Patient-centered care in diabetes care-concepts,relationships and practice

We still do not have comprehensive knowledge of which framework of patientcentered care(PCC)is appropriate for diabetes care,which elements of PCC are evidence-based,and the mechanism by which PCC elements are associated with outcomes through mediators.In this review,we elaborate on these issues.We found that for diabetes care,PCC elements such as autonomy support(patient individuality),cooperation and collaboration(system-level approach),communication and education(behavior change techniques),emotional support(biopsychosocial approach),and family/other involvement and support are critically important.All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation.We present the practical implications of these PCC elements.

Quality in Healthcare: The New Frontier of“Patient-Centered Care Approach” in Day Clinics

This article aims to study methodologically hospital buildings and, in particular, the design of day clinics in the recovery area. The definition of design guidelines to improve and qualify the day clinic, enhancing their performance, takes into account the fact that the established requirements of medical protocols must be accompanied by those new requirements related to the massive evolution in health organizations. Changes in medicine, culture and society have necessarily led to a new formulation of the hospital model and the introduction of the theme of the humanization of the curing process has conditioned the morphological-space configuration and the presence of new relationships and spatial functions in the hospitals. The research of this article attempts, therefore, to explore the use of technology to improve the quality of day clinics’ design, formulating strategies that contribute on one side to facilitating the efficiency of service, and on the other side to making the user feel at ease in a welcoming and comfortable environment.

Emperor’s syndrome in the COVID-19 era:Time for patient-centered nephrology?

The coronavirus disease-19(COVID-19)pandemic has been a wake-up call in which has forced us to react worldwide.Health policies and practices have attracted particular attention in terms of human and financial cost.Before COVID-19,chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension,the two now being the major risk factors for COVID-19 infection and adverse outcome.In contrast to the urgent need for action,the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality.Ironically and paradoxically in a field lacking robust clinical trials,clinical practice is driven by guidelines-based medicine on weak evidence.The Emperor’s syndrome,referring to Hans Christian Andersen’s fairy tale,has been described in medicine as voluntary blindness to an obvious truth,being a weak evidence-based therapeutic intervention or weak health care.A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors.COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.

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.

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.

Doctor,Ease My Mind!Associations between Cancer Patients’Emotional Distress and Their Perception of Patient-Centeredness during Oncology Consultations

Objective: To investigate whether perceived patient-centered communication during oncology consultations relates to patient satisfaction and degree of emotional distress following the medical encounter. Methods: 226 cancer patients attending an oncology outpatient clinic completed questionnaires before and after a consultation including the Physician-Patient Relationship Inventory, the brief Profile of Mood States, and the Information satisfaction questionnaire. Results: Patients who perceived the communication during the consultations to be highly patient-centered were more likely to be maximally satisfied with information provided by the oncologist. Additionally, adjusting for pre-consultation distress, as well as sociodemographic, clinical, and consultation-related variables, patients who perceived the oncologist to communicate in a highly patient-centered manner, experienced lower levels of emotional distress after the consultation. Conclusion: Patient-centered communication may be an important quality in oncology as an approach to positively influence patient outcomes, including emotional distress. However, the findings in the present study of an effect of PCC on patient satisfaction and emotional distress are modest, and no firm conclusions can thus be drawn. Practice Implications: Oncology settings may benefit from the positive effects of patient-centered care and physicians should acknowledge the potential of their own relational competence in order to facilitate patient-centered communication.

Patient-centric periodontal research:A pioneering application of patient-reported outcome measures

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.

A population-based approach to the management of depression in a patient-centered medical home

Objective:This article describes the implementation of a population-based strategy to man-age depression in a patient-centered medical home.Methods:Review of English language articles;description of specific protocols utilized in one medical home.Results:Depression is a global concern estimated to affect 350 million people worldwide.Rates for depression vary between the United States and the Peoples’Republic of China,possibly due to significant factors in under diagnosis of this often hidden burden.Given the comorbidity of depres-sion with other health factors and the need for ongoing monitoring and care of this chronic illness,primary care has become a significant part of treatment interventions.Utilizing electronic health records(EHR),our strategy included the creation of a patient registry;selection of evidence-based treatment guidelines and protocols for point of care procedures;patient outreach and screening.Conclusion:The population-based program we outline is highly dependent on the EHR and the flexibility of roles and responsibilities of clinical staff.Further investigation is warranted into improved patient outcomes.

去中心化临床试验的挑战、对策及伦理审查要点

去中心化临床试验正给临床试验带来新的变革,必须坚持以患者为中心的核心理念,充分保障研究参与者的安全和权益。去中心化临床试验与传统临床试验有相同之处,但去中心化临床试验并不适合所有临床试验,更适用于口服给药、研究参与者病情稳定、疗程较长的临床试验。必须根据临床试验的特点选用去中心化临床试验元素,并在改善研究参与者的获得感、安全、权益和尊严与收集的数据质量之间取得平衡。当前中国去中心化临床试验面临诸多挑战,为积极推进中国去中心化临床试验,应完善监管法规和指导原则,基于以患者为中心的设计原则,首次讨论需实时在线交流,研究者提供更多临床试验服务,风险控制和医疗援助的可及性,使用第三方便捷支付,确保公平招募研究参与者,考虑依从性,数字健康技术的验证,远程监查和电子知情同意合规化,确保收集、传送和分析数据的安全性,以及加强多方培训。伦理审查是保护研究参与者安全和权益的重要手段之一,伦理委员会应关注符合以患者为中心的恰当去中心化临床试验元素,电子知情同意的合规、有效,安全性信息处理与报告,数据收集的隐私保护,远程监查的合规性,家庭健康随访,生物样本管理,试验性医疗产品的管理,以及培训计划。与传统临床试验的互补与结合将使去中心化临床试验元素更容易、更顺利地落地。去中心化临床试验借助科技进步力量,将助推中国药物和医疗器械研发的速度,增强国际竞争力,造福更多患者。

21st century critical care medicine:An overview

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.

Palliative care with adequate pain relief challenges the need for euthanasia legislation

Background:In today’s society the ongoing discussion about euthanasia triggers emotionally charged debates surrounding the delicate balance between valuing life and respecting an individual’s autonomy.With the persistence of this debate,there has been the emergence of the concept of the so-called alternative:palliative care.Positioned as a substitute for euthanasia,palliative care aims to alleviate suffering in terminally ill patients without engaging in the ethical dilemmas associated with euthanasia.Methods:This paper explores the facets of palliative care highlighting its core objectives such as providing adequate pain relief as a compassionate alternative to euthanasia.Results:By examining palliative care as a comprehensive approach to end of life support,this study challenges the perceived necessity of euthanasia and advocates,for compassionate and dignified end of life experiences.Conclusion:In conclusion,palliative care emerges as a viable and ethically sound alternative to euthanasia,emphasizing the importance of compassionate end-of-life care and pain management.

将叙事医学渗透到全科医学教学查房的思考

全科医学追求全人理念,十分重视将人文精神有机融入医疗过程。因此,培养全科医生、提升医学人文素养显得尤为重要。叙事医学是真正体现人文关怀和尊重患者人性的学科,有利于将人文精神融入临床实践。以上二者存在天然耦合性。文章从叙事医学视角出发,介绍了叙事医学的发展、作用及意义,分析了目前全科医学住院医师规范化培训中教学查房存在的一些问题,提出以叙事医学为专题教学查房的设想,助力解决全科医学中人文精神技能教育不足的问题,为今后将叙事医学融入全科医学人才培养体系提供参考。

乳腺癌患者自我倡权体验的质性研究

目的 深入了解乳腺癌患者自我倡权的真实体验。方法 采用现象学研究方法,对20名乳腺癌患者进行半结构式访谈,并采用Colaizzi 7步分析法分析资料。结果 提炼出4个主题和11个亚主题:自我倡权意识薄弱(症状报告不主动和过度依赖医生)、自我倡权积极性受多种因素影响(存在逃避心态、信心不足、病耻感严重和害怕破坏医患关系)、自我倡权过程中面临诸多挑战(医护态度欠缺、家庭成员不支持和害怕增加经济负担)及自我倡权积极体验(增强战胜疾病的信心和提高疾病应对能力)。结论 乳腺癌患者自我倡权意识薄弱、积极性较差,在自我倡权过程中面临各种挑战,部分患者积极体验自我倡权。医务人员应多关注自我倡权意识薄弱和积极性较差的乳腺癌患者,给予其更多的帮助和鼓励,同时也应树立“以病人为中心”的服务理念,营造良好氛围促进患者自我倡权。

ACSI模型视角下医院运送服务群体工作满意度的质性研究

目的运用ACSI模型探讨影响医院运送服务群体工作满意度的因素。方法依据ACSI模型拟定访谈题纲,通过现象学研究方法,于2023年2-6月采用目的抽样法选取南京某三级甲等医院的运送服务人员进行半结构式访谈,借助NVivo12Plus软件对访谈所得文本进行定向内容分析。结果共提炼3个主题,8个亚主题:运送工作期望(对运送工资报酬的期望、对运送工作性质的期望);运送工作感知质量(对运送工作量的感知、对运送纠纷处理困难的感知、对运送工作身体劳累的感知、对运送岗位胜任力的感知);运送工作感知价值(同等工作付出所获报酬的感知、同等报酬所需工作付出的感知)。结论运送服务群体的工作满意度受多种因素影响,各因素之间相互影响并处于动态变化之中。因此建议管理人员帮助运送员工建立合理的工作期望、采用精益化管理方式提高运送工作感知质量,从而进一步提升运送工作感知价值。

以患者为中心加强医院文化建设分析

在实施医院文化建设之时,需要加入以患者为中心的相关工作内容,将其作为指导思想,可以使院内各项服务工作质量获得一定程度上的提升,对医院整体形象也具有提升作用。本文主要针对医院文化的内涵、特点以及现状展开说明,明确医院文化建设重要性,同时对以患者为中心加强医院文化建设的对策进行综述。

中医医院急危重症患者安全转运管理实践的应用与探讨

目的探讨中医医院临床支持中心(简称中心)在急危重症患者安全转运中的管理实践,分析其管理模式、安全转运工作量及满意度,为促进急危重症患者安全转运提供参考依据。方法总结重庆市中医院临床支持中心近10年在危急重症患者安全转运工作中的管理经验,回顾性分析2015年1月至2023年12月重庆市中医院临床支持中心120急诊急救组、重症转运组转运患者工作量。采用随机抽样法,使用自行设计的问卷调查医院急诊科、重症监护室以及相关临床科室500名医务工作者对中心工勤人员参与急危重症患者安全转运的满意度。结果中心参与转运急危重症患者达到323499总人次,未发生管道脱落、跌倒、坠床等意外责任事件。满意度调查显示,医务工作者对中心工勤人员的工作能力满意度为98%,服务态度满意度为96%,工作效率满意度为95%,职业素养满意度为80%。结论临床支持中心在大型三甲中医医院急危重症患者转运中发挥重要作用,为减轻临床医务人员的工作压力、安全转运危急重症患者提供有力的保障,在提高医务人员满意度方面起到了积极作用。今后中心可从员工激励制度、针对性培训、信息化建设3方面出发,进一步促进持续质量改进。

基于患者体验的玻璃体腔注药中心流程优化效果分析

目的以提升玻璃体腔注药患者体验为目标,优化诊疗流程,缩短等候时间。方法在进行玻璃体腔注药的患者病历中,采用系统抽样方法抽取流程优化前后相同时段内的病历,作为观察组(n=336)和对照组(n=150)。比较两组患者的医疗质量、医疗效率和患者等候时间数据。结果流程优化后,玻璃体腔注药手术预约时间从(67.77±29.95)小时降至(10.66±5.69)小时,手术日在院时间从(4.52±0.94)小时降至(2.55±0.67)小时,术前检查时间从(14.34±6.49)小时降至(5.19±1.60)小时。手术医生半日均手术量从(37.88±10.94)例提升至(47.50±4.77)例,差异有统计学意义(P<0.01)。两组患者术后继发性青光眼和眼内炎发生率的差异无统计学意义(P>0.05)。结论围绕患者体验的玻璃体腔注药中心流程优化工作减少了患者等候时间,提升患者体验效果明显。

GPP规范化药学服务仿真顶点课程设计与探索

良好药学服务质量管理规范(Good Pharmacy Practice,GPP)的实训基地以及与之相应的教学体系的短缺,使得药学专业学生无法应对当前药学服务高质量发展所面临的各项挑战。围绕以患者为中心的服务目标,聚焦高阶药学实践能力,参考美国药学教育框架与职业能力评估体系,教学团队设计GPP规范化药学服务在线虚拟综合实训顶点课程,为学生持续提供同质化、规范化、标准化的药学服务沉浸式教学体验。

护理部垂直管理下病员辅助服务中心岗位管理研究

目的 探讨护理部垂直管理下病员辅助服务中心岗位管理效果。方法 从组织架构、岗位设置与分级、岗位培训、岗位考评及岗位绩效考核等方面开展岗位管理。结果 实施后,员工综合能力、患者及科室满意度均得到了提升(P<0.05),不良事件发生数、患者意外情况发生数、接单延误次数、患者投诉量、科室投诉量及员工离职率均降低。结论 护理部垂直管理下病员辅助服务中心岗位管理模式能够提升员工综合能力,提高患者和科室满意度,稳定人员队伍。