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.

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.

Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

Integrated and Seamless Services for Active Aging, a Model for Zhuhai

The Aging Tsunami as it is often quoted to describe the worrying situations of rapidly aging in China has not met with detail planning in facilities upgrade and careful consideration in service models. Broad brushed central policies categorizes services into home care, community care and institutional care and set policy goals at 90-6-4, representing the percentage of older people in receiving respective care. This leaves local officials helpless on how these ideals can be actualized. Some cities have inclined to build huge older people homes and pour resources into institutional care, forgetting the need for older people to be connected with the society. This paper reviews the historical developments of older people services in Hong Kong and recommends an integrative model of social work services connecting institutional, community and home care into a seamless network. The city of Zhuhai will be presented as a perfect experimental city on how its existing facilities can be converted and developed according to the model. Survey on the situations of the 16 public older people homes will be used to illustrate the potentials of an integrative model.

An Integrated Rehabilitation Model: An Ideal Framework for Limiting Health Care Costs

The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.

Integrating palliative care in oncologic emergency departments:Challenges and opportunities

Although visiting the emergency departments(EDs) is considered poor quality of cancer care,there are indications these visits are increasing.Similarly,there is growing interest in providing palliative care(PC) to cancer patients in EDs.However,this integration is not without major challenges.In this article,we review the literature on why cancer patients visit EDs,the rates of hospitalization and mortality for these patients,and the models for integrating PC in EDs.We discuss opportunities such integration will bring to the quality of cancer care,and resource utilization of resources.We also discuss barriers faced by this integration.We found that the most common reasons for ED visits by cancer patients are pain,fever,shortness of breath,and gastrointestinal symptoms.The majority of the patients are admitted to hospitals,about 13% of the admitted patients die during hospitalization,and some patients die in ED.Patients who receive PC at an ED have shorter hospitalization and lower resource utilization.Models based solely on increasing PC provision in EDs by PC specialists have had modest success,while very limited ED-based PC provision has had slightly higher impact.However,details of these programs are lacking,and coordination between ED based PC and hospitalwide PC is not clear.In some studies,the objectives were to improve care in the communities and reduce ED visits and hospitalizations.We conclude that as more patients receive cancer therapy late in their disease trajectory,more cancer patients will visit EDs.Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients.PC specialist should play an active role in educating ED physicians about PC,and provide timely consultations.The impact of integrating PC in EDs on quality and cost of cancer care should be studied.

Reconstruction Model of Ocean Observing Complex Virtual Instrument

With the newly proposed Global Ocean Observing Integration, ocean observing scope has been expanded from the region to the global, therefore the need of large-scale ocean observing system integration has become more and more urgent. Currently, ocean observing systems enabled ocean sensor networks are commonly developed by different organizations using specific technologies and platforms, which brings several challenges in ocean observing instrument （OOI） access and ocean observing system seamless integration. Furthermore, the development of ocean observing systems often suffers from low efficiency due to the complex prograrmning and debugging process. To solve these problems, a novel model, Complex Virtual Instrument （CVI） Model, is proposed. The model provides formal definitions on observing instrument description file, CVI description file, model calculation method, development model and interaction standard. In addition, this model establishes mathematical expressions of two model calculation operations, meanwhile builds the mapping relationship between observing instrument description file and CVI description file. The CVI based on the new model can achieve automatic access to different OOIs, seamless integration and communication for heterogeneous environments, and further implement standardized data access and management for the global unified ocean observing network. Throughout the development, integration and application of such CVI, the rationality and feasibility of the model have been evaluated. The results confirm that the proposed model can effectively implement heterogeneous system integration, improve development efficiency, make full usage of reusable components, reduce development cost, and enhance overall software system quality. We believe that our new model has great significance to promote the large-scale ocean observing system integration.

Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model

In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

Optimization Processes of Tangible and Intangible Networks through the Laplace Problems for Regular Lattices with Multiple Obstacles along the Way

A systematic approach is proposed to the theme of safety,reliability and global quality of complex networks(material and immaterial)by means of special mathematical tools that allow an adequate geometric characterization and study of the operation,even in the presence of multiple obstacles along the path.To that end,applying the theory of graphs to the problem under study and using a special mathematical model based on stochastic geometry,in this article we consider some regular lattices in which it is possible to schematize the elements of the network,with the fundamental cell with six,eight or 2(n+2)obstacles,calculating the probability of Laplace.In this way it is possible to measure the“degree of impedance”exerted by the anomalies along the network by the obstacles examined.The method can be extended to other regular and/or irregular geometric figures,whose union together constitutes the examined network,allowing to optimize the functioning of the complex system considered.

类型化视域下当代我国农村养老模式的比较与融合研究

农村养老是我国养老事业和养老产业的重要组成部分。当代我国农村养老模式主要有家庭养老、互助养老、机构养老和医养结合养老四种,每种模式在我国都有具有典型意义的代表。通过比较,四种模式既凸显出优势也暴露出不足。因此这四种模式,既要根据当地情况因地制宜选择,更要采取以一种模式为主、兼采其他模式所长的融合型模式。可以预见,融合型模式将成为我国今后农村养老发展的趋势。

基于文献和知识学习的重症医学大语言模型探索

目的:通过大语言模型技术学习重症医学专科的临床知识,理解和识别临床医疗需求和临床问题意图,并对临床用户提出的问题进行智能反馈。方法:在通用大语言模型的基础上,进行医疗大语言模型数据集的设计,并收集大量的医学知识数据进行多任务多阶段的大语言模型训练,实现对重症医学临床信息的智能分析。结果:实现对重症医学临床医疗信息的智能化理解及自动化问答。结论:应用医疗大语言模型技术,结合临床规则库、医学文献等外部知识体系,可构建重症临床信息大语言模型系统,为临床医疗提供科学、智能的信息理解和决策支持,为大语言模型技术在医疗领域的进一步研究和应用提供经验和参考。

健康老龄化视域下“医养结合嵌入式”养老服务的质量评价研究

健康老龄化视角下的嵌入式医养结合养老模式是未来老年人养老质量的保障,也体现了老年人对未来老年幸福美好生活的需求。但对该模式的研究多集中在理论研究层面,对实证的研究较为缺乏。本研究基于医养结合的嵌入式养老服务的评价方法和评价原则,对构建嵌入式医养结合养老模式的评价指标体系进行了较为详尽的阐释。发现目前嵌入式养老机构重在养老轻在医疗,医疗机构与养老机构之间存在着衔接不足的问题,具体表现在医护人员的服务主体不够专业、服务项目不够落实、医疗机构与养老机构的资源整合碎片化以及机构管理的多头监管等问题。研究针对相关问题提出了建议,对我国医养结合的嵌入式养老模式的进一步实施具有一定借鉴意义。

某大型公立医院医养结合模式实践探索

随着人口老龄化程度的加深以及医疗需求的增加,家庭病房作为一种医养结合服务模式逐渐受到重视,成为一种对医疗资源紧缺的重要补充手段。广东省第二人民医院建设智慧家庭病房,探索实践医养结合“互联网+养老”新模式。本文以广东省第二人民医院建设智慧家庭病房的医养结合实践为对象,探索分析公立医院医养结合“互联网+养老”模式在应用中存在的问题,并提出相应的对策建议。

无缝钢管张力减径工艺减径率分配修正模型理论研究

无缝钢管张力减径工艺减径率分配是孔型分配合理与否的关键步骤,但其分配仍依赖于经验公式。从金属流动的角度分析了减径率的分配规律,在经验的基础上提出了“三点两段统合式”减径率分配修正模型。将修正模型得到的结果与传统模型计算结果以及企业生产数据相比,发现变化趋势相近,减径率和减径量变化曲线更加光滑,应用于生产有利于金属流动。

医护患一体化模式在口腔癌患者术后口腔功能康复中的应用效果评价

目的:探讨医护患一体化模式在口腔癌患者术后口腔功能康复中的临床应用效果。方法:选择上海交通大学医学院附属第九人民医院2023年1—3月收治的40例口腔癌患者作为对照组,2023年4—6月收治的40例口腔癌患者作为试验组,对照组予以常规护理,试验组给予医护患一体化护理。随访3个月,比较2组患者口腔功能和心理健康情况。采用SPSS 23.0软件包对数据进行统计学分析。结果:试验组吞咽功能、言语功能得分分别为(2.20±0.90)和(76.50±9.7)分,开口度为(39±2.2)mm,对照组分别为(2.70±0.7)分、(64.57±8.2)分和(38±4.3)mm,2组比较差异均有统计学意义(P<0.05);试验组口腔卫生检查合格率、洁牙合格率、冲牙合格率分别为87.5%(35/40)、97.5%(39/40)和92.5%(37/40),对照组分别为67.5%(27/40)、57.5%(23/40)和75.0%(30/40),2组比较有统计学差异(P<0.05)。试验组焦虑、抑郁得分分别为(42.10±3.37)、(40.33±3.56)分,对照组分别为(45.26±3.27)、(46.39±3.10)分,2组比较有统计学差异(P<0.05)。结论:医护患一体化模式可促进口腔癌患者口腔功能康复,提高口腔健康状态,缓解焦虑抑郁状态,改善术后营养状况。

基于米特-霍恩模型的中医药政策在医养结合执行中的分析研究

目的分析我国中医药政策在医养结合执行过程中存在的问题,为完善中医药政策提供借鉴,以此更好地推动医养结合服务的发展和进步。方法采用米特-霍恩模型:政策标准与目标、政策资源、执行方式、执行机构特性、执行人员价值取向、系统环境六大因素为框架,分析中医药政策在医养结合服务执行中存在的问题。结果中医药政策越来越受重视,但在执行中仍受到政策目标不清晰、资源不足、执行方式单一、执行机构特性缺乏规划、执行人员价值取向低和复杂的系统环境等因素的影响。结论为解决中医药政策在医养结合执行中存在的问题,提出建议:完善顶层设计,细化政策实施目标;强化资源保障,提升政策执行效率;丰富执行方式,确保执行效果;多部门联动,加强沟通交流;优化政策执行环境。

家庭养老床位政策的府际差异与模式研究——基于26个市级政策文本的比较分析

目的:家庭养老床位作为链接基层医疗服务资源与养老服务的中介,可有效解决社区、机构养老照护资源失配、错配与家庭照护负担过重的问题,对该政策进行量化分析,对完善家庭养老床位政策内容,优化资源配置,推动家庭养老床位建设具有重要意义。方法:收集我国省会及试点成效较好城市出台的共26份家庭养老床位政策文本,运用文本挖掘和PMC指数模型,构建量化指标评价已有政策,并以上海、杭州、长春、苏州作为典型案例,梳理政策特征差异。结果:政策总体评价为合格等级,质量提升潜力较大;主要呈现学习-试验型、回应-赋能型、模仿-指令型三类政策模式;政策PMC指数在空间维度上存在差异,政策一致性呈现出东高西低的阶梯状,东、中、西、东北地区政策在不同层面各具优势。结论:我国家庭养老床位政策应根据各地区政策模式进行针对性改良,强化基层医养结合制度建设,通过科技赋能优化照护资源整合与配置,并大力发展养老产业,培育照护人才。

医护治一体化康复模式在脑卒中气管切开患者肺康复中的应用

目的探讨医护治一体化康复模式在脑卒中气管切开患者肺康复中的应用效果。方法选取2021年7月1日至2022年6月31日康复医学科收治的脑卒中气管切开患者48例作为研究对象,其中2021年12月31日之前收治的24例作为对照组,之后收治的24例作为试验组。两组患者均给予康复医学科常规康复干预措施,试验组在此基础上进行医护治一体化康复模式管理,观察时间均为4周。两组患者在入院当天及护理干预4周后分别测定用力肺活量(FVC)、1秒用力呼气量(FEV1)、呼气峰值流速(PEF),膈肌厚度及移动度,比较两组患者护理干预4周后肺部感染发生率、抗菌药物使用时间、气管套管拔管率及出院时的满意度。结果两组患者护理干预4周后FVC、FEV1、PEF、膈肌厚度和膈肌平静呼吸移动度均大于入院当天,P<0.05或<0.01;且试验组护理干预4周后的FVC、FEV1、PEF、膈肌厚度和膈肌平静呼吸移动度均大于对照组,P<0.05。护理干预4周后,与对照组比较,试验组肺部感染发生率降低,P<0.05,抗菌药物使用时间缩短,P<0.01。试验组出院当天满意度(91.7%)高于对照组满意度(83.3%),但差异无统计学意义。结论医护治一体化康复模式能有效改善脑卒中气管切开患者的肺功能,降低肺部感染发生率,从而提高患者生活质量,康复干预效果满意,患者满意度高。

基于PEST模型的我国农村医养结合养老服务发展策略研究

我国老龄人口比例逐年攀升,尤其是农村地区,老龄化现象更为严重。文章对我国农村医养结合养老服务的发展状况进行梳理,运用PEST分析模型对其在政治、经济、社会和技术4个方面所面临的困境进行分析研究。在借鉴国外医养结合养老服务实践经验的基础上,针对性地提出加强政策支持、拓宽资金来源、增强宣传和社会参与,以及完善信息建设与人才培养等方面的发展策略,以期对我国农村医养结合养老服务的后续研究与实践提供参考。

基于个案管理的整合照护模式在老年衰弱患者中的构建及应用

目的:探讨基于个案管理的整合照护模式在老年衰弱患者中的构建及应用效果。方法:选取2022年7月1日~12月31日80例老年衰弱患者为研究对象,随机分为研究组和对照组各40例,对照组采用常规老年衰弱护理方案,研究组采用基于个案管理的整合照护模式;比较两组干预前后日常生活能力(采用日常生活能力量表),社会支持度[采用社会支持评定量表(SSRS)],握力、6 m步行时间、5次坐立试验(FTSST)、起立-行走计时测试(TUG),护理满意度。结果:研究组干预后日常生活能力评分及SSRS评分、握力、6 m步行时间、FTSST、TUG均优于对照组(P<0.05),护理满意度高于对照组(P<0.05)。结论:基于个案管理的整合照护模式应用于老年衰弱患者可提高其日常生活能力及社会支持度,改善生活质量,提升护理满意度。