‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including au...‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.展开更多
Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. T...Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.展开更多
Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. T...Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.展开更多
Objective:To analyze the nursing effect of psychological resilience support combined with midwife-integrated full-course care on primiparous women.Methods:A total of 66 primiparous women who were admitted to the hospi...Objective:To analyze the nursing effect of psychological resilience support combined with midwife-integrated full-course care on primiparous women.Methods:A total of 66 primiparous women who were admitted to the hospital for delivery from April 2022 to April 2024 were selected,all of whom underwent vaginal delivery.They were randomly divided into two groups using a random number table.The combined group received integrated full-course care from midwives under the premise of psychological resilience support,while the conventional group only received routine care.The nursing effects were compared between the two groups.Results:The breastfeeding rate of the combined group was higher than that of the conventional group at different time points after delivery,the postpartum complication rate was lower than that of the conventional group,the psychological resilience scores were higher than those of the conventional group at different stages of labor,and the nursing satisfaction was higher than that of the conventional group(P<0.05).Conclusion:Under the premise of psychological resilience support,integrated full-course care implemented by midwives can improve the breastfeeding rate,actively prevent postpartum complications,significantly improve psychological resilience,and achieve better nursing satisfaction.展开更多
Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minim...Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy;important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.展开更多
<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> In 2012, we initiated a new person-centred model, integrated &...<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> In 2012, we initiated a new person-centred model, integrated </span><b><span style="font-family:Verdana;">P</span></b><span style="font-family:Verdana;">alliative advanced home ca</span><b><span style="font-family:Verdana;">RE</span></b><span style="font-family:Verdana;"> and heart </span><b><span style="font-family:Verdana;">F</span></b><span style="font-family:Verdana;">ailur</span><b><span style="font-family:Verdana;">E</span></b><span style="font-family:Verdana;"> ca</span><b><span style="font-family:Verdana;">R</span></b><span style="font-family:Verdana;">e (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Design:</span></b><span style="font-family:Verdana;"> A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Participants:</span></b><span style="font-family:Verdana;"> Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age:</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">81</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">9 years) or control group (n = 36;25 males, 11 females, mean age:</span><span style="font-family:;" "=""></span><span style="font-family:Verdana;">76</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusions</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.</span>展开更多
Fostering integration between caregivers in the ambulatory sector involves transforming the institutional, organizational and technical flamework but also redesigning the work performed by health care professionals. E...Fostering integration between caregivers in the ambulatory sector involves transforming the institutional, organizational and technical flamework but also redesigning the work performed by health care professionals. Empirical research on the implementation of integrated care highlights professional engagement and commitment as a key success factor during the change process. Although a mismatch of motives during the integration process is often reported only a few studies have explored motivational aspects of health care integration. The aim of this study is to explore motivational factors for health care professionals in order to identify the determinants of attractiveness of integrated forms of care. An online-questionnaire was developed to identify the most important motivational factors for health care professionals and to reflect their perceptions on the attractiveness of interdisciplinary forms of care. The sample includes practicing physicians （general practitioners and specialists）, practicing nurses and non-physician professions （physiotherapists, midwives, speech therapists, occupational therapists）. Findings suggest that health care professionals are highly motivated by intrinsic motivators. Physicians turned out to be the most reluctant group towards integrated care models. Participating in integrated forms of care would challenge working independently which represents a strong motivator. The responses of nurses suggest that they are the most favorable group. Integrated care forms would be attractive offering more possibilities for social relationships, expanding responsibilities and challenging work. Results support the importance of health workforce engagement and participation in planning health care integration.展开更多
This review addresses the critical intersection between acute poisoning and the associated psychological trauma,highlighting the need to bridge the gap between emergency care and long-term mental health rehabilitation...This review addresses the critical intersection between acute poisoning and the associated psychological trauma,highlighting the need to bridge the gap between emergency care and long-term mental health rehabilitation.The global incidence of acute poisoning varies,showing different demographic patterns in psychological trauma post-poisoning,with suicide attempts accounting for approximately 76%of cases in some cohorts.Additionally,an estimated 385 million unintentional pesticide poisonings occur annually worldwide.A comprehensive understanding of the biological and neurobiological mechanisms involved—along with accurate diagnostic strategies and treatment methods—is essential.Multidisciplinary and integrated care approaches associated with a reduction in allcause mortality(odds ratio:0.52)and significant symptom burden relief,along with technological and therapeutic innovations,are essential for improving patient outcomes.Finally,this review outlines policy and research recommendations to enhance integrated care systems for the better management of acute poisoning and its associated psychological trauma.展开更多
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 trea...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.展开更多
With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical ...With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.展开更多
Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pul...Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pulmonary tuberculosis patients with lung cancer admitted to our hospital were selected as the research subjects.Using the random number table method,the patients were divided into two groups,a control group and a study group,with 30 cases in each group.The chest computed tomography(CT)examination results,mental state assessment(including depression scale and anxiety scale)scores,incidence of adverse reactions,treatment effect,and length of hospital stay were compared between the two groups.Results:The treatment effect of the patients in the study group was better than that of the patients in the control group(P<0.05);the duration of hospitalization,chest CT examination results,mental state assessment scores,and incidence of adverse reactions of the study group and the control group,were significantly different(P<0.05).Conclusion:The integrated medical care model combined with psychological intervention can effectively improve the treatment effect of pulmonary tuberculosis patients with lung cancer and prevent the occurrence of adverse reactions;thus,it should be promoted in clinical practice.展开更多
Objective: the effect of survival rate and complications of integrated emergency care inside and outside the hospital combined with evidence-based nursing for patients with acute myocardial infarction was investigated...Objective: the effect of survival rate and complications of integrated emergency care inside and outside the hospital combined with evidence-based nursing for patients with acute myocardial infarction was investigated. Methods: 55 AMI patients admitted to our hospital from November 2019 to November 2020 were selected as the experimental group, and 55 AMI patients admitted to our hospital during the same period were selected as the reference group. The experimental group received integrated emergency care combined with evidence-based nursing, while the control group received outpatient and emergency routine emergency care. The duration of emergency treatment, rescue results, incidence of complications and cardiac function level of patients in two groups under different intervention modes were compared. Results: the duration of OTD, DTN, triage assessment, D2B and hospital stay in the experimental group were shorter than those in the reference group (P < 0.05). The rescue success rate of the experimental group was significantly higher than that of the reference group. The death rate, AMI recurrence rate and PCI rate were significantly lower than those in the reference group, with statistical significance (P < 0.05).The incidence of complications in the experimental group was 21.82%, significantly lower than that in the control group (50.91%, P < 0.05). Conclusion: through evidence-based nursing emergency identify first aid problem and solve to optimize the integration of inside and outside hospital emergency first aid process, which can effectively shorten the hospitalization time and start time for PCI treatment after admission, triage assessment and D2B time, thus improve rescue success rate, reduce recurrence AMI, again PCI rate and incidence of complications. It plays a positive role in reducing the case fatality rate.展开更多
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 hospita...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.展开更多
Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis ...Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.展开更多
Objective: To evaluate the effect of comprehensive care on glioma patients and on their quality of life and surgical effect. Methods: 60 hospitalized glioma patients were selected as the main body (2019.11-2021). All ...Objective: To evaluate the effect of comprehensive care on glioma patients and on their quality of life and surgical effect. Methods: 60 hospitalized glioma patients were selected as the main body (2019.11-2021). All patients were surgically treated and divided into two groups by type. This group was designated as the study group (30 cases) and the control group (30 cases). The control group used usual care and integrated care. To compare surgical efficacy, quality of life, pain, satisfaction with care, and mood state. Results: High quality, surgical efficacy of life, nursing satisfaction, low pain score and emotional status in the control group (P <0.05). Conclusion: Comprehensive nursing is ideal for glioma patients, which can reduce pain and bad mood, and improve nursing satisfaction and quality of life.展开更多
Objective:To explore the application effect of the care of patients with inguinal hernia surgery,medical and nursing integration model with a view to providing help for the optimization of clinical surgical care progr...Objective:To explore the application effect of the care of patients with inguinal hernia surgery,medical and nursing integration model with a view to providing help for the optimization of clinical surgical care program.Methods:Seventy-eight inguinal hernia patients who underwent surgical treatment in a hospital during the period of December 2023 to November 2024 were selected and divided into a control group and a study group,each with 39 cases,using the mean score method.The control group was given the usual clinical surgical care model,and the observation group was given the medical and nursing integration model,and the nursing effects of the two groups were compared.Results:The postoperative pain level score of patients in the observation group(2.23±0.52)was lower than that of the control group(3.86±1.02);the gastrointestinal recovery time of patients in the observation group(23.12±4.06h),and the time to get out of bed(15.42±4.19d)were shorter than that of the control group(29.53±3.47 h)and(20.85±3.08 d),and the differences were statistically significant(P<0.05);postoperative sleep efficiency score(the observation group 5.12±1.14),sleep disorder score(6.42±1.29),time to sleep score(7.56±1.57),and daytime function score(6.25±1.19)in were significantly lower than those in the control group[(7.46±1.29),(8.63±1.41),(10.37±1.38),and(8.49±1.24),respectively],with the differences being statistically significant(P<0.05).;the incidence of complications such as urinary retention,local hematoma,and incision infection during the treatment period of the patients in the observation group(2.56%)was significantly lower than that of the control group(20.51%),and the difference was statistically significant(P<0.05);in the observation group,the patient care satisfaction(97.44%)was significantly higher than that of the control group(76.92%),and the difference was statistically significant(P<0.05).Conclusion:The integrated model of medical care has significant advantages in the care of patients undergoing inguinal hernia surgery,which can effectively alleviate postoperative pain,shorten the gastrointestinal recovery time and the time to get out of bed,and at the same time significantly improve the quality of patient’s sleep,and reduce the risk of complications such as urinary retention,local hematomas,and incisional infections,to obtain a higher degree of satisfaction from patients,and it is recommended that it should be popularized and applied in other medical departments.展开更多
At present,China has entered an aging society,and there is an urgent need for a large number of high-quality geriatric nursing professionals.However,the existing geriatric nursing team is difficult to meet the actual ...At present,China has entered an aging society,and there is an urgent need for a large number of high-quality geriatric nursing professionals.However,the existing geriatric nursing team is difficult to meet the actual needs both in terms of quality and quantity.In this regard,under the background of the integration of medical and elderly care services,colleges and universities should strengthen the training of geriatric nursing talents.This paper conducts an in-depth analysis on the training of geriatric nursing teams under the background of the integration of medical and elderly care services,aiming to provide some references for promoting the reform of geriatric nursing talent training in colleges and universities and improving the level of geriatric nursing services in China.展开更多
Against the backdrop of the accelerated aging of the population,the elderly care model integrating medical and elderly care services has become a crucial approach to addressing the challenges of elderly care.As direct...Against the backdrop of the accelerated aging of the population,the elderly care model integrating medical and elderly care services has become a crucial approach to addressing the challenges of elderly care.As direct providers of integrated medical and elderly care services,the professional competence of elderly caregivers directly affects the quality of services and the quality of life of the elderly.This paper aims to conduct an in-depth study on the professional competence of elderly caregivers under the integrated medical and elderly care model.Firstly,it clarifies the components of elderly caregivers’professional competence,analyzes the existing problems in their current professional competence,and proposes targeted improvement strategies.The purpose is to build a high-quality and professional team of elderly caregivers,provide strong support for the development of the integrated medical and elderly care cause,and promote the professionalization of integrated medical and elderly care services.展开更多
With the gradual deepening of aging,the barrier-free design of outdoor spaces in healthcare and wellness buildings is crucial to the quality of life for the elderly in their later years.The mountainous terrain of Chon...With the gradual deepening of aging,the barrier-free design of outdoor spaces in healthcare and wellness buildings is crucial to the quality of life for the elderly in their later years.The mountainous terrain of Chongqing poses higher requirements for barrier-free design.This paper analyzes the barrier-free needs of the elderly,systematically reviews the current status of barrier-free design in Chongqing’s healthcare and wellness buildings,and proposes targeted smart strategy suggestions from four aspects:barrier-free transportation space,activity space,landscape sketches,and place spirit,combining regional characteristics.These suggestions aim to improve and enhance the quality of the elderly care environment in Chongqing.展开更多
Primary care has been dubbed the“de facto”mental health system of the United States since the 1970s.Since then,various forms of mental health delivery models for primary care have proven effective in improving patie...Primary care has been dubbed the“de facto”mental health system of the United States since the 1970s.Since then,various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs.Despite increases in collaborative care implementation and reimbursement,prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb.Meanwhile,primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether,citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available,high false-positive results,and small treatment effects.In this perspective,a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care.In addition,we propose systemic changes to improve the dissemination of mental health treatment in primary care.展开更多
文摘‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.
文摘Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.
文摘Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.
文摘Objective:To analyze the nursing effect of psychological resilience support combined with midwife-integrated full-course care on primiparous women.Methods:A total of 66 primiparous women who were admitted to the hospital for delivery from April 2022 to April 2024 were selected,all of whom underwent vaginal delivery.They were randomly divided into two groups using a random number table.The combined group received integrated full-course care from midwives under the premise of psychological resilience support,while the conventional group only received routine care.The nursing effects were compared between the two groups.Results:The breastfeeding rate of the combined group was higher than that of the conventional group at different time points after delivery,the postpartum complication rate was lower than that of the conventional group,the psychological resilience scores were higher than those of the conventional group at different stages of labor,and the nursing satisfaction was higher than that of the conventional group(P<0.05).Conclusion:Under the premise of psychological resilience support,integrated full-course care implemented by midwives can improve the breastfeeding rate,actively prevent postpartum complications,significantly improve psychological resilience,and achieve better nursing satisfaction.
文摘Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy;important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.
文摘<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> In 2012, we initiated a new person-centred model, integrated </span><b><span style="font-family:Verdana;">P</span></b><span style="font-family:Verdana;">alliative advanced home ca</span><b><span style="font-family:Verdana;">RE</span></b><span style="font-family:Verdana;"> and heart </span><b><span style="font-family:Verdana;">F</span></b><span style="font-family:Verdana;">ailur</span><b><span style="font-family:Verdana;">E</span></b><span style="font-family:Verdana;"> ca</span><b><span style="font-family:Verdana;">R</span></b><span style="font-family:Verdana;">e (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Design:</span></b><span style="font-family:Verdana;"> A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Participants:</span></b><span style="font-family:Verdana;"> Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age:</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">81</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">9 years) or control group (n = 36;25 males, 11 females, mean age:</span><span style="font-family:;" "=""></span><span style="font-family:Verdana;">76</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusions</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.</span>
文摘Fostering integration between caregivers in the ambulatory sector involves transforming the institutional, organizational and technical flamework but also redesigning the work performed by health care professionals. Empirical research on the implementation of integrated care highlights professional engagement and commitment as a key success factor during the change process. Although a mismatch of motives during the integration process is often reported only a few studies have explored motivational aspects of health care integration. The aim of this study is to explore motivational factors for health care professionals in order to identify the determinants of attractiveness of integrated forms of care. An online-questionnaire was developed to identify the most important motivational factors for health care professionals and to reflect their perceptions on the attractiveness of interdisciplinary forms of care. The sample includes practicing physicians （general practitioners and specialists）, practicing nurses and non-physician professions （physiotherapists, midwives, speech therapists, occupational therapists）. Findings suggest that health care professionals are highly motivated by intrinsic motivators. Physicians turned out to be the most reluctant group towards integrated care models. Participating in integrated forms of care would challenge working independently which represents a strong motivator. The responses of nurses suggest that they are the most favorable group. Integrated care forms would be attractive offering more possibilities for social relationships, expanding responsibilities and challenging work. Results support the importance of health workforce engagement and participation in planning health care integration.
文摘This review addresses the critical intersection between acute poisoning and the associated psychological trauma,highlighting the need to bridge the gap between emergency care and long-term mental health rehabilitation.The global incidence of acute poisoning varies,showing different demographic patterns in psychological trauma post-poisoning,with suicide attempts accounting for approximately 76%of cases in some cohorts.Additionally,an estimated 385 million unintentional pesticide poisonings occur annually worldwide.A comprehensive understanding of the biological and neurobiological mechanisms involved—along with accurate diagnostic strategies and treatment methods—is essential.Multidisciplinary and integrated care approaches associated with a reduction in allcause mortality(odds ratio:0.52)and significant symptom burden relief,along with technological and therapeutic innovations,are essential for improving patient outcomes.Finally,this review outlines policy and research recommendations to enhance integrated care systems for the better management of acute poisoning and its associated psychological trauma.
文摘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.
基金the 2021 General Project of Liaoning Department of Education(LJKR0125)the 2021 General Project of National Natural Science Foundation of China(52178011)+1 种基金the 2021 Liaoning Provincial Social Science Planning Fund Project(L21BRK003)the 2023 Research Topic on the Economic and Social Development of Liaoning Province(2023lslybkt-076).
文摘With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.
文摘Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pulmonary tuberculosis patients with lung cancer admitted to our hospital were selected as the research subjects.Using the random number table method,the patients were divided into two groups,a control group and a study group,with 30 cases in each group.The chest computed tomography(CT)examination results,mental state assessment(including depression scale and anxiety scale)scores,incidence of adverse reactions,treatment effect,and length of hospital stay were compared between the two groups.Results:The treatment effect of the patients in the study group was better than that of the patients in the control group(P<0.05);the duration of hospitalization,chest CT examination results,mental state assessment scores,and incidence of adverse reactions of the study group and the control group,were significantly different(P<0.05).Conclusion:The integrated medical care model combined with psychological intervention can effectively improve the treatment effect of pulmonary tuberculosis patients with lung cancer and prevent the occurrence of adverse reactions;thus,it should be promoted in clinical practice.
文摘Objective: the effect of survival rate and complications of integrated emergency care inside and outside the hospital combined with evidence-based nursing for patients with acute myocardial infarction was investigated. Methods: 55 AMI patients admitted to our hospital from November 2019 to November 2020 were selected as the experimental group, and 55 AMI patients admitted to our hospital during the same period were selected as the reference group. The experimental group received integrated emergency care combined with evidence-based nursing, while the control group received outpatient and emergency routine emergency care. The duration of emergency treatment, rescue results, incidence of complications and cardiac function level of patients in two groups under different intervention modes were compared. Results: the duration of OTD, DTN, triage assessment, D2B and hospital stay in the experimental group were shorter than those in the reference group (P < 0.05). The rescue success rate of the experimental group was significantly higher than that of the reference group. The death rate, AMI recurrence rate and PCI rate were significantly lower than those in the reference group, with statistical significance (P < 0.05).The incidence of complications in the experimental group was 21.82%, significantly lower than that in the control group (50.91%, P < 0.05). Conclusion: through evidence-based nursing emergency identify first aid problem and solve to optimize the integration of inside and outside hospital emergency first aid process, which can effectively shorten the hospitalization time and start time for PCI treatment after admission, triage assessment and D2B time, thus improve rescue success rate, reduce recurrence AMI, again PCI rate and incidence of complications. It plays a positive role in reducing the case fatality rate.
文摘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.
基金Baoding Science and Technology Plan Project“The Effect of Medical-Nurse Integrated Nursing Model Combined with Psychological Intervention on the Clinical Curative Effect of Tuberculosis and Lung Cancer Patients”(Project number:2141ZF318).
文摘Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.
文摘Objective: To evaluate the effect of comprehensive care on glioma patients and on their quality of life and surgical effect. Methods: 60 hospitalized glioma patients were selected as the main body (2019.11-2021). All patients were surgically treated and divided into two groups by type. This group was designated as the study group (30 cases) and the control group (30 cases). The control group used usual care and integrated care. To compare surgical efficacy, quality of life, pain, satisfaction with care, and mood state. Results: High quality, surgical efficacy of life, nursing satisfaction, low pain score and emotional status in the control group (P <0.05). Conclusion: Comprehensive nursing is ideal for glioma patients, which can reduce pain and bad mood, and improve nursing satisfaction and quality of life.
文摘Objective:To explore the application effect of the care of patients with inguinal hernia surgery,medical and nursing integration model with a view to providing help for the optimization of clinical surgical care program.Methods:Seventy-eight inguinal hernia patients who underwent surgical treatment in a hospital during the period of December 2023 to November 2024 were selected and divided into a control group and a study group,each with 39 cases,using the mean score method.The control group was given the usual clinical surgical care model,and the observation group was given the medical and nursing integration model,and the nursing effects of the two groups were compared.Results:The postoperative pain level score of patients in the observation group(2.23±0.52)was lower than that of the control group(3.86±1.02);the gastrointestinal recovery time of patients in the observation group(23.12±4.06h),and the time to get out of bed(15.42±4.19d)were shorter than that of the control group(29.53±3.47 h)and(20.85±3.08 d),and the differences were statistically significant(P<0.05);postoperative sleep efficiency score(the observation group 5.12±1.14),sleep disorder score(6.42±1.29),time to sleep score(7.56±1.57),and daytime function score(6.25±1.19)in were significantly lower than those in the control group[(7.46±1.29),(8.63±1.41),(10.37±1.38),and(8.49±1.24),respectively],with the differences being statistically significant(P<0.05).;the incidence of complications such as urinary retention,local hematoma,and incision infection during the treatment period of the patients in the observation group(2.56%)was significantly lower than that of the control group(20.51%),and the difference was statistically significant(P<0.05);in the observation group,the patient care satisfaction(97.44%)was significantly higher than that of the control group(76.92%),and the difference was statistically significant(P<0.05).Conclusion:The integrated model of medical care has significant advantages in the care of patients undergoing inguinal hernia surgery,which can effectively alleviate postoperative pain,shorten the gastrointestinal recovery time and the time to get out of bed,and at the same time significantly improve the quality of patient’s sleep,and reduce the risk of complications such as urinary retention,local hematomas,and incisional infections,to obtain a higher degree of satisfaction from patients,and it is recommended that it should be popularized and applied in other medical departments.
文摘At present,China has entered an aging society,and there is an urgent need for a large number of high-quality geriatric nursing professionals.However,the existing geriatric nursing team is difficult to meet the actual needs both in terms of quality and quantity.In this regard,under the background of the integration of medical and elderly care services,colleges and universities should strengthen the training of geriatric nursing talents.This paper conducts an in-depth analysis on the training of geriatric nursing teams under the background of the integration of medical and elderly care services,aiming to provide some references for promoting the reform of geriatric nursing talent training in colleges and universities and improving the level of geriatric nursing services in China.
文摘Against the backdrop of the accelerated aging of the population,the elderly care model integrating medical and elderly care services has become a crucial approach to addressing the challenges of elderly care.As direct providers of integrated medical and elderly care services,the professional competence of elderly caregivers directly affects the quality of services and the quality of life of the elderly.This paper aims to conduct an in-depth study on the professional competence of elderly caregivers under the integrated medical and elderly care model.Firstly,it clarifies the components of elderly caregivers’professional competence,analyzes the existing problems in their current professional competence,and proposes targeted improvement strategies.The purpose is to build a high-quality and professional team of elderly caregivers,provide strong support for the development of the integrated medical and elderly care cause,and promote the professionalization of integrated medical and elderly care services.
基金Research Fund Projects of Chongqing Institute of Engineering:Research on the Intelligent Design of Indoor and Outdoor Spaces for Chongqing’s“Integrated Medical and Elderly Care”Health and Wellness Buildings in the Context of Digitization(2023xsky01)Research on Spatial Syntax Parameters and Combination Patterns of Urban and Rural Community Elderly Care Centers from a Multi-Dimensional Perspective(2024XZKY003)Funding support:2024 Curriculum Ideological and Political Demonstration Course Construction Project of Chongqing Institute of Engineering,“Residential Landscape Design”(Project Number:KC20240006)。
文摘With the gradual deepening of aging,the barrier-free design of outdoor spaces in healthcare and wellness buildings is crucial to the quality of life for the elderly in their later years.The mountainous terrain of Chongqing poses higher requirements for barrier-free design.This paper analyzes the barrier-free needs of the elderly,systematically reviews the current status of barrier-free design in Chongqing’s healthcare and wellness buildings,and proposes targeted smart strategy suggestions from four aspects:barrier-free transportation space,activity space,landscape sketches,and place spirit,combining regional characteristics.These suggestions aim to improve and enhance the quality of the elderly care environment in Chongqing.
基金National Institute of Mental Health Agency for Healthcare Research and Quality(AHRQ),No.R01HS025198(to Moise N).
文摘Primary care has been dubbed the“de facto”mental health system of the United States since the 1970s.Since then,various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs.Despite increases in collaborative care implementation and reimbursement,prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb.Meanwhile,primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether,citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available,high false-positive results,and small treatment effects.In this perspective,a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care.In addition,we propose systemic changes to improve the dissemination of mental health treatment in primary care.
