were selected as the control group,and 78 patients with PCCI who received EIT and MCLMM intervention were selected as the observation group.The incidence of postoperative complications,compliance and disease selfmanagement behavior after six months of intervention,modified Rankin scale(mRS)and Barthel index(BI)scores in the acute phase and after one year of intervention,and recurrence within one year were compared between the two groups.RESULTS The total incidence rate of postoperative complications in the observation group(7.69%)was lower than that in the control group(18.84%)(P<0.05).The scores for medical compliance behavior(regular medication,appropriate diet,and rehabilitation cooperation rates)and disease self-management behavior(self-will,disease knowledge,and self-care ability)in the observation group were higher than those in the control group(P<0.05).After one year of intervention,in the observation group,the mRS score was significantly lower,and the BI score was significantly higher than those in the control group(P<0.05).The recurrence rate within one year in the observation group(3.85%)was significantly lower than that in the control group(13.04%)(P<0.05).CONCLUSION MCLMM can reduce the incidence of complications after EIT for PCCI,improve patient compliance behavior and disease self-management ability,and promote the recovery of neurological function.

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.

Applying healthcare failure mode and effect analysis to patient pain management in the anesthesia recovery period

Objective： To standardize pain management in the anesthesia recovery period and improve the effects of analgesia on acute postoperative pain. Methods： Using healthcare failure mode and effect analysis （HFMEA）, we analyzed the primary cause of patients＇ pain and subsequently determined the process and risk priority number （RPN）. Results： Actions were taken to improve patients＇ pain. After using HFMEA, the experimental group＇s visual analog scale （VAS） scores were lower than those of the control group at 1 h and at discharge from the post-anesthetic intensive care unit （PAICU）. The differences were statistically significant （P 〈 0.05）. Conclusions： The application of failure mode and effect analysis can relieve pain and improve the quality of nursing.

Pattern of Stroke Admissions, Radiodiagnostic Compliance, and Outcomes in the Intensive Care Unit of a Tertiary Hospital, South-South, Nigeria

Background: Stroke patients form an integral part of patients admitted into the intensive care unit (ICU);and may need airway maintenance, supplemental oxygen and even endotracheal intubation for mechanical ventilation. Method: In this retrospective study, the medical records and radiological investigations of the patients were assessed. Also, their socio-demographics, and clinical diagnosis and background co-morbidities were noted. The radiological diagnosis post CT was used to determine the type of stroke for those compliant;while clinical assessment alone was used to determine the diagnosis in those who did not do CT. They were also classified into 2 groups: those requiring mechanical ventilation (for ICU care) and those without the need for mechanical ventilation (for high dependency Unit (HDU) care). The eventual clinical outcome was noted. Result: A total of eighty-eight cases, 67% (n = 59) were males and 33% (n = 29) females. 89.8% (n = 79) had hypertension, 3.4% (n = 3) had diabetes while 6.8% (n = 6) had both hypertension and diabetes. Of the hypertensives, 36.7% (n = 29) had hemorrhagic stroke and 66.3% (n = 50) had ischaemic stroke. 53.3% (n = 46) patients had High dependency Unit (HDU care while 47.7% (n = 42) were mechanically ventilated. Of the number in HDU, 51.5% (n = 17) were haemorrhagic, while 52.7% (n = 29) were ischaemic. Clinical diagnosis of ischemic stroke was done in 55 (62.5%) and hemorrhagic stroke in 37.5% (n = 33). Of the lot, only 19.3% (n = 17) of them did CT and 80.7% (n = 71) did not have CT done. None did MRI. Late presentation (beyond 24 hrs) was a common feature for most of the patients, for whom immediate cardio-respiratory support became necessary. Overall mortality rate was 62.5% (n = 55). 39.1% (n = 18) of the HDU (46) patients died, while 88.1% (n = 37) of the ventilated (42) patients died. 56.6% (n = 26) were discharged from the HDU and 4.3% (n = 2) referred to another facility. Of the 42 patients on mechanical ventilation 88.1% (37) died, 9.5% (n = 4) discharged, and 2.4% (n = 1) referred to another health facility. Summary: Low neuroimaging compliance by Stroke patients in our environment and late presentation to hospital, impacts negatively on good outcome of the disease. This, coupled with the high cost of these facilities, makes their use unaffordable, suggesting a strong indication for comprehensive quality and affordable health care and health insurance in the country.

Responding to fire in an intensive care unit: Management and lessons learned

Healthcare institutions are vulnerable to disruptionfrom events such as earthquakes, fires, and floods, andthe damage incurred can endanger the lives of patientsin the hospital.[1] In this type of scenario hospital staffhave primary responsibility for the hospitalized patients＇safety, since patients are neither fit to respond to sucha disaster, nor do they know how to respond.[2,3] Thesituation becomes more difficult and challenging if thedisaster occurs in critical care areas such as intensivecare units （ICUs） and operating rooms.

Nursing Care Management Strategies in Isolation Wards during the COVID-19 Outbreak

Coronavirus disease 2019 (COVID-19) is highly infectious and has spread worldwide. Medical staff may be exposed to the infection under circumstances of medical supply shortages and improper protection. How to better protect medical staff has become the focus of all walks of life. Therefore, during the COVID-19 outbreak, timely adjustments and optimization of nursing management strategies in isolation wards are important for improving care quality and reducing the infection of medical staff. Based on a literature review and clinical nursing management practices, this article summarizes the nursing management strategies in isolation wards during the COVID-19 outbreak, aiming to provide references for clinical nursing managers.

美国管理型商业医疗运行模式和管控实现路径探析

目前我国医疗保险市场正不断探索管理型商业健康险的本土化发展模式,《“健康中国2030”规划纲要》明确提出要促进商业保险公司与社会医疗及专业护理机构合作,发展健康管理组织(Health Maintenance Organization, HMO)等新兴管理型医疗组织形式。管理型医疗(Managed Care)作为美国医疗保险市场份额最大、市场化程度最高、覆盖面最广的一类私营计划,在医疗成本控制和服务质量管理上独树一帜。本文介绍了美国管理型商业健康险的内涵和特点,简要梳理了管理型医疗的发展背景,分析了商业健康险市场HMO、PPO和POS三种主要管理型医疗的运行模式,并从经济管控和程序管控两种路径探究了美国管理型商业健康险的有效管控的实现过程,最后对管理型医疗进行客观评述和启示总结。

Effects of cooperative nursing and patient education on postoperative infection and self-efficacy in gastrointestinal tumors

BACKGROUND Gastrointestinal tumors have a high incidence rate.The application value of the cooperative nursing care system of medical care has received widespread attention in recent years.However,there are few studies on the value of the joint application of collaborative nursing care and self-efficacy education.AIM To explore the effect of cooperative nursing care management/self-efficacy education on postoperative infection and self-efficacy in gastrointestinal tumor surgery patients.METHODS A total of 102 patients with gastrointestinal tumors treated in our hospital from October 2018 to February 2020 were selected and divided into a conventional group(n=51)and a combined group(n=51)according to the nursing plan.The routine group adopted routine nursing,and the joint group adopted the medical care cooperative responsibility system nursing management combined with selfefficacy education.The self-efficacy scores,coping style scores,self-experience burden scores,and postoperative complication rates of the two groups before and after intervention were counted.RESULTS After intervention,the daily life behavior management,cognitive symptom management,and disease management scores of the two groups were higher than those before the intervention,and those of the combined group were higher than those of the conventional group(all P=0.000).After the intervention,the positive response scores of the two groups were higher than those before the intervention,the negative response scores were lower than those before the intervention,and the combined group was better than the conventional group(all P=0.000).After the intervention,the two groups’emotional,economic,and physical factor scores were lower than those before the intervention,and the combined group was lower than the conventional group(all P=0.000).The incidence of infection in the combined group(1.96%)was lower than that in the conventional group(15.69%)(P=0.036).CONCLUSION Cooperative nursing care management and self-efficacy education improved the physical and mental states of gastrointestinal cancer surgery patients,change the response to disease,and reduce the risk of postoperative infection.

Sleep,health behaviors,and behavioral interventions:Reducing the risk of cardiovascular disease in adults

Numerous health behaviors, including physical activity,diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease(CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline populationhealth-level care management approaches for patients with psychiatric conditions(e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large.

Inflammatory bowel disease:Efficient remission maintenance is crucial for cost containment

The inflammatory bowel diseases(IBD) are chronicincurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mildmoderate colitis, and do not work in Crohn's; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn's; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically(not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.

The US Payor Landscape： Results from a Survey of Medical Directors and Pharmacy Directors on Comparative-Effectiveness Research

The paper is to determine the types of approaches preferred by medical and pharmacy directors of US payer organizations to enhance the Pharmacy ＆ Therapeutic decision-making process and how medications accepted onto the formulary should be covered. An online interactive survey of US medical and pharmacy directors was conducted in 2012. In addition to a 10-point Likert scale （10 = agree completely, 1 = disagree completely）, qualitative responses and interpretive analysis were used to explore beliefs about certain statements. The results showed that the 30 respondents （20 medical directors and 10 pharmacy directors） rated current progress in obtaining usable CER （comparative-effectiveness research） at only an average of 4.17 on the 10-point scale. They hoped to regularly utilize CER information in formulary decision making by 2015 （average rating, 6.03）. The rating of evidence-based medicine use in coverage decision making today was somewhat higher, at an average of 7.08 （medical directors, 7.38; pharmacy directors, 6.40）. The survey participants believe that emerging CER results will greatly affect the following areas： optimization/improvement of clinical guidelines, medical/pharmacy benefit management, assessments of the value and appropriateness of interventions, and pharmaceutical research and development. Therefore, payers expect CER to play an increasing role in helping them determine the value of new therapies.

Delirium in Intensive Care Unit Patients： Ten Important Points of Understanding

INTRODUCTION Delirium is a significant independent indicator of poor prognoses for critically ill patients （including in-hospital mortality, prolonged hospitalization, increased medical costs, and long-term cognitive impairment）. Intensive care medicine experts have been paying attention to and carried out research on delirium for better prediction, prevention, management, and treatment, and even better prognosis of patients in critical condition. Based on the latest findings of theoretical research and in combination with clinical experience, literature on delirium has been reviewed and ten points of basic understanding of delirium in critically ill patients have been identified.

Unveiling the challenges encountered by newly graduated nurses during night shifts:A descriptive qualitative study

Objectives:Newly graduated nurses commence night shifts during a phase of heightened vulnerability to reality shock,exacerbating the challenges faced by these graduates.Therefore,this study aimed to identify the challenges experienced by newly graduated nurses when undertaking night shifts in order to help identify a strategy for supporting their adaptation to these shifts.Methods:Semi-structured personal interviews were used to collect data.Fifteen newly graduated nurses were selected to participate in the study by purposive sampling method from November 2021 to March 2022 in one of four general hospitals situated in the southwestern region of Japan.Semi-structured interviews were analyzed by using thematic analysis.Results:The analysis revealedfive central themes and nine subthemes:challenges in task efficiency(task organization challenges,challenges in time-constrained task performance),challenges in responding to patients’changing conditions(challenges in responding to patients’irregular conditions,challenges in responding to nighttime changes in patients’behaviors),challenges in independent practice(challenges in engaging in independent nursing practice,challenges in dealing with unexpected events),challenges in establishing collaborative relationships(challenges in working closely with other staff,challenges in establishing collaborative relationships during night shifts with limited resources),challenges in adapting to shift work(challenges in managing physical conditions for shift work).Conclusions:Newly graduated nurses often encounter challenges in performing their tasks during the transition period.When working night shifts,they face additional hurdles unique to nocturnal duties.Thefindings underscore the necessity for these graduates to develop night shift-specific readiness to effectively navigate the demands inherent in such work schedules.

Priority Setting in Health Care with Disease and Treatment Risks

This paper deals with the issue of priority setting in health care under uncertainties about the severity of the illness and the effectiveness of medical treatment. We examine the effect of a disease uncertainty(a treatment uncertainty) on the allocation of health care resources in the presence of a treatment risk(a disease risk) and identify preference conditions under which the social planner allocates more resources to higher risk population. We allow for the simultaneous presence of two risks and investigate the joint effect of two-source uncertainties on health care allocation when the two risks are either small or positively quadrant dependent. The effect of inequality aversion on health care allocation is also analyzed by introducing an equity weighting function. Our work extends the previous model of health care priority to two-risk framework and provides new insights into the problem of health care decision making under uncertainty.