Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer: Impact on Patient Self-Management and Care Delivery in Safety-Net and Non–Safety-Net Centers

PURPOSE: Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non–safety-net institutions. METHODS: Ten institutions (five safety-net and five non–safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort. RESULTS: Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non–safety-net centers (87.6%, 74.2%, P = .001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P < .001) and ability to manage care (78.9%, 72.1%, P = .02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P = .045) and flu vaccination (38.6%, 27.9%, P = .001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non–safety-net patients, even after controlling for all other variables. CONCLUSION: 4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non–safety-net patients, indicating that 4R may reduce care disparities.

Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms

The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic of coronavirus disease 2019 (COVID-19). Across the globe, a subset of patients who sustain an acute SARS-CoV-2 infection are developing a wide range of persistent symptoms that do not resolve over the course of many months. These patients are being given the diagnosis Long COVID or Post-acute sequelae of COVID-19 (PASC). It is likely that individual patients with a PASC diagnosis have different underlying biological factors driving their symptoms, none of which are mutually exclusive. This paper details mechanisms by which RNA viruses beyond just SARS-CoV-2 have be connected to long-term health consequences. It also reviews literature on acute COVID-19 and other virus-initiated chronic syndromes such as post-Ebola syndrome or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to discuss different scenarios for PASC symptom development. Potential contributors to PASC symptoms include consequences from acute SARS-CoV-2 injury to one or multiple organs, persistent reservoirs of SARS-CoV-2 in certain tissues, re-activation of neurotrophic pathogens such as herpesviruses under conditions of COVID-19 immune dysregulation, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation issues, dysfunctional brainstem/vagus nerve signaling, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage care for specific patients with the diagnosis.

Nurses’ Preparedness, Readiness, and Anxiety in Managing COVID-19 Pandemic

Nurses’ preparedness has been very important for them to treat patients effectively during the COVID-19 pandemic and serve the community. Nurses provide a vital role in mitigating the effects of health crises. In order to help nurses better understand their skills, abilities, and knowledge, as well as the actions that they should take to manage care, the research aims of this study are to (1) investigate the level of preparedness, readiness, and anxiety among nurses during the COVID-19 outbreak in Sabah, Malaysia; (2) examine the effects of various differences in preparedness and readiness among nurses; and (3) examine the effect of COVID-19 preparedness on anxiety among nurses. The results revealed that the nurses were moderately competent in managing the COVID-19 care situation. Each of the 3 differentiating characteristics (age, work experience, and previous disaster experience) did not predict how nurses would manage COVID-19 preparedness significantly. Besides, we also found only 2 dimensions of preparedness (familiarity with epidemiology and surveillance and familiarity with psychological issues) significantly predicted nurses’ anxiety levels. Familiarity with epidemiology and surveillance predicted nurses’ anxiety positively; in contrast, familiarity with psychological issues negatively influenced nurses’ anxiety.

Telehealth as an Important Player in the Management of Hepatitis C Virus

Background: Hepatitis C virus (HCV) is a global public health issue that can cause both acute and chronic liver diseases. There is a high risk of HCV burden, but limited access and cost remain a challenge for proper diagnosis and treatment. Leveraging eHealth technology may indicate a viable solution for the management of HCV patients. Objective: To review the literature regarding the role of eHealth, including telemedicine, in the management of HCV. Methods: Databases including PubMed, Google Scholar, Medline, Web of Science, and Science Direct were searched from 1 January 2008 to 30 June 2020 to identify different types of eHealth interventions used for the management of adult HCV patients. Our search also determined the role of telehealth for HCV patients in the current pandemic. Results: Four main categories emerged from this scoping review that includes improving treatment rates via utilizing telehealth services, satisfaction with the telehealth services, disease management, health promotion, and similarity between telehealth and traditional modalities. Conclusion: Current evidence suggests that telemedicine is a cost-effective and unique platform to improve patients’ access to quality services that curb the increasing burden of this silent killer in developing countries. This modality can certainly be utilized in the current crisis to manage care for HCV patients efficiently.

The Older Cancer Patient

Approximately one-third of all persons reaching the age of 70 will receive a cancer diagnosis. By 2022, there will be 18 million cancer survivors in the United States, and approximately 63% will be 65 or older. Among the population 65 and older, cancer is the second leading cause of death. These increasing incidence rates combined with longer survival will place new demands on the cancer delivery system. The single largest payers for healthcare, Medicare and Medicaid, will experience increased stress as immunologic and other costly therapies become the standards of care. It is important to understand how to manage care for older persons with cancer, many of whom may already be dealing with other chronic health problems. Factors beyond chronological age must be considered when care decisions are made. Given the increased life expectancy resulting from improved treatment of cancer, as well as management of other chronic diseases, cancer and aging are important areas of concern for the future of healthcare. Older patients, even those with few or no comorbid conditions, are less likely to receive treatment with a curative intent. Older cancer patients face the challenge of finding individualized, patient-centered cancer care that considers how physiological, social, psychological, and, more recently, economic parameters interact with treatment options to attain outcomes that manage the disease while preserving quality of life. This chapter discusses these parameters as they pertain to cancer and cancer treatment in the older individual.

Perspectives of Family Caregivers Confronted With Care-Resistant Behavior From Persons With Dementia

Problem: Care-resistant behavior is often bundled with other behavioral symptoms of dementia, but it is a unique behavior requiring targeted interventions. Purpose: To describe the experiences of caregivers receiving online coaching to manage care-resistant behaviors exhibited by persons with dementia. Design: Qualitative. Sample & Procedure: 20 caregivers (12 female, 8 male) were recruited from Memory Disorders and Geriatrics clinics to participate in 6 weeks of online coaching sessions delivered by a doctorally prepared nurse practitioner. Coaching sessions were recorded and transcribed. NVivo12 software was used to manage the thematic analyses. Results: Caregivers followed a general trajectory. They initially reported feelings of anger, frustration, and guilt. They believed that the person with dementia was purposefully “being stubborn and mean.” As the coaching sessions progressed, these negative emotions and the attributions of intent altered. By the conclusion of the six weeks, caregivers expressed feelings of success and ingenuity in applying coaching strategies. Conclusion: Online coaching is an effective way to individualize strategies that enable the caregiver to manage and reduce care-resistant behavior. Implications: The use of a doctorally-prepared nurse practitioner to deliver coaching, while effective, is not sustainable. Next steps include developing a coaching training program that could be embedded into existing community resources for community-dwelling caregivers. Limitations: Participants were limited to referrals from two clinics in the same institution.

Promoting rational antibiotic use in Turkey and among Turkish migrants in Europe – implications of a qualitative study in four countries

Background Antimicrobial resistance is considered one of the major threats to global health. The emergence of resistant microorganisms is a consequence of irrational use of antibiotics. In Turkey, the consumption of antibiotics is relatively high and antibiotics are among the most commonly used drugs. However, Turkey has adopted new, more restrictive policies and regulations on antibiotics. In addition, Turkish migrants to EU countries, such as Germany, the Netherlands and Sweden, may encounter health systems that promote a more restrictive and rational antibiotic use. The objective of this paper was to explore the variation in implemented policies related to rational antibiotic use that citizens in Turkey and Turkish migrants in Germany, the Netherlands and Sweden are subjected to and to discuss the implications for the promotion of rational antibiotic use. Data were collected through focus groups and individual interviews with citizens, physicians and pharmacists in the four countries. In total, 130 respondents were interviewed. Content analysis was used. Results Three relevant themes were identified: Implementation of regulations and recommendations, Access to antibiotics and Need for health communication. Irrational use of antibiotics was reported mainly in Turkey. While it had become less likely to get antibiotics without a prescription, non-prescribed antibiotics remained a problem in Turkey. In the three EU countries, there were also alternative ways of getting antibiotics. Low levels of knowledge about the rational antibiotic use were reported in Turkey, while there were several sources of information on this in the EU countries. Communication with and trust in physicians were considered to be important. There were also system barriers, such as lacking opportunities for physicians to manage care in accordance with current evidence in Turkey and factors limiting access to care in EU countries. Conclusions Several fields of importance for promoting rational antibiotic use were identified. There is a need for harmonisation of health-related regulations and policy programmes. Antibiotics should only be available with a prescription. Programmes for rational antibiotic use should be implemented on a broad scale, in medical care, at pharmacies and in the population. Methods for health communication and patient-centred care should be further developed and implemented in this field.

What Skills Do Older Self-Funders in England Need to Arrange and Manage Social Care? Findings from a Scoping Review of the Literature

Older people in England who pay for social care from their own funds (‘self-funders’) receive little help in seeking and arranging care compared to older people funded by their local council. This suggests an implicit assumption that people funded by local councils need help to manage their care whereas self-funders do not. This article reports findings from a scoping review of published evidence from England, Scotland and Wales on the skills that older people need, and the help they get, to seek, arrange or manage use of social care, and how this help affects outcomes. Searches undertaken in October 2018 resulted in the inclusion of thirty-six empirical papers and seven reviews. Thematic analysis identified the importance of everyday life and specific business skills, and personal attributes including objectivity when evaluating options. The review identified two significant gaps in the evidence: first, how help in seeking and arranging care compensated for lack of, or complemented existing, skills; and secondly, how outcomes for people receiving help in arranging care compared with those not receiving help. The article concludes that a tailored approach to supporting older people arrange and manage care, irrespective of funding, should be considered.

Health-care workers’ knowledge and management skills of psychosocial and mental health needs and priorities of individuals with COVID-19

Purpose The purpose of this study is to identify the knowledge and management skills of health-care workers regarding psychosocial and mental health priorities and needs of individuals with COVID-19. Design/methodology/approach This is a cross-sectional descriptive study. The data collected conveniently from 101 health-care workers in Jordan directly managing care of individuals with COVID-19. Findings Health-care workers have moderate-to-high level of knowledge and management skills of psychological distress related to COVID-19; means ranged from 50%–70% agreement and confidence. In general, health-care workers were able to identify mental and psychosocial health needs and priorities at a moderate level. Health-care workers knowledge had a positive and significant correlation with age (r = 0.24, p = 0.012) and years of experience (r = 0.28, p = 0.004), and a significant difference was found in their management between those who are trained on psychological first aids and those who are not (t = −3.11, p = 0.003). Practical implications There is a need to train health-care workers to integrate psychosocial and mental health care to manage care psychological distress related to COVID-19. Originality/value This study is emphasizing the need for mental health psychosocial support training and in integration. Health-care workers providing care to individuals with COVID-19 are not aware of mental health priorities and needs of their patients. This paper contributes to the body of knowledge adding more understanding about competencies of health-care workers providing care and their preparedness to manage care individuals with COVID-19.

Carers Create: Carer perspectives of a creative programme for people with dementia and their carers on the relationship within the (carer and cared-for) dyad

Introduction Relationships between people with dementia and their carers can prove challenging over the trajectory of the disease. Interventions with a potential to address this include arts and music-based activities. This research project aimed to evaluate a community engagement programme (Carers Create) where both people with dementia and their carers participate together in singing and other activities. A specific focus was on the impact of the sessions on the dyadic relationship. Methods A grounded theory approach involved conducting three focus group interviews with carers of people with dementia ( n = 16) facilitated by members of a local U3A (University of the Third Age) who were trained and supported by university researchers. Recorded conversations were transcribed and analysed using a three-stage coding and thematic development technique. Results Four overarching themes were identified from the discourse: remembering the positive qualities of the cared-for, the physical and emotional demands of caring, Carers Create as a shared, beneficial activity and the enduring value of Carers Create. Conclusion Carers found the sessions to positively influence the relationship with the person they cared for through offering some relief from the day-to-day pressures of caring and, in some cases, restoring elements of a previously strong relationship. Crucial to the experience was the fact that the sessions included both carer and cared-for, offering activities to do together, and that they took place within a group, thereby offering a degree of mutual support. In addition, some carers were able to build on learning which had taken place and use certain techniques, such as singing, to help manage care, thus extending the improved relationship.