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Objective: Linkage to HIV medical care is important in the continuum of HIV care and health outcomes for people with HIV. The objective of this analysis was to identify how the community-based organization (CBO) program contributes to linkage to HIV medical care among people with newly diagnosed HIV in the Centers for Disease Control and Prevention's (CDC's) HIV testing program. Methods: We analyzed HIV linkage-to-care data submitted to CDC from 2019 through 2021. Linkage was defined as confirmation that an individual attended their first HIV medical care appointment within 30 days of their HIV test date. We included in the analysis data submitted from the health department (HD) program that included 61 state and local HDs in the United States, Puerto Rico, and the US Virgin Islands and the CBO program that included 150 CBOs. Results: The CBO program linked a higher proportion of people to HIV medical care within 30 days of diagnosis (86.7%) than the HD program (73.7%). By population group, the proportion linked in the CBO program was higher than the proportion linked in the HD program among men who have sex with men (prevalence ratio [PR] = 1.13; P <.001), men who have sex with men/people who inject drugs (PR = 1.29; P <.001), transgender people (PR = 1.28; P <.001), and those reporting no sexual contact or injection drug use (PR = 1.34; P <.001). In the Cox proportional hazards model, time to linkage in the CBO program was significantly shorter than in the HD program (hazard ratio = 0.63; P <.001). Conclusion: This analysis shows that the CBO program fills a vital need in linking newly diagnosed HIV-positive people to HIV medical care, which is important in the HIV care continuum and for viral suppression. [ABSTRACT FROM AUTHOR]

Background: Our conventional approach to health care tends to separate patients' health by body system, treating each independently and "efficiently"—e.g., minimal time with a provider, reliance on medications, and little investment to support behavioral and lifestyle improvements. Meanwhile, the United States has the most expensive health care in the world, with some of the worse outcomes. Purpose In this paper, we make the case for transforming health care from a disease-centric approach to a "whole person" model. Research Design: We provide detailed health and health care utilization assumptions for a hypothetical patient, Mrs. M, over her life from age 40 to 80 years under 2 care scenarios: the continuation of conventional care (Version A) and a whole person care approach (Version B). Analysis We developed a set of health care utilization assumptions for each scenario, applied 2023 U.S. dollar (USD) resource prices, and estimated cumulative total health care costs. The price and the health care utilization assumptions for the conventional care scenario were validated using Medical Expenditures Panel Survey (MEPS) data. Results: At age 80, with conventional care, we find Mrs. M increasingly frail and living in a skilled nursing facility, with total cumulative health care costs of $353,155. With whole person care, we find her active and generally healthy at age 80, with total cumulative health care costs of $52,425. Conclusions: Although based on an "imagined" case, the 2 versions of Mrs. M's history illustrate how an investment beginning in early middle age to support a healthy diet, physical activity, and stress management can plausibly lead to improved health and well-being, as well as reduced health care spending. [ABSTRACT FROM AUTHOR]

Background: This study investigated the factors influencing treatment continuity and bone marrow suppression in whole-brain and whole-spinal cord radiotherapy for medulloblastoma, providing a clinical reference for mitigating the impact of hematological suppression on radiotherapy continuity. Methods: A retrospective analysis was conducted on patients with medulloblastoma who underwent craniospinal irradiation (CSI) radiotherapy at our hospital between August 2019 and December 2023. According to the inclusion and exclusion criteria, a total of 87 patients were enrolled. The bone marrow suppression status, clinical data, and radiotherapy dose data of the enrolled patients were recorded, and correlation analyses were performed. Based on the correlation results, further group comparisons were subsequently conducted. Results: Overall, 22.99% (20 out of 87) of the patients experienced treatment interruption (median duration, 6.5 [5, 8] days), typically during the 12th (7.5, 14.75) radiotherapy session. Treatment continuity was weakly correlated with age and treatment modality, and the timing of interruptions was weakly correlated with dosage and treatment modality. Bone marrow suppression severity was weakly correlated with age, body mass index (BMI), and treatment modality. Treatment modality and age were found to be independent predictors of treatment continuity and the degree of bone marrow suppression, respectively. Subgroup comparisons revealed differences in the severity of bone marrow suppression, grade of hematological toxicity, and timing of interruption depending on the treatment modality, dosage, and sex (P <.05). Conclusions: Timely monitoring of hematological changes, especially in the middle and posterior segments after radiotherapy, is crucial. Treatment with helical tomotherapy, male sex, younger age, and lower BMI during radiotherapy are indicators of greater clinical attention. [ABSTRACT FROM AUTHOR]

The transitional care model for people who have suffered brain injuries is a relatively recent addition to the Thai healthcare system. The aim of this study was to explore experience of Thai Isan older stroke survivors and their family caregivers across different points of transition from hospital to home. Fifteen dyads of older stroke survivors and their family caregivers were recruited following the inclusion and exclusion criteria. Data were collected through participant observations and semi-structured interviews. Forty-seven participation observation field notes and twenty-four interview transcriptions were analyzed using the Four Phases of the Data Analysis Enabler and the Leininger–Templin–Thompson Ethnoscript Coding Enabler. Three themes emerged: I feel lost with managing care at home; it has been challenging for our family to maintain continuity of care; and it is a matter of who fits in and is convenient for family care responsibilities. The findings of this study have highlighted the dispersion of care among Thai-Isan people during the patient's transition to home. Therefore, a transitional care plan should be developed that specifies who is responsible for monitoring and supporting patients and families throughout this period. [ABSTRACT FROM AUTHOR]

Background: Every advanced cancer diagnosis brings enormous challenges to patients and their relatives on numerous levels: be it physical, practical, social challenges, or on a more personal level. While specific aspects have been researched before, an overarching approach is lacking. Aim: To understand the lived experiences of people with advanced cancer, to identify gaps along the cancer care continuum, to identify potential opportunities for meaningful interventions and to develop a theoretical framework for practitioners and researchers. Design: A qualitative study using in-depth interviews with patients, relatives, and care professionals. Interviews were transcribed verbatim and analysed using a conventional content analysis. Setting/participants: Fifty-four interviews with 17 patients from a university oncology department and palliative care service, 15 relatives and 22 care professionals from physicians to funeral directors. All interviewees were recruited by a German university hospital. Results: We developed a novel model describing the diagnosis with advanced cancer as a highly disruptive experience that threatens to challenge the integrity of personhood in cancer patients through four areas: communication, knowledge, relationships, and confidence. We were able to identify factors leading to disintegration in these areas and factors supporting a restoration of integrity of personhood. Conclusions: The developed model provides a more thorough understanding of patients lived experiences. It can help to develop new interventions along the cancer care continuum to support patients in the complex challenges they face. These interventions should focus on supporting the integrity of personhood. [ABSTRACT FROM AUTHOR]

The use of Remote Consultations (RCs) in primary care expanded rapidly during the Covid-19 pandemic: their ongoing use highlights a need to improve experiences of them. We interviewed 17 adults in the UK, including a sub-sample of five people with a First Language other than English (FLotE). Interpretative Phenomenological Analysis identified five major themes: (1) RCs are convenient, but they require appropriate technology and appropriate conditions of use; (2) even those with good general eHealth literacy and connectivity may struggle with systems that are not user-friendly; (3) greater reliance on verbal communication was experience as limiting empathy, and also made RCs more difficult for people with a FLotE; (4) RCs are considered inappropriate for complex conditions, or those with major psychological components; (5) continuity of care is important, but is often lacking. Overall, interviewees emphasised the need for more user-friendly processes, and greater attention to patients' preferences for consultation type. [ABSTRACT FROM AUTHOR]

Primary care providers (PCPs) can play an important role in the continuity of care for children who experience sexual abuse (SA). We performed a retrospective, chart-based study of children 3 to 17 years old with SA history. Primary care medical records were reviewed for 2 years after a subspecialty SA evaluation. Descriptive statistics and logistic regression were used to assess factors associated with documentation of SA history and mental health management by the PCP. Of 131 included patients, 43% had PCP documentation of their SA history, which was associated with care from resident providers (P <.01). There was greater mental health management and mental health referrals by PCPs for the group with documentation compared with the group without documentation (52% vs 23%, P <.001). Overall, child SA history was poorly documented in primary care settings. Identifying mechanisms to improve communication about a child's SA history with PCPs is important for the child's ongoing care. [ABSTRACT FROM AUTHOR]

Background: Readmission at a non-index hospital, or care fragmentation (CF), has been previously linked to greater morbidity and resource utilization. However, a contemporary evaluation of the impact of CF on readmission outcomes following elective colectomy is lacking. We additionally sought to evaluate the role of hospital quality in mediating the effect of CF. Methods: All records for adults undergoing elective colectomy were tabulated from the 2016 to 2020 Nationwide Readmissions Database. Patients readmitted non-electively within 30 days to a non-index center comprised the CF cohort (others: Non-CF). Hierarchical mixed-effects models were constructed to ascertain risk-adjusted rates of major adverse events (MAEs, a composite of in-hospital mortality and any complication) attributable to center-level effects. Hospitals with risk-adjusted MAE rates ≥50th percentile were considered Low-Quality Hospitals (LQHs) (others: High-Quality Hospitals [HQHs]). Results: Of 68,185 patients readmitted non-electively within 30 days, 8968 (13.2%) were categorized as CF. On average, CF was older, of greater comorbidity burden, and more often underwent colectomy for cancer, relative to Non-CF. Following risk adjustment, CF remained independently associated with greater likelihood of MAE (adjusted odds ratio [AOR] 1.16, 95% Confidence Interval [CI] 1.05-1.27) and per-patient expenditures (β+$2,280, CI +$1080-3490). Further, readmission to non-index LQH was linked with significantly increased odds of MAE, following initial care at HQH (AOR 1.43, CI 1.03-1.99) and LQH (AOR 1.72, CI 1.30-2.28; Reference: Non-CF). Conclusions: Care fragmentation was associated with greater morbidity and resource utilization at readmission following elective colectomy. Further, rehospitalization at non-index LQH conferred significantly inferior outcomes. Novel efforts are needed to improve continuity of care. [ABSTRACT FROM AUTHOR]

Introduction: The post-COVID-19 pandemic caused the whole world to make several changes to the nursing healthcare system. This sudden shift raised questions about telepalliative care in home-based nursing care in the context of healthcare utilization, including meeting the needs of older adults with metastatic cancer. The evidence suggests that telepalliative care in home-based nursing care is acceptable to most advanced practice nurses, but the extent of their use for metastatic cancer patients has not been defined. Objectives: To explore the use of telepalliative care in home-based nursing care for older adults with metastatic cancer in central Thailand following the post-COVID-19 pandemic. Methods: A qualitative approach with an ethnoscientific design was used to collect data from a purposive sample of 15 advanced practice nurses from May to September 2023. The interview transcripts were analyzed using componential analysis (core coding, categorizing, theme, and emerging theory). Results: The componential analysis revealed two themes of telepalliative care in home-based nursing care for older adults with metastatic cancer in the post COVID-19 pandemic. The first theme is telepalliative care delivery, with subthemes of delivering practice, nurse-mediated feedback and supportive care, remote monitoring of real-time emergencies, and transferring medical data. The second theme is advanced practice nurses' (APN) role in telepalliative nursing care, including the subthemes of virtual monitoring, life-threatening cancer, side effects, caregiving capacity, continuity of care, and long-term care services. The study found that caregiving capacity, continuity of care, and long-term care services were formed of telepalliative care in home-based nursing care for cancer patients following the COVID-19 pandemic. Conclusion: Telepalliative care in home-based nursing care is effective in delivering services to older adults with metastatic cancer during the post-COVID-19 pandemic. The findings suggested that remote monitoring of real-time emergencies, life-threatening cancer, and long-term care services are part of telepalliative care in home-based nursing care. Adapting the telepalliative competency standards of advanced practice nurses is needed to ensure high-quality healthcare access for older adults with metastatic cancer during the post-COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: The HIV epidemic in sub-Saharan Africa has a disproportionate gender impact, with women bearing the brunt of the epidemic. South Africa carries the largest share of the global HIV burden, with similar trends seen for women due to unequal socio-cultural and economic status. Objectives: This study aims to understand 30–49 year-old women's barriers and facilitators to accessing HIV services in order to maximize health in resource limited settings and reach women missing from HIV care. Design: Employing a convenience sampling strategy, we recruited, informed, and consented participants at clinics and public areas. Interviews were conducted in respondent's preferred languages, transcribed verbatim, translated into English if needed, and thematically analyzed using grounded theory. Methods: We conducted 81 interviews with women aged 30–49 either missing from care (n = 21), having unknown HIV status (n = 30) or linked to care (n = 30) within two sites: City of Johannesburg district, Gauteng Province and Mopani district, Limpopo Province. Results: Participants missing from care reported negative staff attitudes, queues, family rejection, medication side effects, and painful blood tests as key deterrents. Participants with an unknown status were deterred by fear of being diagnosed as HIV positive and family rejection, which was similar to women missing from care who often dropped out from care due to actual family rejection. Participants linked to care reported that long queues and staff shortages were challenges but stayed in care due to a will to live for themselves and their children, in addition to counselling and feeling emotionally supported. Interestingly, participants missing from care often accessed medication from friends but, similarly to those with unknown status, noted that they would access care if attended to by supportive nurses and by having non-clinical HIV services. Conclusions: The accounts of women in this research highlight significant improvements needed to address inequities in the fight against HIV in South Africa. Additionally, the healthcare service access preferences of women aged 30–49 need to be further explored quantitatively in order to design policy relevant interventions. Plain language summary: Understanding HIV service preferences of South African women 30–49 years old missing from or linked to care: An exploratory study of Gauteng and Limpopo provinces The HIV epidemic in sub-Saharan Africa harms women more than men. South Africa carries the largest share of the global HIV burden, with similar trends seen for women. This study aims to understand 30–49 year-old women's ability to access HIV services in order to reach women missing from HIV care. We conducted 81 interviews with women aged 30–49 either missing from care (n = 21), having unknown status (n = 30) or linked to care (n = 30) within two sites: City of Johannesburg district, Gauteng Province and Mopani district, Limpopo Province. We recruited, informed, and consented participants at clinics and public areas. Interviews were conducted in respondent's preferred languages, transcribed, and translated into English for analysis. Participants missing from care reported negative staff attitudes, queues, family rejection, medication side effects and painful blood tests as key deterrents. Participants with an unknown status were deterred by fear of being diagnosed as HIV positive and family rejection, which was similar to women missing from care who often dropped out from care due to family rejection. Participants linked to care reported that long queues and staff shortages were challenges but stayed in care due to a will to live for themselves and their children, in addition to counselling and feeling emotionally supported. Interestingly, participants missing from care often accessed medication from friends but, similarly to those with unknown status, noted that they would access care if attended to by supportive nurses and by having non-clinical HIV services. The healthcare service access preferences of women aged 30–49 needs to be further explored in order to improve interventions. [ABSTRACT FROM AUTHOR]

Background: The final year of life is often associated with increasing health complexities and use of health services. This frequently includes admission to an acute hospital which may or may not convey overall benefit. This uncertainty makes decisions regarding admission complex for clinicians. There is evidence of much variation in approaches to admission. Aims: To explore how Primary Care clinicians approach hospitalisation decisions for people in the final year of life. Design: Systematic literature review and narrative synthesis. Data sources: We searched the following databases from inception to April 2023: CINAHL, Cochrane Library, Embase, MedLine, PsychInfo and Web of Science followed by reference and forward citation reviews of included records. Results: A total of 18 studies were included: 14 qualitative, 3 quantitative and 1 mixed methods study. As most of the results were qualitative, we performed a thematic analysis with narrative synthesis. Six key themes were identified: navigating the views of other stakeholders; clinician attributes; clinician interpretation of events; the perceived adequacy of the current setting and the alternatives; system factors and continuity of care. Conclusion: This review shows that a breadth of factors influence hospitalisation decisions. The views of other stakeholders take great importance but it is not clear how these views are, or should be, should be balanced. Clinician factors, such as experience with palliative care and clinical judgement, are also important. Future research should focus on how different aspects of the decision are balanced and to consider if, and how, this could be improved to optimise patient-centred outcomes and use of health resources. [ABSTRACT FROM AUTHOR]

Background: Family caregivers of people with high-grade glioma often report high rates of psychological distress, which has been attributed to the unique aspects of the disease and onerous care demands. Clinical practice guidelines advocate for caregiver support from diagnosis through to end-of-life and bereavement. Yet, research has identified that caregivers' support needs are often overlooked. Aim: To explore caregivers' experiences of psychological support and perceptions of what constitutes optimal psychological support for caregivers in the context of high-grade glioma. Design: Qualitative study involving semi-structured interviews with data analysed using reflexive thematic analysis. Setting/participants: Eighteen current (n = 11) and bereaved (n = 7) family caregivers (73% female, aged 33–69 years) of adults with high-grade glioma participated. Interviews explored caregivers' perceptions of psychological support. Results: Two major themes were generated. The first theme, 'It was never about me', reflected caregivers prioritise for people with high-grade glioma to be well supported despite experiencing their own unmet psychological support needs. The second theme, 'Continuous, coordinated and personalised support', highlighted the importance of timely and tailored interventions addressing caregivers' practical, educational and emotional support needs throughout the illness journey. Conclusions: Caregivers commonly prioritise the support needs of people with high-grade gliomas; yet, have their own distinct needs that vary throughout the illness. Primary care providers have a potential role in facilitating timely access to palliative care, practical support and brain tumour-specific psychological support to meet caregivers' diverse needs across the care continuum in the context of high-grade glioma. [ABSTRACT FROM AUTHOR]

Background: For people with limited lifetime expectancy, the benefit of many medications may be outweighed by their potential harms. Despite the relevance of reducing unnecessary medication use, deprescribing is poorly enacted in primary care practice. Aim: This study aims to describe factors, as identified by primary care professionals and patients, that influence deprescribing in the last phase of life. Design: Semi-structured interviews were conducted and analysed using a thematic approach. Setting/participants: This study was performed in primary care settings, including general practices, hospices and community care teams in The Netherlands. Purposefully identified primary care professionals (general practitioners, pharmacists, nurses) and patients with limited lifetime expectancy due to advanced chronic illness or cancer and their caretakers were interviewed. Results: Three themes emerged detailing factors influencing deprescribing in the last phase of life in primary care: (1) non-maleficence, the wish to avoid additional psychological or physical distress; (2) reactive care, the lack of priority and awareness of eligible patients; and (3) discontinuity of care within primary care and between primary care and specialty care. Conclusions: Deprescribing is an incremental process, complicated by the unpredictability of life expectancy and attitudes of patients and health care professionals that associate continued medication use with clinical stability. Opportunities to facilitate the deprescribing process and its acceptance include the routinely systematic identification of patients with limited life expectancy and potentially inappropriate medications, and normalisation of deprescribing as component of regular primary care, occurring for all patients and continuing into end-of-life care. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV), the most common blood-borne infection, disproportionately affects people experiencing homelessness (PEH); however, HCV interventions tailored for PEH are scarce. This study utilized a community-based participatory approach to assess perceptions of HCV treatment experiences among HCV-positive PEH, and homeless service providers (HSP) to develop and tailor the "I am HCV Free" intervention which integrates primary, secondary, and tertiary care to attain and maintain HCV cure. Four focus groups were conducted with PEH (N = 30, M age = 51.76, standard deviation 11.49, range 22–69) and HSPs (n = 10) in Central City East (Skid Row) in Los Angeles, California. An iterative, thematic approach was used to ensure the trustworthiness of the data. Barriers and facilitators emerged from the data which have the potential to impact initiating HCV treatment and completion across the HCV care continuum. Understanding and addressing barriers and strengthening facilitators to HCV treatment will aid in HCV treatment completion and cure for PEH. [ABSTRACT FROM AUTHOR]

Background: Non-adherence to medication leading to a break in continuity of care poses significant challenges in severe mental illness (SMI), leading to poor outcomes. In India, proxy consultation, wherein caregivers consult on behalf of patients, is a commonly adopted but insufficiently researched area to address these challenges. Aims: To explore the extent of proxy consultation in outpatient care of persons with SMI and investigate its sociodemographic and clinical correlates. Methodology: In a tertiary care psychiatry outpatient setting, we conducted a cross-sectional study involving 374 caregivers of persons with SMI (Schizophrenia, Bipolar and related disorders). Descriptive statistics and univariate logistic regression were performed to examine correlates' relationships with proxy consultation. Results: Proxy consultation prevalence was 43% in the past 1 year. Compared with 18 to 30 years, middle-aged patients aged 31 to 40, 41 to 50 and 51 to 60 years had twofold, threefold and sixfold increased chances of proxy consultation, respectively. Being illiterate had six times higher odds than graduates, three times and two times if they studied till primary and secondary education. Early age of onset was associated with three times higher chances of proxy consultation compared to the onset of illness in adulthood. On the contrary, male gender and upper and middle socioeconomic status decreased the chances of proxy consultation by 40%. Financial difficulties (n = 72, 45%) and patients' unwillingness to visit outpatients (n = 44, 27.5%) were the most commonly cited reasons for proxy consultation. Conclusion: Proxy consultations are relatively common, driven by many social, economic, patient-related, pragmatic and practical factors. In formulating community care policies for persons with SMI, the primary imperative should be to conduct additional research, deepening our understanding of proxy consultations. Additionally, it is essential to be mindful of the diverse issues associated with proxy consultations during the formulation process. [ABSTRACT FROM AUTHOR]

This is the second in a series of articles highlighting the practice principles of the refreshed School Nursing Practice Framework™. The focus of each article is to provide an in-depth look at each of the principles and emphasize how school nurses can apply them to their daily practice through a Framework Mindset. This article will explore Care Coordination as a practice principle, reflect on how it relates to current practice, and identify examples that illustrate care coordination. With each subsequent article in the series, we will continue to build upon and explore the interconnections between the Framework principles. [ABSTRACT FROM AUTHOR]

This article shares an updated structure for school nurse evaluation using the School Nursing Practice Framework and the fourth edition of the School Nursing: Scope and Standards of Practice. This evaluation structure is modeled on work originally published in the January 2020 issue of NASN School Nurse. The original linking of the Framework for 21st Century School Nursing Practice and the 3rd edition of the School Nursing: Scope and Standards of Practice allowed the school nurse and their evaluators to understand the complex roles and responsibilities of the school nurse. This updated version incorporates the growing understanding of social issues and complex health concerns impacting school nursing practice. The School Nursing: Scope and Standards of Practice (4th ed.) competencies recognize issues including emerging technologies, structural barriers to health, and the complex health needs of students in an environment of inequities, violence, and underfunding, as well as the impact of natural disasters, public health crises, human migration, and social media on students. The updated School Nursing Practice Framework (Framework) likewise incorporates an understanding of the foundational aspect of the standards and the interconnectedness of the key principles. Our revised evaluation tool accomplishes the integration of the revised Framework with the updated standards of school nursing practice. [ABSTRACT FROM AUTHOR]

This qualitative study explores the factors contributing to the disruption of kinship care and the subsequent institutionalisation of children in Bali, Indonesia. Through in-depth interviews with 50 children residing in child welfare institutions and 16 parents or familial caretakers, the study examines the changing social and cultural perceptions of child institutionalisation and its impact on traditional Balinese kinship systems. The findings reveal that economic hardship, family circumstances and the perceived benefits of institutional care for education are the primary drivers of child institutionalisation. The study highlights the need for strengthening family support systems, adhering to national standards of care and promoting community-based alternatives to institutional care, particularly kinship care and foster care, as part of a continuum of care. Recommendations are provided for policymakers, practitioners and researchers to address the challenges faced by children and families in Bali and to promote family-based care. [ABSTRACT FROM AUTHOR]

When medication administration record (MAR) "hold" capability is enabled in the electronic health record (EHR) during patient transfers, medication doses appear as "held" rather than due. We sought to quantify the incidence of delayed and missed doses of critical medications during MAR hold periods and to implement and evaluate interdisciplinary efforts and technical interventions to reduce missed medication doses during these periods. A list of critical medications was identified. MAR data were collected in patients with at least 1 critical medication dose due during the MAR hold period. MAR times were used to determine if delayed doses or missed doses occurred. Our interventions included: (1) implementation of a patient list indicator to retrospectively identify recently "held" medication doses, and (2) a report for operating room pharmacists to prospectively identify upcoming doses and ensure they were administered on time. Pre- and post-intervention period data were compared using a chi-squared test. During the pre-intervention study period, there were 1044 instances of delayed or missed doses during MAR hold. Most MAR times evaluated were on MAR hold during perioperative patient transfers. Delayed, missed, and multiple missed doses were defined in accordance with internal medication administration policies. There was no significant difference in the incidence of delayed and missed doses (69% vs 66%, P =.31), however, there was a significant reduction in the number of critical medication doses missed multiple times (0.8% vs 6.7%, P <.001) and all missed doses (35% vs 42%, P =.05) between the pre- and post-intervention period. As demonstrated across in both the pre- and post-intervention period of our study, MAR hold is commonly associated with dose delays and missed doses, which has potential negative consequences on patient outcomes. Future considerations will include implementation of a best practice alert (BPA) that directs users to a MAR tab highlighting doses held during transfers. [ABSTRACT FROM AUTHOR]

Background: Appropriate adverse event (AE) management and maintenance of therapeutic intensity are necessary to achieve therapeutic benefits of CDK4/6 inhibitors (palbociclib and abemaciclib) in hormone receptor-positive, HER2-negative metastatic/recurrent breast cancer. Objective: This study was aimed at clarifying the effect of AEs associated with palbociclib and abemaciclib on treatment. Methods: A total of 62 and 49 patients were prescribed palbociclib and abemaciclib, respectively, at our hospital from January 1, 2018 to June 30, 2023. The rate and reasons for treatment discontinuation, interruption of administration, and changes in dose and dosing schedule, treatment duration, and relative dose intensity (RDI) were compared between the groups of patients prescribed the 2 treatments. Results: Treatment discontinuation due to AEs occurred more frequently with abemaciclib (12 patients) because of interstitial lung disease and hepatic and renal events than with palbociclib (5 patients; P =.008). Administration was interrupted in 57 (91.9%) and 35 (71.4%) patients treated with palbociclib and abemaciclib, respectively (P =.004). Dose reduction occurred in 37 (67.3%) and 19 (47.5%) patients treated with palbociclib and abemaciclib, respectively (P =.053). The median [range] treatment duration was 301 [21-1643] days for palbociclib and 238 [70-1526] days for abemaciclib (log-rank test, P =.581). The median RDI was 59.7% and 59.6% for palbociclib and abemaciclib, respectively (P =.539). Although the AEs of palbociclib and abemaciclib affected the treatment considerably, the treatment duration and RDI were similar. Conclusion: CDK4/6 inhibitors should be selected based on the tolerability and manageability of each AE. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore and describe how public health nurses at child health clinics experience and perceive the follow-up of children and families when there is concern about the child's care. The goal was to contribute to knowledge development to guide health-promoting nursing care for children and their families. Theoretical perspectives included health promotion, child-centered and family-centered care, in addition to nursing care. An exploratory qualitative design informed by a hermeneutic approach was used. Data were collected in 3 focus groups with 16 public health nurses and analyzed using latent content analysis. The findings detail public health nurses' internal negotiation processes in the follow-up of children and the family, and the ways these negotiation processes were influenced by various prerequisites, the approaches for follow-up, dilemmas that affected public health nurses' approaches, and prolonged dwellings on past responses to children and families of concern. The lack of routines and goals for follow-up, a dominant parental perspective, and ambiguity related to health promotion and disease prevention, all created challenges for the public health nurses. Based on these findings, a model of public health nurse's follow-up when there is concern about the child's care was developed for future research. [ABSTRACT FROM AUTHOR]

In Japan, many pregnant women and mothers suffer from anxiety, depression, and other postnatal issues that can be exacerbated by their birth experiences. While benefiting from advanced medical care, these women's mental and psychological health may be disregarded in their maternity care. Midwives have the potential to play a significant role in improving women's birth experiences. Hence, this study aimed to explore the meaning of the woman–midwife relationship, with a specific focus on sensing peace of mind and trust to improve women's birth experiences. Using a hermeneutic phenomenological approach, 14 Japanese women were interviewed. Sensing peace of mind and trust was one of the significant meanings of the woman–midwife relationship and is articulated across five themes: (1) attuning to the world, (2) different kinds of safety and trust, (3) relying on and entrusting midwives, (4) making a mother, and (5) an emotional bridge. The positive relationship with midwives enhanced the women's mental well-being through allowing the women to attune to the peaceful mind which directed their future perspectives and sustained them in motherhood. They became confident mothers by trusting their midwives. The maternity care system in Japan needs to shift to more relationship-based care to ensure continuity of midwifery care that will improve women's birth experiences and their long-term well-being. [ABSTRACT FROM AUTHOR]

Background & objectives: Identifying the impacts of COVID-19 on patients' and practitioners' access to legal assisted dying and euthanasia (AD&E) services is vital to informing service continuity in an ongoing pandemic. Methods: An anonymous online survey collected qualitative and quantitative data from health practitioners and agencies providing legal AD&E services (n = 89), complemented by semi-structured interviews with 18 survey respondents who volunteered. Results: Following governments' responses to the dynamic pandemic context, rates of AD&E inquiries and requests fluctuated across and within jurisdictions, based on a complex interaction of factors affecting patient access to AD&E agencies and assessors as services were disrupted. Service flexibility and nimbleness became key elements in continuing service availability and included calculated 'rule-breaking' considered justifiable to adhere to established bioethics. Making innovative adjustments to usual practice led to reviewing the effectiveness of AD&E services and laws, resulting in providers now improving services and lobbying for legislative change. [ABSTRACT FROM AUTHOR]

Aim: This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. Background: Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. Method: We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. Result and Conclusion: Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients. [ABSTRACT FROM AUTHOR]

Introduction: The popularity of video consultations in healthcare has accelerated during the COVID-19 pandemic. Despite increased availability and obvious benefits, many patients remain hesitant to use video consultations. This study investigates the relative importance of the consultation mode compared to other attributes in patients' appointment choices in Germany. Methods: A discrete choice experiment was conducted to examine the influence of appointment attributes on preferences for video over in-clinic consultations. A total of 350 participants were included in the analysis. Results: The level of continuity of care (46%) and the waiting time until the next available appointment (22%) were shown to have higher relative importance than consultation mode (18%) and other attributes. Participants with fewer data privacy concerns, higher technology proficiency, and more fear of COVID-19 tended to prefer video over in-clinic consultations. The predicted choice probability of a video over a typical in-clinic consultation and opting out increased from <1% to 40% when the video consultation was improved from the worst-case to the best-case scenario. Conclusion: This study provides insight into the effect of the consultation mode on appointment choice at a time when telemedicine gains momentum. The results suggest that participants preferred in-clinic over video consultations. Policymakers and service providers should focus on increasing the level of continuity of care and decreasing the time until the next available appointment to prompt the adoption of video consultations. Although participants preferred to talk to their physician in person over consulting via video per se, the demand for video consultations can be increased significantly by improving the other appointment attributes of video consultations such as the level of continuity of care. [ABSTRACT FROM AUTHOR]

Objectives: As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK. Methods: Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices. Results: Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes. Conclusions: We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision – that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met. Methods: This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection. Results: Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care. Conclusions: Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic. [ABSTRACT FROM AUTHOR]

The wide expansion of community supervision has resulted in large-scale reliance on probation officers to facilitate change among both youth and adults. This is especially true for supervising high-risk populations, such as gang-involved individuals. To understand how probation officers balance the dual goals of public safety and rehabilitation, in-depth interviews with 12 youth and adult officers in Oregon were conducted. Results revealed that both groups had a shared understanding of gang pathways and desistance barriers. However, they held differing views on the factors that drive success and compliance. Youth officers utilize therapeutic philosophies and emphasize restoration through community resources to help youth desist from gang activity. Adult officers endorse law enforcement philosophies, emphasize accountability and personal choices, and center punitive strategies when using interagency collaboration. This study contributes to the literature on role perceptions and decision-making, and suggests that continuity of care in supervision philosophies can yield more successful outcomes for high-risk youth and adults. [ABSTRACT FROM AUTHOR]

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that provides early integrated intervention and treatment to patients with Alcohol Use Disorder (AUD) and/or Substance Use Disorders (SUD). Three Primary Care Medical Homes (PCMHs) in North Texas were selected as pilot sites for a SAMHSA grant designed to integrate SBIRT into existing services. The goal of this program is to support the stabilization and community reintegration of individuals who present with SUD by providing them with a continuum of care from screening, to brief intervention, to brief treatment, to referral for more advanced services. Specific aims of the grant included: provide SBIRT services to eligible participants, decrease substance and alcohol use at 6-month follow-up, improve patient physical and behavioral health measured at 6 months, and decrease in emergency department visits and costs for program participants. This brief report examines project design, outlines the implementation strategies, and provides preliminary results. [ABSTRACT FROM AUTHOR]

Background: The life expectancy of people with a learning disability is increasing and with this comes a greater risk of developing dementia. Dementia poses new challenges for both family and formal learning disability carers as they try to support dementia's progressive nature and quality of life for their care recipient. This qualitative systematic review explores the evidence base of family and formal carers' experiences and needs of caring for someone with both a learning disability and dementia. Methods: Six electronic databases (PubMed, PsycINFO, Cochrane Library, Prospero, Scopus, CINAHL), were searched in May 2022, utilising a predefined search strategy. Thirteen papers fulfilled inclusion criteria and were included in in the review. Results: Thematic synthesis was used to explore and synthesise the qualitative findings of the studies. Four conceptual themes were identified following analysis: Knowledge and skills, Accessing support, Repercussions of dementia for carers, Influences of continuity of caring role. Conclusion: There are significant training and educational needs for all carers who support the dual diagnosis of dementia and learning disability. Differences between family and formal carers relate to the organisational support and process available to formal carers. Parity across services combined with sufficiently trained carers may support dementia diagnosis and improve quality of care provided. Further research is needed to address environmental, and economic barriers carers face to facilitate ageing in place for their care recipients. [ABSTRACT FROM AUTHOR]

Sleep is essential for maintenance and restoration of health, yet studies exploring this in hospitalized children are scarce. In a qualitative study, we assessed the perceived quality of sleep, factors affecting sleep, and the role of health care professionals in the sleep environment for hospitalized children aged 1 to 12 years. Data were obtained from 11 semi-structured, audio-recorded, and verbatim-transcribed interviews with parents, and analyzed using a systematic thematic analysis. The interviews were coded based on iterative assessment of transcripts. Subsequently, categories and interpretative main themes were identified. Four themes emerged: (1) being informed, keeping informed; (2) coordination of care; (3) parents as main advocates for their child's sleep; and (4) environmental disturbers. Parents reported differences in their child's sleep quality during hospital compared with home. Sleep is substantially affected during hospitalization, prompting the need for interventions to improve the quality of sleep of children. Parents provided valuable suggestions for improvements. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacists in primary care clinics improve medication adherence and reduce medication errors but these require further investigation to determine its potential impact on health care readmission rates. Methods: This review assessed the addition of a clinical pharmacist to the primary care provider's transitions of care appointment. The primary outcome of this review was the change in acute health care encounters (hospital readmissions and/or Emergency Department visits) in the 6-month period before to the 6 months following initial clinical pharmacist intervention. Each patient served as their own control. Secondary outcomes included the number and types of pharmacist interventions, percentage of pharmacist recommendations accepted, number and categories of drug-related problems (DRPs), nonadherence reasons, 30-day hospital readmission rate, 30-day Emergency Department (ED) rate, time to first hospital readmission, time to first ED readmission, and preventable readmission rate. Results: The total number of combined acute health care encounters in 6 months decreased by 15% from 280 at baseline to 238 after pharmacist intervention (P =.087) for the 206 patients included in the final analysis. The 30-day hospital readmission rate was 9.7% and the median time between first hospital readmission was 54.5 days (IQR 63.5). We identified a total number of 310 DRPs with a mean of 1.5 DRPs (SD 1.3) identified per patient. The providers accepted 88% of the pharmacists' recommendations. Conclusions: Clinical pharmacists embedded in a primary care setting demonstrated improved patient care during transitions of care by identifying and resolving drug-related problems, with a trend in decreasing acute health care utilization. [ABSTRACT FROM AUTHOR]

Pharmacy has evolved significantly over the past 20 years, despite advances in pharmacotherapy and the expanding scope of pharmacy practice, pharmacists have struggled to collaborate across disciplines to create improved processes that enable the best outcomes from these innovations. A lack of innovation at any part of the healthcare system could inhibit the progress of practice innovations thereby leading to suboptimal patient medication and health outcomes. The Utah Pharmacy Summit was held in late 2022 with the goal of promoting pharmacist collaboration and a unified pharmacist voice within the state. The success of the Summit leads us to encourage collaborative forums across the Globe. [ABSTRACT FROM AUTHOR]

Background: In addition to the morbidity and mortality associated with acute infection, COVID-19 has been associated with persistent symptoms (>30 days), often referred to as Long COVID (LC). LC symptoms often cluster into phenotypes, resembling conditions such as fibromyalgia, postural orthostatic tachycardiac syndrome (POTS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). LC clinics have been established to best address the needs of LC patients and continuity of care. We developed a cross-sectional survey to assess treatment response through our LC Clinic (LCC). Methods: A 25-question survey (1-10 Likert scale) was expert- and content-validated by LCC clinicians, patients, and patient advocates. The survey assessed LC symptoms and the helpfulness of different interventions, including medications and supplements. A total of 852 LCC patients were asked to complete the survey, with 536 (62.9%) responding. Results: The mean time from associated COVID-19 infection to survey completion was 23.2 ± 6.4 months. The mean age of responders was 52.3 ± 14.1 (63% females). Self-reported symptoms were all significantly improved (P <.001) from the initial visit to the LCC (baseline) to the time of the follow-up survey. However, only 4.5% (24/536) of patients rated all symptoms low (1-2) at the time of the survey, indicating low levels of full recovery in our cohort. The patients rated numerous interventions as being helpful, including low-dose naltrexone (45/77; 58%), vagal nerve stimulation (18/34; 53%), and fisetin (28/44; 64%). Conclusions: Patients report general improvements in symptoms following the initial LCC visit, but complete recovery rates remain low at 23.2 ± 6.4 months. [ABSTRACT FROM AUTHOR]

The demand for digital platforms in managing heart failure (HF) is expected to increase with promising effects on readmission and health expenditure. The study aims to explore current post-discharge management strategies and identify the need and acceptance of digital platforms, to ensure the development of a user-friendly mobile application for HF patients. Using a cross-sectional analytical research design, 90 consecutive patients diagnosed with HF who were discharged from a Tertiary Care Center were enrolled. Tele-interview was conducted using a self-developed and validated tool. The mean age of participants was 55.54 ± 10.33 years. The participants' adherence to HF management strategies was low in terms of physical exercise and weight monitoring. More than one-third were willing to self-record their measurements and use a mobile application. The common mobile application features requested were medication information/reminder (88.6%), health education (84.3%), chat with nurses (84.3%), physical activity (81.4%), symptoms (78.6%), diet (78.6%) and weight management (72.9%). The findings from this initial phase of mobile development are expected to help leverage better development of digital interventions for HF patients. [ABSTRACT FROM AUTHOR]

Nursing assistants (NAs) are critical professionals across the long-term care continuum. Despite the demands of NAs, these frontline personnel experience workplace challenges and turnover at a disproportionate rate compared to other professionals. Much research has explored the experiences of nursing assistants using federal survey data and national datasets. Guided by a socio-ecological model and the job-demands resource model, this study utilized a sequential mixed-methods approach to uncover a more nuanced understanding of NA workplace experience. Results from this combined qualitative (N = 17) and quantitative (N = 354) study found that there are several workplace aspects, such as organizational culture and supervisor relationships, that contribute to NA experiences across system levels. Further exploration of direct care tasks directly from nursing assistants is necessary to understand full intentions. [ABSTRACT FROM AUTHOR]

A major challenge for juvenile correctional facilities (JCF) is providing literacy instruction to a transitory student population with a wide range of literacy abilities. The purpose of this study was to identify unique literacy profiles of students in long-term JCF taking into consideration their reading abilities, language abilities, intelligence quotient (IQ), disability classification, age, and grade level. Using latent profile analyses with a sample of 370 in the southeastern United States, we identified three distinct classes. Three ability groups of students (average literacy abilities, below-average literacy abilities, substantially below-average literacy abilities) were identified. Thirty-six percent performed at the average level, 55% performed below grade level; and 8% had substantial literacy deficits with an overrepresentation of students with emotional disturbance (ED) and specific learning disability (SLD). Findings provide the foundation for an evidence-based multi-tiered system of supports literacy framework within JCF. Instructional implications concerning the provision of English Language Arts in JCF are provided. [ABSTRACT FROM AUTHOR]

School nursing is a unique nursing specialty that benefits from a practice framework that aids school nurses in explaining and accomplishing their role. In 2016, the NASN debuted its Framework for 21st Century School Nursing Practice™, which has shaped school nursing practice as well as education, leadership, research, and collaboration with stakeholders. However, practice frameworks are not meant to remain the same indefinitely. Therefore, NASN evaluated and updated the Framework to ensure its continued alignment with the education and healthcare landscape. The purpose of this article is to share the history of the Framework for 21st Century School Nursing Practice™ development, provide the rationale for the update, and discuss the strategic process NASN used to update its Framework now entitled the School Nursing Practice Framework™. [ABSTRACT FROM AUTHOR]

Background and Objectives: Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. Methods: Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. Results: Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. Conclusions: This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD. [ABSTRACT FROM AUTHOR]

Background: The adoption of telehealth became a necessity for healthcare organizations during the COVID-19 pandemic. Transplant pharmacists are integral members of the multi-disciplinary care team who quickly adapted application of these technologies to ensure continuity of care. Objective: To assess transplant pharmacists' experience with telehealth during the COVID-19 pandemic. Methods: A 23-question online survey was developed to assess transplant pharmacists' experience with telehealth during the COVID-19 pandemic. Results: Forty-five pharmacists responded to the survey from a broad range of transplant centers. The majority of respondents indicated infrequent use of telehealth (98%) before the COVID-19 pandemic, but this was significantly changed during the pandemic with only 9% reporting infrequent use. Pharmacists anticipated a decrease in future use, but 91% of respondents stated they would like to continue utilization of telehealth in their practice post-pandemic. Conclusions: The adoption of telehealth during COVID-19 was widespread and has the potential to facilitate continuity of care. Though pharmacists anticipated a decrease in future use, a majority favored continued utilization of telehealth in their practice. [ABSTRACT FROM AUTHOR]

Introduction: This study explored treatment of executive functioning impairment in adults after acquired brain injury (ABI), clinician's confidence and support received, in a sample of occupational therapists in the United Kingdom. Methods: A 24-item online questionnaire was sent to 750 members of the Royal College of Occupational Therapists Specialist-Section in Neurological Practice. Data was collected at a nominal and ordinal level and included yes/no Likert-type scale and free field comments. Descriptive statistical analysis was completed. Results: Seventy-six occupational therapists working in a range of neurological settings completed the survey. Frequently used interventions included education (n = 57, 75%), task modification (n = 56, 73%), instrumental activities of daily living (ADL) (n = 54, 71%), personal ADL (n = 53, 70%) and goal setting (n = 53, 70%). Seventy-one percent used metacognitive strategies. Occupation-based metacognitive approaches were rarely used. Thirty-one (41%) participants reported being fairly confident and 28 (37%) were very confident. Support for clinical practice was accessed most frequently through joint clinical sessions (n = 30, 39%). Findings: Participants used various clinical interventions to treat service users with executive dysfunction after ABI. Meta-cognitive strategies were employed; however, occupation-based metacognitive approaches were infrequently utilised, suggesting uncertainty in adopting these in practice. The need for further training on evidence-based interventions and knowledge translation support was highlighted. [ABSTRACT FROM AUTHOR]

Primary mental healthcare nurses are an essential workforce that provide necessary inpatient psychiatric treatment. Continuity of care has become a significant aspect of the provision of mental health services. However, caring for South African healthcare users comes with challenges, including difficulties accompanying the provision of care for acutely ill patients with complex mental health problems. Therefore, this study explored the perceptions and experiences of primary mental healthcare nurses concerning the continuity of care required in post-inpatient psychiatric treatment for mental health users from low-income communities in the Western Cape. Through undertaking a study using a qualitative exploratory design and purposive sampling technique, and in which nine primary mental healthcare nurses from two psychiatric hospitals in the Western Cape were interviewed, the researchers were able to obtain a deeper understanding of the participants' experiences. Four themes were identified during the reflexive thematic analysis namely: the roles and responsibilities of primary mental healthcare nurses, the lack of support within the current continuity-of-care system, barriers to continuity of care for women patients, and suggested improvements for quality of mental healthcare. It was evident that both women patients and primary mental healthcare nurses experienced various forms of marginalisation, discrimination, and gendered oppression. This intersectionality accentuates systemic issues within the current public healthcare system and highlights the stigmatisation of mental illness, especially among women. Overall, primary mental healthcare nurses have a plethora of roles and responsibilities within the primary healthcare sector, which hinder their ability to provide mental health services to women patients. Their reports highlight the needs of a specific patient population that first need to translate into changes that will assist in improving their roles as primary mental healthcare nurses. Their shared experiences of a lack of support from South Africa's healthcare system were the focal points of this study. [ABSTRACT FROM AUTHOR]

Assisted Outpatient Treatment (AOT) is a court-mandated program intended to engage adults with serious mental illness who have challenges with voluntary treatment adherence. AOT programs are designed to promote outpatient treatment participation, reduce emergency care, and decrease justice involvement. Research has found AOT programs to be effective in reducing hospitalizations and justice involvement. Yet, concerns have been raised, including limiting individual autonomy and self-determination and overrepresentation of individuals from BIPOC backgrounds. This article describes the evolution the AOT Houston Model. Through applying the social work lens, this innovative model builds on AOT strengths and addresses limitations. The Houston AOT Model has five goals guided by the core tenets of client empowerment and self-determination. This Model prioritizes six elements including housing, employment, access to public benefits, transportation, service continuity, and care coordination/communication. Implications for practice and policy are presented with strategies for successful implementation of comprehensive AOT programs in other jurisdictions. [ABSTRACT FROM AUTHOR]

The article comments on the development of a standardized, laboratory result-based hepatitis C virus (HCV) clearance cascade for public health jurisdictions. It identifies elements for constructing a population-level HCV cascade, as well as the important data-to-share opportunities measured by a laboratory result-based HCV cascade. It informs about the funding to support health departments to implement laboratory result-based HCV cascades and cites limitations of HCV cascade.

A transition-aged youth with an individualized education program has the right to free, appropriate public education that includes postsecondary transition planning and services. The documented transition supports need to meet both procedural and substantive requirements. While many court cases have included transition components, few have been decided at the appellate court level. In Gibson v. Forest Hills (2016), Chloe Gibson, a transition-aged youth with intellectual and developmental disabilities, was provided inadequate postsecondary transition planning and services. According to the U.S. Court of Appeals for the Sixth Circuit, Chole's right to a free, appropriate public education was violated due to procedural errors related to inviting her to individualized education program (IEP) meetings, conducting age-appropriate transition assessments, and including programming leading to supported competitive employment in a community setting. This decision supports the federal requirements of including a transition-aged student's strengths, interests, preferences, and needs when planning their life after high school. [ABSTRACT FROM AUTHOR]

This article addresses the complex issues surrounding trans youths' shared care perceived by parents in primary care settings in the UK. The analyses in this article draws on qualitative data derived from an online survey of 153 parents with trans children. Through the conceptual framework of healthcare assemblages, findings suggest that quality shared care for trans youth is based upon transient service relationships inherent in their healthcare—primary care, gender identity services, endocrinologists, and Adolescent Mental Health Services (CAHMS)—and, as such, this complexity must be understood better by GPs in order for quality shared care to be administered. We explored various blockages to quality shared care within primary care surgeries that produced limit situations, such as lack of knowledge, training, or experience with trans healthcare. One other key factor was that there were strong external forces that were limiting trans youths' quality shared care in the form of abject depictions from beyond the consultation, which all produced negative effects. Despite these blockages, we also demonstrate how and where quality shared care is received. For instance, we show that continuity of care or treatment after an initial diagnosis or assessment contributes to quality shared care as too does personalized care to those youths receiving it. Overall, this research provides insights into the complex perceptions of parents about what quality shared care is and ought to be for trans youth. [ABSTRACT FROM AUTHOR]

This commentary critiques the Danish CHANGE trial, which evaluated 3 levels of outpatient intervention intensity, in a group of outpatients with obesity and schizophrenia. Neither adding care coordination with weekly nurse contacts alone nor combining this treatment with assertive community lifestyle coaching as compared to treatment as usual improved outcomes, which included cardiovascular disease risk calculation, cardiorespiratory fitness, weight, and self-reported behaviors such as smoking, physical activity, and diet. The CHANGE trial investigators appear strongly averse to recommending the development and implementation of lifestyle medicine programs as a major component when treating outpatients with severe mental disorders. The potential dismissal of lifestyle medicine as a component of treatment for severe mental disorders is problematic. Valuable lessons can be learned from more thoroughly analyzing secondary outcomes such as medical and psychiatric hospitalization rates and total health care cost. The CHANGE trial data analysis needs to be expanded beyond the focus on changes in weight and serum cholesterol. Insulin resistance and high refined carbohydrate intake may be major factors in determining both the medical and psychiatric clinical course of schizophrenia. Assertive community lifestyle coaching is a novel treatment modality. Evidence strongly suggests assertive community lifestyle coaching substantially decreases both psychiatric and medical hospitalization rates. [ABSTRACT FROM AUTHOR]

Aim: To outline and discuss care transitions and care continuity following hospital discharge of older people with complex care needs in three Nordic cities: Copenhagen, Tampere and Stockholm. Methods: Data on potential pathways following hospital discharge of older people were obtained from existing literature and expert consultations. The pathways for each system were outlined and presented in three figures. The hospital discharge process of the systems was then compared. Results: In all three care systems, the main care path from hospital is to home. Short-term intermediate healthcare can be provided in all three systems, possibly creating additional care transitions; however, once home, extensive home healthcare may prevent further care transitions. Opportunities for continuity of care include needs assessments (all cities) and meetings with the patient about care upon return home (Copenhagen, Stockholm). Yet this is challenged by lack of transfer of information (Tampere) and patients' having to apply for some services themselves (Tampere, Stockholm). Conclusions: Comparisons of the discharge processes studied suggest that despite individual care planning and short- and long-term care options, transitional care and care continuity are challenged by limited access as some services need to be applied for by the older person themselves. [ABSTRACT FROM AUTHOR]

Immigrant parents may struggle to secure and maintain employment if they raise children with disabilities. The current study examines data from immigrant parents responding to the 2018 National Survey of Children's Health, including 618 raising children with special health care needs (CSHCN) and 2937 parenting children needing typical care. Parents of CSHCN had higher levels of both aggravation and resilience, but less access to a medical home than parents with typical care responsibilities. Immigrants were less likely to change jobs, but more likely to cut back work hours, or quit work, if they had CSHCNs lacking a medical home, missing more school days, and living in unsafe neighborhoods. Parents of CHSHNs also spent substantial time coordinating care and providing health care at home. Results indicate the need for service providers to connect immigrant families with CSHCNs with culturally supportive organizations that can help them handle family responsibilities while maintaining employment. [ABSTRACT FROM AUTHOR]

Background: Groote Schuur Hospital is a large Academic Hospital in South Africa that is in the process of integrating palliative care (PC) via a vertical nurse-led doctor-supported (VNLDS) service that was initially established to deliver clinical care. PC integration should occur across multiple dimensions and may result in variable degrees of integration between levels of the healthcare system. This research evaluates the VNLDS through a theory-driven evaluation to describe how the service affected integration. Methods: A mixed-method sequential design consisting of a narrative literature review on the theory of integration and PC, retrospective quantitative data from a PC service delivery database, qualitative data from semi-structured interviews and document analyses. It was structured in three phases which assisted in confirming and expanding the data. Statistical analyses, deductive thematic coding and documentary analyses were conducted according to the conceptual framework of PC integration. Results: The PC integration process was facilitated in the following ways: (i) the service provided good clinical PC; (ii) it was able to integrate on a professional level into specific diseases, such as cancer but not in all diseases; (iii) developing organizational structures within the service and (iv) the observed benefit of good clinical care increased the value stakeholders assigned to PC, thereby driving the adoption of PC. However, there are still clinicians who do not refer to PC services. This gap in referral may be grounded in assumptions and misconceptions about PC, especially at the organizational level. Discussion: Observed PC service delivery is core to integrating PC across the healthcare system because it challenges normative barriers. However, the VNLDS could not achieve integration in leadership and governance, education and hospital-wide guidelines and policies. Whole system integration, foregrounding organizational commitment to PC excellence, is core to integrating PC. Conclusion: The VNLDS service has effectively linked PC in specific disease profiles and normalized the PC approach where healthcare workers observed the service. These integrational gaps may be grounded in assumptions and misconceptions about PC, especially at the organizational level. Plain language summary: How does a nurse led palliative care service affect palliative care integration in a big teaching hospital? This article evaluates a nurse led doctor supported service in providing palliative care and how it affected the integration of palliative care in an Academic Hospital in South Africa. This study will help us understand the goals of integration, the extent of integration achieved by this service and how and why it was achieved or not. [ABSTRACT FROM AUTHOR]