The multidisciplinary team severe asthma day case assessment and its impact on patient care

People with severe and difficult to control asthma can be a complex and heterogenous group of patients often with multiple comorbidities. Living with this disease imposes a huge physical and psychological burden upon the patient which requires a comprehensive, systematic and patient-focused assessment, using a wide range of clinical expertise from within the multidisciplinary team. This article describes a severe asthma systematic and multidimensional day case assessment, and the positive benefits that the authors perceive it offers for patient care. These benefits include a confirmed diagnosis, consideration of alternative diagnosis, enhanced adherence, medication optimisation, access to and gatekeeping of high-cost specialist medications, improved patient self-management skills and signposting to appropriate therapies. As a consequence, they believe that this facilitates better patient outcomes through a reduction in corticosteroid exposure, exacerbations and hospitalisation. This severe asthma multidisciplinary team day case approach offers more than just physical benefits when compared with the traditional medical model. Patient feedback reports an excellent patient experience, feeling listened to, understood, empowered and hopeful for the future.

Person-Centered Care in Nursing Homes: Potential of Complementary and Alternative Approaches and Their Challenges

A person-centered approach to care shifts the mind-set of care partners from a traditional medical model to a social model in managing chronic conditions. Using a qualitative descriptive approach, this study examines the barriers and facilitators to the implementation of person-centered care (PCC) and how the integration of complementary and alternative approaches (CAA) has the potential to improve residents’ quality of life in nursing homes (NHs). Findings indicate that NHs offer a wide range of engagement activities, but these activities are not purposefully integrated into a person-centered plan of care. Factors such as turnover, “working short,” supervisor support, and rising resident care needs make it challenging to implement PCC in NHs. This knowledge of the landscape of activities will help us identify and improve strategies for supporting residents at a deeper, more meaningful level. CAA has the potential to be therapeutic for residents if integrated into collaborative approaches to care.

A Scoping Review of Health Promotion in the Nursing Home Setting

Background Nursing homes in many countries continue to follow a traditional medical model of care. This study explored health promotion approaches in the nursing home setting, partly in order to move away from a medical model and to improve the well-being of residents and staff. Methods A scoping study was conducted to review the scientific literature. The Integrated Model of Population Health and Health Promotion was adapted for utilization with the literature analysis. Result A total of 64 publications met the inclusion criteria and were analysed. Five main approaches were shown to have applied health promotion in nursing homes, although gaps were present in the usage of systematically applied health promotion. Conclusion A variety of approaches do exist for the nursing home setting which apply health promotion; however, their usage is fragmented. This study revealed that a framework designed to support nursing homes in the systematic usage of health promotion, could improve the well-being for both residents and staff.

Servicing the Senior Swallow: A Family-Centered Private Practice Model of Service Delivery

Purpose Person-centered care shifts the focus of treatment away from the traditional medical model and moves toward personal choice and autonomy for people receiving health services. Older adults remain a priority for person-centered care because they are more likely to have complex care needs than younger individuals. Even more specifically, the assessment and treatment of swallowing disorders are often thought of in terms of setting-specific (i.e., acute care, skilled nursing, home health, etc.), but the management of dysphagia in older adults should be considered as a continuum of care from the intensive care unit to the outpatient multidisciplinary clinic. In order to establish a framework for the management of swallowing in older adults, clinicians must work collaboratively with a multidisciplinary team using current evidence to guide clinical practice. Private practitioners must think critically not only about the interplay between the components of the evidence-based practice treatment triad but also about the broader impact of dysphagia on caregivers and families. The physical health and quality of life of both the caregiver and the person receiving care are interdependent. Conclusion Effective treatment includes consideration of not only the patient but also others, as caregivers play an important role in the recovery process of the patient with swallowing disorders.

Dualism and the ‘difficult patient’: why integrating neuroscience matters

SUMMARYPatients with psychiatric illness present a unique challenge to clinicians: in contrast to the traditional medical model, in which patients are conceptualised as being stricken by a disease, patients with certain psychiatric illnesses may seem complicit in the illness. Questions of free will, choice and the role of the physician can cause clinicians to feel helpless, disinterested or even resentful. These tensions are a lasting legacy of centuries of mind–body dualism. Over the past several decades, modern tools have finally allowed us to break down this false dichotomy. Integrating a modern neuroscience perspective into practice allows clinicians to conceptualise individuals with psychiatric illness in a way that promotes empathy and enhances patient care. Specifically, a strong grasp of neuroscience prevents clinicians from falling into the trap in which behavioural aspects of a patient's presentation are perceived as being separate from the disease process. We demonstrate the value of incorporating neuroscience into a biopsychosocial formulation through the example of a ‘difficult patient’.

Development of a physiotherapy-led atraumatic back pain pathway: a novel initiative to improve the management of complex back pain in the emergency village

ObjectivesTo see if consultant physiotherapists could effectively manage spinal patients within the emergency village of a tertiary spinal referral centre.DesignA change was made to the traditional medical model for managing patients presenting to the emergency department with low back pain that could not be managed within the national 4-hour standard.ParticipantsA convenience sample of patients presenting to the emergency department of a tertiary spinal surgical centre who are unable to be managed in a timely manner by the clinicians in the emergency department.InterventionConsultant physiotherapists took on autonomous ownership of this group of patients, including clinical assessment, management and appropriate follow-up often without the need for medical input.OutcomesThe new model showed a reduction in the number of admissions, a significant reduction in length of stay and an improvement in overall staff and patient satisfaction along with a reduction in patients returning to the emergency department.ConclusionsConsultant physiotherapists are in an ideal position to manage this cohort of patients autonomously in the emergency village allowing medics to be released to manage other patient groups.

Practice and Exploration of Open Experimental Teaching in Preventive Medicine

<p>With the transformation of disease model and the development of related basic science, the research mode of preventive medicine is also changing. The traditional medical model mainly refers to the biomedical model. With the exploration of the medical field, the biomedical model has been transformed into the modern medical model, that is, the bio-psychology-social medical model. And the preventive medicine model has undergone significant changes along with the transformation of the entire medical model. Modern preventive medicine is an important means to protect human health. Due to people's social attributes, various social and psychological factors will affect the health of the population.Through people's new cognition and research on various factors affecting health in modern preventive medicine, modern preventive medicine has very obvious social benefits.This article mainly explains the practice and exploration of open experimental teaching of preventive medicine in China.</p>

Ireland

This chapter examines the prevalence and pathways to the diagnosis of dementia, as well as dementia care infrastructure, in the Republic of Ireland. The economic burden of dementia in Ireland is explored, including both formal and informal costs. Dementia care in the community, residential, and acute hospital settings is described. Associated policy, legislation, standards, and guidelines relevant to dementia care in Ireland are addressed. Current funding structures are examined. The contributions of dementia-specific educational efforts and relevant research in Ireland are highlighted. Challenges encountered in moving from a more traditional medical model of dementia care to a psycho-social, person-centred care model in Ireland, including inequitable funding allocation, are outlined.

Lifestyle Medicine in a Concierge Practice: My Journey

While lifestyle medicine (LM) has been increasingly recognized for its value in preventing and managing chronic disease, the conventional primary care practice has struggled to be a financially viable model for this time-intensive, highly personalized approach. However, the concierge medicine model provides many advantages to those seeking to incorporate the tenets of LM. Concierge medicine is characterized by smaller patient panels, extended visits, continuous follow-up, and a distinctive emphasis on prevention and wellness. These characteristics promote high-quality, individualized care. North Cypress Internal Medicine and Wellness was able to successfully transform from a more traditional medical model to one with essential LM-focused offerings with expert assistance, as well as ongoing support from a dedicated team of lifestyle-oriented health professionals who provide wellness coaching, proactive chronic care management, and prevention programs. This article describes the transition and includes specific details of services and care offered at a concierge practice. It illustrates how this alternative model can provide an effective solution for delivering the full potential of LM.