Relationship between care model and disease activity states and health-related quality of life in systemic lupus erythematosus patients

Objective To assess whether the care model (comprehensive vs regular) has any impact on the clinical outcomes of systemic lupus erythematosus patients. Methods Between August 2019 and January 2020, we evaluated SLE patients being cared for at two Peruvian hospitals to define the impact of care model on disease activity state and health-related quality of life (HRQoL). Disease activity was ascertained with the SLEDAI-2K and the Physician Global Assessment (PGA) which allows to define Lupus Low Disease Activity State (LLDAS) and Remission. HRQoL was measured with the LupusQoL. The association between care model and disease activity (Remission and LLDAS) state was examined using a binary logistic regression model. The association with HRQoL was examined with a linear regression model. All multivariable analyses were adjusted for possible confounders. Results 266 SLE patients were included, 227 from the comprehensive care model and 39 from the regular care model. The regular care model was associated with a lower probability of achieving remission (OR 0.381; CI: 95% 0.163–0.887) and LLDAS (OR 0.363; CI: 95% 0.157–0.835). Regular care was associated with a better HRQoL in two domains (pain and emotional health). We found no association between the care model and the other HRQoL domains. Conclusion A comprehensive care model was associated with the probability of achieving remission and LLDAS but had no apparent impact on the patients’ HRQoL.

Patient centric integrative supportive care model at a tertiary cancer care center of India

Palliative care is emerging as a recognized and needed branch all over the country. Integration of palliative care with oncology enhances patient’s quality of life, decreases suffering and depression, ensures good end of life care, better patient’s satisfaction, and decreases cost by avoiding unnecessary chemotherapy or ventilator support. The aim of this narrative analysis is to provide a truly integrated supportive model of palliative care practiced at DR BRA IRCH, AIIMS, Delhi, a tertiary cancer care center in India. It consists of inpatient and outpatient services with round the clock consultation teams. Integration of palliative care with other oncology has helped us in providing holistic and comprehensive care to the patients. We aim that this model might help in creating patient centric comprehensive care model in various other cancer centers with limited resources.

Perioperative management of wounds with nanosilver dressing after neoadjuvant chemotherapy for breast cancer

Neoadjuvant chemotherapy (NAC) can improve the success rate of breast cancer surgery; however, most patients have obvious negative thoughts about NAC. Failure to effectively relieve these negative emotions or thoughts will adversely affect the quality of life of the patients after treatment. Therefore, a majority of nursing staff are committed toward reducing patients’ negative emotions through good perioperative management as well as improving the treatment effects and postoperative quality of life of patients. A good perioperative management of breast cancer should include postoperative wound and patient psychological care. This study found that patients using nanosilver dressings have greatly reduced total wound drainage, drainage tube removal time, and postoperative complications within four days after surgery and that the rate of wound healing was obviously improved. This suggests that nanosilver dressings can improve the rate of wound healing and reduce the risk of complications. At the same time, we found that postoperative negative emotions of patients receiving comprehensive care were effectively relieved and their mental flexibility was also improved. In addition, the quality of sleep, quality of life, and nursing satisfaction of patients receiving comprehensive care were significantly higher than those receiving traditional care models. This shows that the comprehensive care model is capable of reducing the negative emotions of patients during the perioperative period and also helps to improve the quality of life of patients after surgery. Therefore, this study demonstrates that the use of nanosilver dressings as a comprehensive care model can reduce the risk of negative emotions and complications in addition to improving the rate of wound healing and postoperative quality of life.

Natural Recovery and Supportive Community Networks

The natural recovery process of “maturing out” appears to be an active process of renewal and growth, leading to transformative growth that involves the individual’s body, mind, and spiritual dimensions. If spontaneous or “maturing out” recovery accounts for about 4 to18% of the alcohol and other drug (AOD) challenges to the field of behavioral health treatment, how does one effectively partner with the other 82% who have alcohol and other drug issues? To answer this concern, we must ask a few more questions. (1) What developmental factors influence growth? (2) What social determinants of health enhance recovery? (3) What is a supportive community network? and (4) What constitutes evidence-based practice? When one only looks at the biological reasons for behavioral health challenges, the assumption is that getting well and overcoming deficiencies is a function of the individual rather than the system of care. This kind of narrow perspective has contributed to a behavioral health delivery system that continually struggles to provide an integrated, comprehensive care model. This restrictive thought process undermines individuals’ confidence to change and is unduly dismissive of community leaders’ efforts.

Dental Student Perspectives of a Comprehensive-Based Teaching Methodology: A Confidence, Effectiveness, and Challenge Report

Background/Objectives. The holistic methodology in education has been widely appreciated and implicated in dental schools in the last decade. Our department of conservative dentistry decided to reform the educational model of teaching from a traditional requirement-based model to a hybrid model incorporating comprehensive care treatment. The aim of our study was to assess students’ confidence and perspectives regarding the benefits of a comprehensive model of teaching. Materials and Methods. A questionnaire was distributed at the end of the academic year 2018-2019 and designed to investigate students’ opinions on the benefits of the new model of teaching, as well as difficulties encountered and possible shortcomings. In addition, self-perceived confidence level was assessed for the purpose of comparing confidence during supervised tasks versus confidence during comprehensive patient care. Results. Complete responses were gathered from 127 students out of 202, giving a response rate of 63%. The majority of students believed that the comprehensive model of teaching allowed them to better address patients’ needs, gave higher satisfaction, positively influenced self-confidence, permitted greater exposure to clinical techniques, and enhanced reasoning and analytical skills. However, their confidence was still lower in comprehensive patient management when compared to supervised tasks. Conclusion. Our students showed an appreciation of the comprehensive care model. Self-learning and didactic skills were enhanced. It would, therefore, be beneficial to adapt this methodology to earlier years and other disciplines to enhance the effectiveness of education and achievement of learning outcomes.

Students' perspectives and views toward a comprehensive based model of teaching: Confidence, effectiveness and challenges

Background The holistic methodology in education has been widely appreciated and implicated in dental schools in the last decade. Our department of conservative dentistry decided to reform the educational model of teaching from a traditional requirement-based model to a hybrid model incorporating comprehensive care treatment. The aim of our study was to assess students’ confidence and perspectives regarding the benefits of a comprehensive model of teaching. Methods A questionnaire was distributed at the end of the scholastic year 2018-2019 and designed to investigate students’ opinions on the benefits of the new model of teaching as well as difficulties encountered and possible shortcomings. In addition, self-perceived confidence level was assessed for purpose of comparison between their confidence in supervised tasks versus confidence during comprehensive case treatment. Results Completed responses were gathered from 127 students out of 202 giving a response rate of 63%. The majority of students believed that comprehensive cases allowed them to better address patients’ needs, gives higher satisfaction, positively influences self-confidence, permits greater exposure to clinical skills/techniques and enhances reasoning and analytical skills. However, their confidence was still lower in comprehensive case management when compared to supervised tasks. Conclusions Our students showed an appreciation of the comprehensive care model. Self-learning and didactic skills were enhanced. It would therefore be beneficial to adapt this methodology to earlier years and other disciplines, to enhance the effectiveness of education and achievement of learning outcomes.

Introduction

This introductory chapter provides a background of Forest Grove Elder Services and its nurse practitioners (NPs). It advances the notion of clinic work to illustrate the ways in which the Grove's NPs brought care work into the medical encounter. The term “clinic work” reflects the reality that the NPs' work was different in both form and content from the medical work of their physician colleagues. It also underlines the ways in which the NPs' work invoked a different form of relationality—it was in deep relationship with the organization or clinic in which it was located. Forest Grove Elder Services is not an ordinary outpatient clinic. It is a federally backed policy experiment to evaluate whether a comprehensive care model could ameliorate the state's economic burdens for long-term care. In some ways, the Grove's experimental objective was to figure out how to deliver care work under the aegis of medical care. Thus, the Grove's NPs were not simply performing an expansive form of work on behalf of their patients; they were also providing an expansive form of organizational care work for their employer. The chapter then considers the utility of NPs under state retrenchment.