Safety of family integrated care model in neonatal intensive care unit: a Meta-analysis / 中国新生儿科杂志

Objective:To systematically evaluate the safety of family integrated care (FICare) model in neonatal intensive care unit (NICU).Methods:Multiple medical databases were searched for clinical studies on FICare in NICU published from January 1, 2010 to May 28, 2022. The quality of the literature was evaluated using Risk?of?Bias?2 tool?and cohort evaluation criteria from the Cochrane Systematic Evaluation Manual depending on the types of studies included. Meta-analysis was performed using Review Manager 5.3 software.Results:Six randomized controlled trials and four cohort studies were included for meta-analysis. The results of meta-analysis showed that compared with the traditional care model, FICare model did not increase the risk of nosocomial infection ( RR=0.75, 95% CI 0.46-1.24, P=0.27) and unstable medical conditions ( RR=0.86, 95% CI 0.61-1.22, P=0.40). No significant difference existed in the all-cause mortality between FICare and traditional care ( RR=2.74, 95% CI 0.88-8.57, P=0.08). Conclusions:FICare does not increase the risk of nosocomial infection, unstable medical conditions and adverse events compared with traditional care. It is safe and feasible to implement FICare in NICU.

Restricción del crecimiento intrauterino y enfermedades no transmisibles durante las edades pediátricas

Introducción: En la aparición de las enfermedades crónicas durante las edades pediátricas y la adolescencia, la restricción del crecimiento intrauterino se considera un factor clave. Objetivo: Determinar la relación entre la restricción del crecimiento intrauterino y las enfermedades no trasmisibles durante las edades pediátricas. Métodos: Se realizó una revisión narrativa con búsqueda bibliográfica en Pubmed, SciELO, LILACS y Google académico en los últimos cinco años sobre el tema que se trata. Se examinaron artículos originales, de revisión y capítulos de libros. Se utilizaron las palabras clave: retardo del crecimiento fetal, factores de riesgo cardiometabólicoy atención integrada a las enfermedades prevalentes de la infancia. Se descartaron aquellos artículos no pertinentes o que tuvieran deficiencias metodológicas notables. Análisis y síntesis de la información: Se expusieron las definiciones de "pequeño para la edad gestacional" y "restricción del crecimiento intrauterino", se mostró la clasificación más actualizada, se mencionaron las enfermedades que aparecen en la infancia en estos recién nacidos de riesgo y se señalaron sus mecanismos. Conclusiones: El antecedente de restricción del crecimiento intrauterino se relaciona con alteraciones del crecimiento pondoestatural, del neurodesarrollo; el síndrome metabólico; las afecciones cardiovasculares; las enfermedades endocrinas, hepáticas, respiratorias, del sistema inmunológico y renales, los trastornos auditivos y de la visión. Estas afecciones se presentan en etapas tempranas de la vida como la infancia y la adolescencia.

Introduction: In the occurrence of chronic diseases during pediatric ages and adolescence, intrauterine growth restriction is considered a key factor. Objective: To determine the relationship between intrauterine growth restriction and noncommunicable diseases during pediatric ages. Methods: A narrative review was performed with a literature search in Pubmed, SciELO, LILACS and Google Scholar in the last five years on the topic under discussion. Original articles, review articles and book chapters were examined. The keywords used were: fetal growth retardation, cardiometabolic risk factors, integrated care for prevalent childhood diseases. Articles that were not relevant or had notable methodological deficiencies were discarded. Analysis and synthesis of the information: The definitions of "small for gestational age" and "intrauterine growth restriction" were exposed, the most updated classification was shown, the diseases that appear during infancy in these at-risk newborns were mentioned and their mechanisms were pointed out. Conclusions: The history of intrauterine growth restriction is related to alterations of pondoestatural growth, neurodevelopment, metabolic syndrome, cardiovascular conditions, endocrine, hepatic, respiratory, immune system, renal, hearing and vision disorders. These conditions surface in early stages of life such as infancy and adolescence.

Research progress on intrinsic capacity in older adults / 中华老年医学杂志

In order to cope with increasingly severe global population aging, WHO defines "healthy ageing" as the process of developing and maintaining the functional ability required for healthy living of the elderly.Functional ability is related to the interaction between intrinsic capacity(IC)and the environment.IC refers to the sum of all the physical and mental abilities of the individual.Unlike frailty and disability, IC focuses on the functional aspects of the elderly, longitudinally tracking a person's life, rather than on health conditions of the individual at a certain time.Evaluation of IC, including cognitive function, psychological status, sensory function, vitality and locomotor function, is expected to become crucial to predict outcomes and risks of care dependence in the elderly.Starting from screening for IC declines of the elderly in the community, integrated care is formulated taking older people and their caregivers into consideration to improve the quality of life of the elderly to the greatest extent and reduce the social burden.

Effects of family integrated care on positive feelings and readiness for hospital discharge among mothers of premature infants / 中华行为医学与脑科学杂志

Objective:To investigate the effects of family integrated care(FICare) on positive feelings and readiness for hospital discharge among mothers of premature.Methods:From January to October 2021, a total of 100 premature infants were admitted to the neonatal intensive care unit(NICU) of General Hospital of Ningxia Medical University, and their mothers were admitted to this program.They were divided into research group (52 cases) and control group (48 cases) randomly.The premature infants in the control group received NICU routine care during hospitalization, meanwhile the premature infants and the mothers in the research group were given FICare on the routine care during hospitalization.On the 2nd day of admission (before the intervention) and 1 day before discharge (after the intervention), the positive aspects of caregiver (PAC) and the readiness for hospital discharge scale (RHDS) were used to evaluate the positive feelings and readiness for discharge of premature infants' mothers in the two groups.The t-test of two independent samples was used for measurement data between the two groups, and the paired t-test was used for intra-group comparison by SPSS 22.0 statistical software.The comparison of enumeration data between the two groups was carried out by chi-square test. Results:There were no significant differences in the scores of PAC and discharge readiness (both P>0.05) between the two groups before intervention.After the intervention, the premature mothers' total score of PAC in the research group and control group were((32.00±2.79), (27.40±3.37)), the self-affirmation dimension were ((18.55±2.39), (16.10±1.77)), the life outlook dimension were( (13.45±1.93), (11.30±2.20)), and all the scores in the research group were higher than those of the control group (all P<0.05). The total scores of readiness for hospital discharge in the research group and control group were ((106.75±6.11), (100.40±10.41)), personal status dimension were ((26.92±2.37), (25.11±3.32)), adaptability dimension were ((43.50±2.70), (40.64±4.65)), and the anticipatory support dimension were ((36.33±2.16), (34.29±3.29)). The total scores and each dimensions of the mothers' readiness for hospital discharge in the research group were higher than those in the control group (all P<0.05). After the intervention, the positive feeling total score and all dimensions score of the two groups of premature mothers were higher than before intervention (all P<0.05). After intervention, the total score of readiness for hospital discharge and the scores of all dimensions of premature mothers in the research group were higher than before intervention (all P<0.05). And there were no significant difference in the total scores of readiness for hospital discharge and other dimensions in the control group comparison before and after intervention(all P>0.05), except adaptability dimensions ( P<0.05). Conclusion:The findings suggest that FICare can improve the positive feelings of mothers of premature infants and hospital discharge readiness especially.

Delivering patient-centered care: outcomes of comprehensive geriatric assessment across healthcare settings / Avaliação geriátrica ampla: uma revisão narrativa sobre os benefícios do cuidado centrado no paciente nos vários ambientes de saúde

Comprehensive geriatric assessment (CGA) is a systematic multidimensional and interdisciplinary evaluation that enables clinicians to recognize age-related impairments and develop a coordinated treatment plan and follow-up suited to the patient's needs. Considering the growing number of older persons requiring care in health systems everywhere and the importance of shifting from a disease-specific care model to a more comprehensive care model, we aimed to present the benefits of CGA for older people in different healthcare settings using a narrative review. This patient-centered model of care has been associated with lower hospital (re)admission, maintenance of function, improved quality of life, less caregiver burden, and higher patient satisfaction with the care provided across different healthcare settings. In some contexts ­ for example, hospitalized older people ­, CGA has already been established as the standard model of care as it was consistently related to reduced mortality. Consistent findings from specific contexts (eg, oncology, orthopaedics) also show the importance of CGA in aiding clinicians make better decisions for older patients. It is noteworthy that further evidence from costeffectiveness studies is still warranted, particularly in community settings. Another encouraging topic for future research is the role of technology in disseminating CGA-based models of care.

A avaliação geriátrica ampla (AGA) é um modelo de atenção sistemático, multidimensional e interdisciplinar, que permite aos médicos reconhecer incapacidades relacionadas à idade e desenvolver um plano de tratamento e acompanhamento voltado para as necessidades específicas do paciente. Considerando o crescente número de pessoas idosas que procuram cuidados de saúde em todos os países e a importância de mudar de um modelo de atenção centrado na doença para um modelo mais abrangente e centrado no paciente, nosso objetivo foi apresentar os benefícios da AGA para idosos em diferentes ambientes de saúde usando uma revisão narrativa. Essa forma de abordagem tem sido associada à menor taxa de (re)internação hospitalar, à manutenção da funcionalidade, à melhoria da qualidade de vida, à menor sobrecarga do cuidador e à maior satisfação do paciente com os cuidados recebidos nos diferentes ambientes de saúde. Em alguns contextos, por exemplo, de idosos hospitalizados, a AGA já se estabeleceu como padrão de atendimento, pois tem sido consistentemente associada à redução da mortalidade. Há também evidências substanciais de contextos específicos, como de oncologia e ortopedia, mostrando a importância da avaliação ampla para os médicos, pois colabora com a tomada de decisão quanto ao melhor tratamento dos pacientes idosos. Vale ressaltar que mais evidências baseadas em estudos de custo-efetividade ainda são necessárias, principalmente em ambientes da comunidade. Outro tópico interessante para pesquisas futuras é examinar o papel das tecnologias na disseminação de modelos de atendimento baseados na AGA.

Impact of Home Nursing Care on the Consultation Time of Emergency Home Visits: A Prospective Cohort Study / 日本プライマリ・ケア連合学会誌

Introduction: This study examined the association between the use of home nursing care and the consultation time of emergency home visits among patients using home health care. Methods: Participants were recruited from three urban clinics in Japan between September 1 and November 30, 2019. Univariate analysis and multivariate negative binomial regression analysis considering institutional clusters were performed on the relationship between the two. Results: A total of 278 patients were included in the analyses. The use of home nursing care was significantly associated with a decrease in the time spent during emergency home visits in both univariate and multivariate analyses (P < 0.018 and P < 0.001, respectively). The multivariate analysis estimated the mean reduction in consultation time to be 10.3 minutes (95% confidence interval, 9.9-10.8). Conclusion: The use of home nursing care reduced the consultation time in emergency home visits. This study suggested that home nursing care can reduce the burden on physicians providing home visits, but further studies are needed to improve collaboration.

A scoping review on strategies, influencing factors and evaluation of foreign stroke service system integration / 中华医院管理杂志

Objective:To summarize the strategies, influencing factors and evaluation methods of foreign stroke service system integration, so as to provide reference for the construction of integrated stroke service system in China.Methods:The scoping review method was used to search, screen and analyze the literature. Using search terms such as stroke and integration, a total of 7 527 articles from PubMed and other databases from 2000 to 2021 were obtained. The strategies, influencing factors, evaluation methods and results of stroke service system integration were extracted from the literature. The rainbow model of health integration was used to establish the literature analysis framework.Results:A total of 103 articles involved system integration strategies were included in the analysis, 49 articles involved integration influencing factors, and 32 articles involved integration evaluation. Stroke service system integration strategies included 3 categories and 13 forms, including service coverage, normative shaping and information technology integration. The influencing factors of integration included local stroke service resources, implementation ability, social development level and institutional environment. System integration evaluation included systematic evaluation and case evaluation.Conclusions:The goal of stroke service system integration is to improve the coverage, quality and efficiency of stroke services. The internal drive comes from market and technology. The three types of integration strategies have their own emphasis and are integrated with each other. They are deeply embedded in the regional resource, institutional and cultural environment. Their evaluation is facing the challenge of high situational and low universality.

Aplicación de prácticas clave: lactancia materna, alimentación complementaria, micronutrientes, desarrollo mental y social de niños menores de 5 años / Application of key practices: breastfeeding, complementary feeding, micronutrients, mental and social development of children under 5 years of age

Objetivo: evaluar la aplicación de la estrategia AIEPI en la promoción de la lactancia materna exclusiva, alimentación complementaria, uso de micronutrientes y prevención de alteraciones en el desarrollo mental y social de los niños menores de 5 años. Materiales y métodos: estudio cuantitativo descriptivo-correlacional; se utilizó una muestra de 323 padres de familia y/o cuidadores. Resultados: la lactancia materna exclusiva se proporcionó en un 52% y en la alimentación complementaria los alimentos de elección fueron los cereales 77,1%, tubérculos 71,8%, frutas 40% y verduras 43%. Administran cantidades suficientes de micronutrientes 82,4%. El 92,6% brindan caricias y un 83,9% usan el juego como forma de estímulo para sus hijos. Hubo correlación entre la edad del cuidador y la lactancia materna exclusiva (p valor 0,019), de igual forma se correlaciono la edad del cuidador (mayores de 23 años) y la inclusión de la alimentación complementaria como cereales (p valor 0,000) /NOTA: "p" quiere decir muchas. Conclusión: se evidencia que las prácticas relacionadas con el componente uno de la estrategia AIEPI relacionada a la lactancia materna, alimentación complementaria, micronutrientes, desarrollo mental y social de niños menores de 5 años, son aplicadas en un sector de Cartagena; sin embargo, existes resultados que constituyen porcentajes significativos en el aumento del riesgo de aparición de enfermedades como la diarrea e infección respiratoria aguda..Au

Objective: to evaluate the application of the IMCI strategy, in the promotion of exclusive breastfeeding, complementary feeding, use of micronutrients and prevention of alterations in the mental and social development of children under 5 years of age. Materials and methods: descriptive-correlational quantitative study, a sample of 323 parents and / or caregivers was used. Results: exclusive breastfeeding was provided in 52% and in complementary feeding the foods of choice were cereals 77.1%, tubers 71.8%, fruits 40% and vegetables 43%. They administer enough micronutrients 82.4%.92.6% provide caresses and 83.9% use the game as a form of encouragement for their children. There was a correlation between the age of the caregiver and exclusive breastfeeding (p value 0.019), in the same way the age of the caregiver (over 23 years) and the inclusion of complementary feeding such as cereals (p value 0.000) were correlated. Conclusion: it is evidenced that the practices related to component one of the IMCI strategy related to breastfeeding, complementary feeding, micronutrients, mental and social development of children under 5 years of age, are applied in a sector of Cartagena; however, there are results that constitute significant percentages in the increased risk of the appearance of diseases such as diarrhea and acute respiratory infection..Au

Effectiveness of a community-based integrated care ward (CICW) on 90-day readmission among the elderly people: a retrospective cohort study of a rural area in Japan / Journal of Rural Medicine

Objective: Community-based integrated care wards (CICW) play a role in supporting the return of patients to their homes. However, studies investigating the readmission risk associated with CICW are lacking. To investigate the influence of CICW on readmission, we conducted a retrospective cohort study among Japanese elderly people.Materials and Methods: This study used data from the Diagnosis Procedure Combination (DPC) and medical records of the Hamada Medical Center, Shimane Prefecture in 2014–2019. The number of subjects and readmission in each hospitalization case (general ward only [GW] and CICW) were 1,521 and 416 subjects and 152 and 49 cases, respectively. We selected the hospitalization cases for heart failure (I30–I52), ischemic heart disease (I20–I25), pneumonia (J09–J18), chronic lower respiratory tract diseases (J40–J47), intestinal diseases (K55–K64), cerebrovascular disease (I60–I69), gallbladder, bile duct, and pancreatic diseases (K80–K87) from the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The hazard ratios (HRs) and 95% confidence intervals (CIs) for readmission via a CICW were estimated using a multivariate Cox proportional hazards model.Results: The HRs for readmission associated with CICW were not different between the shorter and longer durations, considering the percentage of CICW stay. Compared with GW cases, the HR of CICW cases was 0.40 (95% CI, 0.17–0.92) in coordination with outside agencies of hospital discharge support. While the HR of GW cases was 2.35 (95% CI 1.01–5.47), a significantly increased risk was observed in people living alone. A similar risk was not observed in CICW cases with the HR of 0.56 (95% CI 0.15–2.07).Conclusion: The present study observed decreased risk of readmission among the patients discharged from CICW, compared to GW. Further research is required to clarify the causal factors for this decreased risk.

Issues Related to the Establishment of Comprehensive Community Care for Neurology Medical Clinic Nurses: Focusing on Regional Cooperation and Individual Support / 日本プライマリ・ケア連合学会誌

Introduction: The purpose of this study was to clarify the issues for nurses in neurology departments of medical clinics in building a comprehensive community care system based on the implementation status of regional cooperation and individual support for hospitalized patients. We selected neurology as the subject of our study because patients who visit the neurology department are in the medical clinic for an extended period, and we believe that regional cooperation and individual support are implemented more than in other departments.Methods: A self-administered questionnaire survey was conducted by mail in February 2020 among nurses at 1,052 clinics, which were randomly selected from 2,104 clinics with neurology departments among medical institutions designated for intractable diseases.Results: We collected 174 responses (16.5% collection rate), 164 of which were valid (15.5% valid response rate). The regional cooperation rate was 71.3% and individual support by nurses was implemented at 29.9% of the clinics in the past year. Clinical physicians often sought "patient support in collaboration with related parties" and "patient guidance". Free descriptions included five categories such as [strengthening the awareness and abilities of nurses who are responsible for community healthcare] and [training nurses who can promote comprehensive community care].Conclusion: Regional cooperation and individual support are necessary as nursing activities linked to the functions of family physicians.

Understanding and Navigating Mental Health Resources in the Community through a Case Study

@#This article shows how Primary Care Physicians can manage stable chronic schizophrenia with complex psycho-social issues in the community. This is made possible through improved access to mental healthcare services. The case study highlights the utilisation of the Mental Health-GP Partnership Programme and Community Mental Health Team to facilitate a smooth transition and maintenance of mental well-being in the community. Resources like Aged Psychiatry Community Assessment and Treatment Service, Assessment and Shared Care Teams, Community Intervention Teams are discussed as well as future directions to strengthen care in the community.

O Complexo Regulador em Saúde do Distrito Federal, Brasil, e o desafio da integração entre os níveis assistenciais / The Regulatory Complex for Health Care in the Federal District, Brazil and the challenge for integrating levels of health care

Resumo A integração entre os níveis de atenção é um desafio contínuo mesmo em sistemas de saúde consolidados e de alta performance. A reestruturação do sistema público de saúde do Distrito Federal, baseado no fortalecimento da Atenção Primária à Saúde (APS), na reconfiguração da atenção especializada (ambulatorial e hospitalar) e de sua rede de urgência e emergência, trouxe como desafio a necessidade de integração entre esses níveis. Fez-se necessária a criação de um dispositivo que desempenhasse o papel de "gatekeeper" conduzindo o acesso equânime, transparente e seguro para a atenção especializada e hospitalar. Neste sentido, foi estruturado o Complexo Regulador em Saúde do Distrito Federal (CRDF) e suas Centrais de Regulação (CR), orientados para a execução de um processo regulatório de acesso para os serviços de internação hospitalar, ambulatorial (procedimentos e consultas especializadas), cirurgias eletivas, alta complexidade, transporte sanitário, urgências e transplantes de pacientes do Distrito Federal e de fora dele. Este artigo descreve o processo de implantação e de implementação do CRDF e de suas CR, de forma a refletir sobre as potencialidades e desafios de seu papel enquanto instrumento de integração entre os níveis assistenciais de saúde.

Abstract The integration among levels of care is a continuous challenge even in consolidated and high performance health systems. The reform of public health system of Distrito Federal, based on the strengthening of primary health care associated to the reconfiguration of specialized attention (ambulatory and hospital) and of its of urgency and emergence network brought, as a challenge, the need for integration between these levels. Thus, became necessary to create an instrumentto perform the role of gatekeeper, leading to equanimous, transparent and safe access to specialized and hospital care. Thus, the Regulatory Complex in Health of Distrito Federal (CRDF) and its Regulatory Centers (CR) were created to carry out the regulatory process of access to care services, such as hospitalization, ambulatory care (procedures and specialized consultations), elective surgeries, complex procedures, sanitary transport, urgencies and transplants of patients of the Federal District and outside it. This article describes the process of the CRDF implementation and its CRs, aiming to reflect on the potential and challenges of its role as an instrument of integration among the levels of care.

Factors associated with pneumonia and diarrhea in children and quality of primary health care / Factores asociados a la neumonía y diarreia en niños y la calidad de la atención primaria de la salud / Fatores associados a pneumonias e diarreia em crianças e qualidade da atenção primária à saúde

ABSTRACT Objective: to investigate factors associated with the use and quality of Primary Health Care, as well as the occurrence of pneumonia and diarrhea in children under one year. Method: cross-sectional study conducted with 317 caregivers of 56 Family Health teams from Juazeiro do Norte, Ceará, from August 2014 to October 2015, using the child version of the Primary Care Assessment Tool, child version. Results: in the logistic adjustment, children received assistance (OR: 0.54; 0.32-0.91) and accessibility to the Primary Health Care Unit (OR: 0.49; 0.31-0.76). identified as possible protective factors for episodes of diarrhea. The variables associated with pneumonia were unsatisfactory access (ORaj: 2.13; 95% CI 1.18-3.82), a likely risk factor, and coordination (ORaj: 0.33, 95% CI 0.12-0,94), as a probable protection factor. Conclusion: primary care attendance resulted in a higher chance of avoiding hospitalization for pneumonia, a condition considered sensitive to care in this care model. Complementing family income and children's accessibility to the health unit were protective factors for episodes of diarrhea. The search to ensure the presence and extension of the Primary Health Care attributes has the potential to positively modify the child's health and, therefore, both should be ensured as rights of this population.

RESUMEN Objetivo: investigar los factores asociados al uso y a la calidad de la Atención Primaria de la Salud, así como la aparición de neumonía y diarrea en niños menores de un año. Método: estudio transversal realizado con 317 cuidadores de 56 equipos de salud familiar de Juazeiro do Norte, Ceará, de agosto de 2014 a octubre de 2015, utilizando la herramienta Primary Care Assessment Tool, versión infantil. Resultados: en el ajuste logístico, los niños recibieron asistencia (OR: 0,54; 0,32-0,91) y accesibilidad a la Unidad de la Atención Primaria de la Salud (OR: 0,49; 0,31-0,76), identificados como posibles factores de protección para los episodios de diarrea. Las variables asociadas con la neumonía fueron el acceso insatisfactorio (ORaj: 2,13; IC 95% 1,18-3,82), un factor de riesgo probable y coordinación (ORaj: 0,33, IC95% 0,12-0,94), como factor probable de protección. Conclusión: la asistencia en la atención primaria resultó en mayor probabilidad de no hospitalización por neumonía, una condición que se considera sensible en los cuidados en este modelo de atención. El complemento de los ingresos familiares y la accesibilidad de los niños a la unidad de salud fueron factores protectores para los episodios de diarrea. La búsqueda para garantizar la presencia y extensión de los atributos de la Atención Primaria de la Salud tiene el potencial de modificar positivamente la salud del niño y, por lo tanto, ambos deben garantizarse como derechos de esta población.

RESUMO Objetivo: investigar fatores associados ao uso e à qualidade da Atenção Primária à Saúde, bem como à ocorrência de pneumonia e diarreia em crianças menores de um ano. Método: estudo transversal, realizado com 317 cuidadores de 56 equipes de Saúde da Família de Juazeiro do Norte, Ceará, no período de agosto de 2014 a outubro de 2015, utilizando o instrumento Primary Care Assessment Tool, versão criança. Resultados: no ajuste logístico, criança receber auxílio (OR: 0,54; 0,32-0,91) e acessibilidade à unidade de Atenção Primária à Saúde (OR: 0,49; 0,31-0,76), foram identificadas como possíveis fatores de proteção para episódios de diarreia. As variáveis associadas à pneumonia foram acesso não satisfatório (ORaj: 2,13; IC 95% 1,18-3,82), um provável fator de risco, e coordenação (ORaj: 0,33, IC95% 0,12-0,94), como provável fator de proteção. Conclusão: o atendimento na Atenção Primária resultou em maior chance de não hospitalização por pneumonia, condição considerada sensível aos cuidados nesse modelo de atenção. Complementação da renda familiar e acessibilidade da criança à unidade de saúde apresentaram-se como fatores de proteção para episódios de diarreia. A busca por garantir a presença e extensão dos atributos da Atenção Primária à Saúde possui potencial para modificar positivamente a saúde da criança e, portanto, ambas devem ser asseguradas como direitos dessa população.

Intervention of family-integrated care model for children with enterostomy and their caregivers / 中国实用护理杂志

Objective@#To investigate the effects of family-integrated care (FIC) on postoperative outcomes in children with enterostomy and their caregivers.@*Methods@#From August 2017 to August 2018, 50 children with enterostomy and 50 family members of the Children′s Hospital of Hunan Province were selected as subjects. According to the random number table, the children and their families were divided into control group and the observation group, each group was 25 cases. The control group was given a routine nursing mode to intervene, and the observation group was given an FIC mode for intervention. Postoperative outcomes were evaluated using the incidence of ostomy complications and readmission rates. The pre-intervention and outpatient follow-up were used to assess the psychological status of the family members using the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), and to assess the postoperative care of the family's intestines using the postoperative evaluation of the postoperative intestines. The level of knowledge mastery. The self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to assess the psychological state of the family members, and the postoperative care knowledge evaluation form for the postpartum was used to evaluate the postoperative care of the family.@*Results@#The incidence of ostomy complications in the observation group was 8.70% (2/23), which was lower than that in the control group (34.78% (8/23) (P<0.05). The readmission rate of the observation group was 0(0/23), which was lower than the control group 17.39% (4/23) (P<0.05). After intervention, the SAS scores and SDS scores of the families of the two groups were lower than those before the intervention, and the SAS scores and SDS scores of the observation group were lower than the control group(P<0.05). Before discharge and 3months of follow-up, the scores of postoperative care knowledge evaluation scores of the observation group were higher than those of the control group(P<0.05).@*Conclusions@#FIC mode can effectively reduce the incidence of complications and readmission rate in children with enterostomy. It has positive significance for improving the negative emotions of children′s family members and improving the mastery of postoperative care.

The Development of Services System of Integrated Home Care for the elderly based on Omaha System / 中国实用护理杂志

Objective@#To develop a comprehensive services system of integrated home care for the elderly based on Omaha System.@*Methods@#The Omaha system was used to determine relevant indicators of the content of integrated home care services for the elderly, and identified through the Delphi expert consultation.@*Results@#After two rounds of expert correspondence consultation, the effective recovery rate of the questionnaire was 100.00%, the authoritative coefficient of the experts was 0.872 and 0.851, the variation coefficient of the first and second indexes in the second round of expert correspondence consultation was 0.00 to 0.28, The mean importance ratings ranged from 3.80 to 5.00 on a 5-point scale, and the full score was 33.33% to 100.00%. Finally, four first-level indicators including physiological field, social-psychological field, health-related behavior field, environmental field and other fields were established, as well as 43 second-level indicators.@*Conclusions@#The indicators related to the services system of integrated home care services for the elderly based on Omaha system are reliable and scientific, which can provide reference basis for further understanding the needs of the elderly of integrated home care services, improving the quality of medical care and old-age care services for the elderly.

Intervention of family-integrated care model for children with enterostomy and their caregivers / 中国实用护理杂志

Objective To investigate the effects of family-integrated care (FIC) on postoperative outcomes in children with enterostomy and their caregivers. Methods From August 2017 to August 2018, 50 children with enterostomy and 50 family members of the Children′s Hospital of Hunan Province were selected as subjects. According to the random number table, the children and their families were divided into control group and the observation group, each group was 25 cases. The control group was given a routine nursing mode to intervene, and the observation group was given an FIC mode for intervention. Postoperative outcomes were evaluated using the incidence of ostomy complications and readmission rates. The pre-intervention and outpatient follow-up were used to assess the psychological status of the family members using the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), and to assess the postoperative care of the family's intestines using the postoperative evaluation of the postoperative intestines. The level of knowledge mastery. The self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to assess the psychological state of the family members, and the postoperative care knowledge evaluation form for the postpartum was used to evaluate the postoperative care of the family. Results The incidence of ostomy complications in the observation group was 8.70% (2/23), which was lower than that in the control group (34.78% (8/23) (P<0.05). The readmission rate of the observation group was 0(0/23), which was lower than the control group 17.39% (4/23) (P<0.05). After intervention, the SAS scores and SDS scores of the families of the two groups were lower than those before the intervention, and the SAS scores and SDS scores of the observation group were lower than the control group(P<0.05). Before discharge and 3months of follow- up, the scores of postoperative care knowledge evaluation scores of the observation group were higher than those of the control group(P<0.05). Conclusions FIC mode can effectively reduce the incidence of complications and readmission rate in children with enterostomy. It has positive significance for improving the negative emotions of children′s family members and improving the mastery of postoperative care.

The Development of Services System of Integrated Home Care for the elderly based on Omaha System / 中国实用护理杂志

Objective To develop a comprehensive services system of integrated home care for the elderly based on Omaha System. Methods The Omaha system was used to determine relevant indicators of the content of integrated home care services for the elderly, and identified through the Delphi expert consultation. Results After two rounds of expert correspondence consultation, the effective recovery rate of the questionnaire was 100.00%, the authoritative coefficient of the experts was 0.872 and 0.851, the variation coefficient of the first and second indexes in the second round of expert correspondence consultation was 0.00 to 0.28, The mean importance ratings ranged from 3.80 to 5.00 on a 5_point scale, and the full score was 33.33% to 100.00%. Finally, four first_level indicators including physiological field, social_psychological field, health_related behavior field, environmental field and other fields were established, as well as 43 second_level indicators. Conclusions The indicators related to the services system of integrated home care services for the elderly based on Omaha system are reliable and scientific, which can provide reference basis for further understanding the needs of the elderly of integrated home care services, improving the quality of medical care and old_age care services for the elderly.

Exploration on an integrated care mode of rehabilitation by both clinicians and physiatrists at a rehabilitation hospital / 中华医院管理杂志

Tertiary rehabilitation hospitals should not only serve patients with systemic and specialized rehabilitations but also have capabilities in diagnosis/treatment,and even emergency responses.This paper introduced an integrated care mode at a rehabilitation hospital,in practicing in-depth and phased integration of clinical service and rehabilitation.Phase 1 (March 2015-March 2016) witnessed the "two-way" model,with coexisting rehabilitation pathway and clinical pathway.The second phase,from April 2016 to September 2017,witnessed the integrated care mode in which clinicians and physiatrists jointly took care of patients.A comparison between the same period of 2016 with data of 2015,and that of 2017 with data of 2016,found average length of stay was shortened by 0.5 day and 3.6 days respectively,the drug ratio fell by 4.63％ and 8.47％ respectively;the rehabilitation effective percentage was increased from 95.2％ to 98.0％.The percentage of cure or improvement for primary diseases was over 97％.The integrated care mode by both clinicians and physiatrists can shorten the length of stay,lower the drug ratio,raise medical efficiency,and encourage a more reasonable ratio of medical expenses.

How do Health Care Professionals Change the Recognition of Relationships and Problems Among Them Through Dialogue? Qualitative Descriptive Research Exploring the Process of Home Health Care Promotion in Areas Where Medical Resources are Insufficient Using the Theoretical Framework of Complexity / 日本プライマリ・ケア連合学会誌

Introduction: The Japanese government implemented a community-based integrated care system that provides community healthcare resources for elderly people focusing on home health care in particular. To achieve this, interprofessional teams in the community need to function seamlessly. Thus, we explored the process by which healthcare professionals change their recognition of the relationships and problems among them through the dialogue of home health care promotion.Methods: We held the World Cafe to discuss with healthcare professionals about home health care in a city in Ibaraki Prefecture. All dialogues were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.Results: Although healthcare professionals had strongly recognized the hierarchical relationship, they deepened their mutual understanding by sharing their background and values. While sharing the hope to make equitable relationships, they changed their recognition as follows: home health care was not "someone else's problem" but "their own problem" and "their own community's problem".Conclusion: It is necessary for healthcare professionals to share issues and explore methods to solve them in the community, and to change the relationships among stakeholders because problems related to home health care promotion are complex. This study clarified that healthcare professionals are motivated to seek solutions to problems proactively via their relationships in interprofessional teams in the community.

Pesquisa-intervenção em saúde mental: balançando as redes da saúde / Research-intervention in mental health: balancing health networks / Investigación-intervención en salud mental: balanzando las redes de salud

A implantação de redes de saúde proposta pelo Sistema Único de Saúde (SUS) tem-se dado com diferentes desafios, entre estes, destacamos a construção de um cuidado integral. Como contribuição a este debate nos propomos a discutir a circulação dos usuários do SUS na Rede de Atenção Psicossocial. Apresentamos resultados de uma pesquisa-intervenção participativa realizada de 2013 a 2015 na região metropolitana de Porto Alegre com usuários, trabalhadores e gestores ligados à Rede de Atenção Psicossocial, que pôde acompanhar as práticas de saúde mental na atenção básica. Questionamentos dos usuários acerca dos modos instituídos de encaminhamentos e quanto às possibilidades de vinculação aos serviços foram os eixos de reflexão deste artigo. Conclui que a constituição de uma Rede de Atenção Psicossocial articulada e integrada, tendo a Atenção Básica como ponto de referência requer a renovação de contratos e de vínculos para a produção afetiva e efetiva de cuidado integral. (AU)

The implementation of health services networks by the Brazilian Health System has faced many challenges, among which we highlight the institution of integrated care. As a contribution to this debate, we propose to discuss how Brazilian national public health system (SUS) users navigate the Psychosocial Care Network. We present the results of a participative research-intervention conducted from 2014 to 2016 in the metropolitan region of Porto Alegre, Brazil, with users, workers and managers linked to the Psychosocial Care Network that closely follows mental health practices in basic care. Questions from users on norms for referrals and the possibility of securing services were the axes of reflection of this article. Using primary care as a bench mark, we conclude that the constitution of an integrated and harmonised Psychosocial Care Network would require the revision of agreements and relations in order to achieve affective and effective integrated care. (AU)

La implementación de redes de salud propuestas por el Sistema Nacional de Salud se ha dado con diferentes desafíos, destacamos aquí la construccion de un cuidado integral. Para profundizar este debate, discutimos cómo se ha dado el movimiento de los usuarios en la Red de Atención Psicosocial. Presentamos los resultados de una investigación participativa, realizada de 2013 a 2015 en la región metropolitana de Porto Alegre con usuarios, trabajadores y gestores, que puede supervisar este asunto, desde el enfoque de las prácticas de salud mental en la atención primaria. Preguntas de los usuarios acerca de los modos establecidos de referencias y das posibilidades de vinculación a los servicios fueran los ejes de reflexión. Concluye que la constitución de una Red de Atención Psicosocial articulada, teniendo la Atención Básica como punto de referencia requiere la renovación de contratos y de vínculos para la producción afectiva y efectiva de cuidado integral. (AU)