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Patient-centered care (PCC) is a concept and standard of care that describes organizing healthcare system around the patient, with the aim is to improve quality of care. PCC approach has become increasingly popular in various healthcare systems, including Israeli healthcare system. However, the complexity of the concept contributes to the difficulties in implementing it in practice. This article reviews the definitions of the PCC concept and the paths of healthcare systems to implement this approach, while focusing on nursing and nursing education. [ABSTRACT FROM AUTHOR]

This study deals with stigmas towards mental illness, individuals with mental illness, psychiatric nurses, and the role of psychiatric nursing within the nursing profession. Responses from 108 psychiatric nurses and 108 non-psychiatric nurses indicated that stigmas towards mental illness, individuals with mental illness, and the role of psychiatric nursing, are more prevalent among non-psychiatric nurses; associations between these stigmas were found among both psychiatric and non-psychiatric nurses. The findings suggest that both psychiatric and non-psychiatric nurses harbor associative stigma related to the practice of psychiatric nursing. Implications are discussed. [ABSTRACT FROM AUTHOR]

Background: In many countries there is a gap between the clinical evidence for cardiovascular disease (CVD) prevention and implementation in clinical practice. Inadequate control of cardiovascular risk factors and underutilization of aspirin, statins, angiotensin converting enzyme inhibitors and β-blockers are well-established examples. The optimal approach to implementation of CVD prevention in clinical practice is still under debate. The screening and monitoring (SaM) approach is based on cyclic monitoring and individual treatment of patients with cardiovascular risk factors in the primary care setting. After achieving improvements in risk factor levels and in the use of preventive medications in a pilot study, it was decided to test the efficacy of this approach in a larger population at risk. Methods: Five primary care clinics adopted the SaM approach. A total of 1622 patients with established CVD, diabetes mellitus or hypertension were assessed by their family physicians for cardiovascular risk factors and use of medications for cardiovascular risk reduction. Interventions were made according to accepted clinical guidelines. Cardiovascular risk factor levels and the use of medications for CVD prevention were retrospectively analyzed. Results: The results demonstrated significant reductions in blood pressure, hemoglobin A1c and low-density lipoprotein-cholesterol levels, as well as significant increases in the use of medications for CVD prevention. Conclusion: A systematic approach to CVD reduction, with an emphasis on multiple risk factor assessment and use of preventive medications in patients at cardiovascular risk, yielded significant improvements in measures of the quality of preventive care. [ABSTRACT FROM AUTHOR]

Introduction: Personal protective equipment (PPE) reduces the risk of pathogens reaching the skin and clothing of health care personnel. We hypothesize that doffing PPE following verbal instructions by a supervisor is more effective in reducing contamination compared with doffing without verbal instructions. Our primary aim was to determine contamination rates with and without supervised doffing. The secondary aim was to determine the number and localization of contaminated body sites and PPE removal times in both groups., Methods: Staff members of Bnai Zion Medical Center participated in this single-center, randomized simulation study (NCT05008627). Using a crossover design, all participants donned and doffed the PPE twice, once under guidance from a trained supervisor and then independently without supervision (group A), or vice versa (group B). Participants were randomized to either group A or B using a computer-generated random allocation sequence. The PPE was "contaminated" with Glo Germ on the thorax, shoulders, arms, hands, legs, and face shield. After doffing the PPE, the participant was examined under ultraviolet light to detect traces of contamination. The following variables were collected: contamination rates, the number and localization of contaminated body sites, and PPE doffing time., Results: Forty-nine staff members were included. In group A, the contamination rate was significantly lower (8% vs. 47%; χ 2 = 17.19; p < 0.001). The sites most frequently contaminated were the neck and hands. Mean PPE doffing time under verbal instructions was significantly longer [mean (SD): 183.98 (3.63) vs. 68.43 (12.75) seconds, P < 0.001] compared with unsupervised doffing., Conclusions: In a simulated setting, PPE doffing following step-by-step verbal instructions from a trained supervisor reduces the rate of contamination but prolongs doffing time. These findings could have important implications for clinical practice and could further protect health care workers against contamination from emerging and high-consequence pathogens., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)

Introduction: The number of dialysis patients is consistently growing and the dialysis population is aging. Of all age groups of dialysis patients, the higher prevalence rate is in the elderly group (aged 75 years and older). The elderly patients have a high rate of comorbidities. Chronic dialysis treatment is expected to prolong survival. Older age and comorbidities are among the most powerful prognostic factors for survival on chronic dialysis. Observational studies found that after adjustment for age and comorbidities, dialysis treatment does not confer survival advantage when compared to conservative management in elderly patients with multiple comorbidities. Comprehensive conservative management is targeted for those patients who are not expected to benefit from chronic dialysis. The focus is on patients' preferences, specifically regarding issues of quality of life, and not necessarily on prolonging survival. For this process, shared decision-making is the recommended strategy. The rate of patients who opt for conservative management varies between countries. There is no data from Israel in this regard, but it is assumed that the conservative option is underutilized. There are different reasons for the current situation, factors that: depend on the caregivers' side, are patient dependent, relate to the health care system and available services and some cultural aspects. Addressing these gaps may require further collection of data, construction of needed services for conservative management and education of the caregivers and the patients.

Introduction: Shortening door-to-balloon time intervals in ST-elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI) is necessary in order to limit myocardial damage. Direct admission to the cardiac care unit (CCU) facilitates this goal. We compared characteristics and short- and long-term mortality of PPCI-treated STEMI patients admitted directly to the CCU with those admitted via the emergency department (ED)., Methods: To compare 303 patients admitted directly to the CCU (42%) with 427 admitted via the ED (58%) included in the current registry comprising 730 consecutive PPCI-treated STEMI patients., Results: Groups were similar regarding demographics, medical history and risk factors. Pain-to-CCU time was 151±164 minutes (median-94) for patients admitted directly and 242±226 minutes (160) for those admitted via the ED, while door-to-balloon intervals were 69±42 minutes (61) and 133±102 minutes (111), respectively. LVEF evaluated during admission (48.3±13% [47.5%] vs. 47.7±13.7% [47.5%]) and mean CK level (893±1157 [527] vs. 891±1255 [507], p=0.45) were similar between groups. Mortality was 4.2% vs. 10.3% at 30-days (p<0.002), 7.6% and 14.3% at one-year (p<0.01), reaching 12.2% and 21.9% at 3.9±2.3 years (median-3.5, p<0.004) among directly-admitted patients vs. those admitted via the ED, respectively. Long-term mortality was 4.1%, 9.4%, 21.4%, and 16% for pain-to-balloon quartiles of <140 min, 141-207 min, 208-330 min, and >330 mins, respectively (p=0.026)., Conclusions: Direct admission of STEMI patients to the CCU for PPCI facilitated the attainment of guidelines-dictated door-to-balloon time intervals and yielded improved short- and long-term mortality. Longer pain-to-balloon time was associated with higher long-term mortality.