bluuebunny/crossref_metadata_2025 huggingface dataset:
A framework for evaluating the implementation and maintenance of integration within the youth mental health system.
Authors: Hodgins Michael , McHugh Catherine , Eapen Valsamma , Hu Nan , Cadiri Mariyam , Curtis Jackie , Lingam Raghu
Published: January 2024

Given the global burden of disease of youth mental disorders, there remains a need to examine how to improve care for this population. Integrated care has been posited as a potential solution, but there is limited evidence on how best to design, staff, and evaluate different models of integrated care for youth mental health. This oral paper presents the findings of a narrative synthesis of the evidence on integrated models of mental healthcare for young people aged 12 to 25 within PubMed, SCOPUS, and PsycINFO databases. Our literature review aimed to: (1) define and summarise the literature on integrated models of mental healthcare for children and young people, and (2) evaluate the effectiveness of integrated models of youth mental healthcare in enhancing mental health outcomes, quality of life, satisfaction with care, and improving health service delivery in young people aged 12-25 years. To be included in our review, studies were English language peer-reviewed and grey literature from January 2001 – October 2021, which included systematic and/or scoping reviews that assess integrated mental healthcare for children and young people aged 12 to 25 years and studies evaluating models of integrated mental healthcare for children and young people using intervention and comparator groups (included in meta-analysis). To synthesise this literature, we generated intial inductive themes describing components of integrated care shared across the youth mental health system including, collaborative care, person centred care, population and evidence-based care, and governance and financing. We incorporated these themes within a deductive framework adapted from the World Health Organisation health system building blocks. These building blocks include service delivery; workforce; information systems and communication; products and technology; and finance along with the cross-cutting themes of leadership, governance, and policy and values. We then mapped these core components of integrated care onto the six intensity levels of integrated care developed by Heath and colleagues providing an overview of how integrated care can be operationalised in terms of health service building blocks. This framework can form a basis for the development of well-articulated models of youth integrated mental health pathways, assisting services identify what operational changes are needed to best implement and sustain integrated care in their own context. Planned future work involving this framework includes using it to map the integration of primary, secondary, tertiary, public, and private youth mental health services within the Australian health system.
Informal coordination of care in Praktyka Lekarza Rodzinnego (PHC facility)- the auto-ethnographic study on building the theoretical model of integrated care based on grassroots initiative
Authors: Hucko Ania
Published: January 2024

Since the adoption of the 2017 bill on primary health care (PHC) introducing a model of integrated care in PHC in Poland, family doctors have been obliged to coordinate the care and to manage the PHC teams. Till now only a small number of PHC facilities decided to conclude contracts on coordinated care with National Health Fund (NHF). There are serious reservations over rural and remote PHC facilities' capabilities to meet all the NHF's criteria regarding coordinated care. This auto-ethnographic study presenting the case of a family doctor in remote area in lubuskie voivodeship shows that mechanisms and models of integrated care are rooted in the primal idea of family medicine and may be successfully adopted and developed aside legally imposed solutions. These mechanisms create a specific grass-rooted system of organising the process of delivering care which is called informal coordination. The study presents the theoretical framework of informal model of integrated care based on 5 principles guaranteeing achieving the two most important goals of coordinated care: its complexity and continuity. It has been conducted as a participatory observation in PHC facility with active involvement of PHC facility's staff members. As long as there is still enough space in healthcare systems for new initiatives regarding coordination of care and new solutions are being developed, this perspective may be valuable for international audiences. The results will serve to develop alternative theoretical model of coordinated care which my be found useful in small, individual, self-sufficient facilities.
Identification of multimorbidity patterns in older adults receiving long-term care in Canada, Italy, Finland and New Zealand: results from the ICARE4OLD project
Authors: De Almeida Mello Johanna , Proost Bregtje , Damiano Cecilia , Vetrano Davide	L. , Declercq Anja , Nova1 Amanda
Published: January 2024

Background: Older adults receiving home care (HC) services and living in long-term care homes (LTC) experience high levels of multimorbidity. In this project - called iCARE4OLD, we aimed first to identify and compare subgroups of care dependent individuals sharing the same patterns of chronic diseases. For these subgroups, we will identify care paths and try to make integration of services and continuity of care possible.

Settings and participants: We studied 102,000 individuals 60+ years receiving HC services or living in LTC homes in Canada, Italy, Finland and New Zealand.

Methods: This is a cross-sectional study including the baseline interRAI HC and LTCF assessments of older people in the period of 2014 until 2018. The project has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement number 965341 and from the New Frontiers Research Fund, grant number NFRFG-2020-00500.

Latent Class Analysis (LCA) was used to classify individuals according to their underlying diseases patterns starting from a list of 19 conditions.

Results: Mean age of the sample was 80 years (65% females). After assessing several fit parameters, a 5-class solution was chosen as the best model for both HC and LTC. The following 5 disease patterns were identified in all countries: (1) Alzheimer/dementia; (2) psychiatric diseases; (3) cardio-pulmonary diseases; (4) stroke/hemiplegia; (5) other dementias. The distribution of sociodemographic, clinical and functional characteristics varied across the different multimorbidity patterns, with the cardio-pulmonary disease and the stroke/hemiplegia patterns showing the highest complexity and impairment.

Results: Our results show that, by using a common assessment tool, it is possible to identify homogeneous morbidity patterns in older patients receiving long-term care. These may be useful to compare health status in care-dependent individuals across different settings and countries, as well as to predict health trajectories and care needs.

Discussion: By applying this methodology to whole populations, care paths can be drawn for home care and residential care clients in a more evidence-based way. The goals would be to use these algorithms to design more integrated care plans for older persons, so that clients and their families are better served, and policy makers can finance the right services and offer targeted care.
Building Collaborative Capacity through formalized and Imposed Cooperation: The Implementation of Health Care Communities in Norway
Authors: Krane Martin Sollund , Høyem Audhild
Published: January 2024

Today, the nexus of ´co-ordination – co-production – co-creation´ constitutes the new political prism through which the ´wicked issues´ of the public sector is re-imagined, and by calling forth new cooperative endeavors stressing shared problem solving, the welfare state might signal a shift in mode of governance from New Public Management (NPM) to New Public Governance (NPG). In this paper we inquire into an empirical example from the Norwegian healthcare sector, namely the implementation of healthcare communities (HCCs).

Public healthcare is an essential part of the Nordic welfare state model. Being a multi-dimensional policy field, it is notoriously characterized by both ´wicked issues´ and complexity – in terms of service provision, organizing and governing. Often patients require several healthcare services from multiple providers. In Norway, healthcare is organized in two main parts, primary (municipalities) and specialized healthcare (central government). While this division in theory should lead to a clear assignment of tasks and responsibilities, it has built-in challenges of lack of continuity of care and the risk of services being fragmented. Furthermore, the NPM-reforms during the last three decades has contributed to organizational fragmentation. Problems of service and organizational fragmentation has served as a core focal point for several health sector reforms in Norway during the last three decades. The latest reform initiative is the implementation of 19 HCCs, where hospital trusts and municipalities, through imposed and formalized cooperation structures are expected to cooperate, as well as co-plan, service provision, aiming to make better, more efficient services, and give patients a more coherent and seamless experience.

We are interested in why and how NPG-inspired ideas of collaboration and co-creation are translated and articulated into the specific institutional context of Norwegian healthcare, and whether the HCC reform imply an actual break with the NPM-logics – or rather represents more of a continuation adding an extra reform layer, so to speak. In this paper the following research question guides our inquiry: In which ways does the HCC reform as an expression of the New Public Government paradigm represent a break or continuation with New Public Management logics in the healthcare sector in Norway, and how are the concepts of co-design, co-creation and collaborative capacity framed and constructed as the remedy for fragmentation by the policy makers?

 

Methodologically, this paper is based on critical discourse analysis of official documents central in the development of the reform, as well as a qualitative analysis of interviews with central and local actors, in addition to a study of relevant public governance literature.
Putting patients’ goals first: strategies and challenges through the eyes of primary care stakeholders
Authors: Haverals Reini , Boeykens Dagje , Sirimsi Mustafa	 Muhammed , Timmermans Lotte , Van de Velde Dominique , De Vriendt Patricia , Boeckxstaens Pauline
Published: January 2024

Introduction: Primary care is in constant transformation to optimize integrated care delivery according the increase of people with multiple and long-term care needs. One of the suggested strategies is person centered integrated care (PC-IC). PC-IC has an explicit focus  on patients’ personal goals. This  should reorient care delivery from the focus on disease oriented quality indicators to outcomes that matter to people. To get this focus on patients goals implemented throughout the system, actions in practice, research, education and policy are required.

Aim: This study aims to explore the experiences of primary care providers, scholars and policy makers towards putting patients’ goals first in primary care, the strategies they use, and challenges they encounter.

Methods: Primary care stakeholders (n=41) - recruited via maximal variation purposive sampling- participated in six focus groups. Data were collected through a semi-structured interview guide, audio recorded, and analyzed following a phenomenological-hermeneutical philosophy of Lindseth and Norberg.

Results: All participants emphasized their fundamental commitment in putting patients' goals first. Participants who were active in patient care discussed how they enabled patients to talk about their values and personal stories in order to elicit their personal goals. They also attempted to establish a balanced relationship by integrating their medical expertise with the goals of their patients. Participants stated that they listened to the goals of patients' significant others in order to gain common understanding on goals and recognize everyone's contribution to the care process. Finally, they used patients’ personal goals as a focus for guiding interprofessional collaboration. Both the clinicians and scholars stressed that (future) care providers need more training to develop the competencies necessary to discuss patients' personal goals and integrate them into care delivery. According to policy, all types of participants agreed that there’s challenges related to organizational constraints, such as time restrictions and a lack of registration systems.

Discussion: The results of this study provide an integrated perspective on the strengths, weaknesses, opportunities and threats for adopting an explicit focus on patient goals throughout the system. In order to support primary care stakeholders to fully engage in the adoption of patients' personal goals in care delivery, the development of models of practice, training and policy plans from a person-centered integrated  system approach are required.
Change management through upskilling and reskilling.
Authors: Ruszanov Anett
Published: January 2024

BeWell is an Erasmus+ Funded project that kicked-off in July 2022 and will last for 4 years. BeWell is aiming to prepare the health workforce, and more broadly the health ecosystem, to cope with future challenges and the continuously changing societal expectations by developing a strategy on upskilling and reskilling the health workforce in the context of the green and digital transition. 

BeWell stands for Blueprint alliance for a future hEalth Workforce stratEgy on digital and green skiLLs and serves the objectives of the European Skills Agenda 2020 that aims to support companies and individuals to develop better skills.

The way health and care is delivered is significantly changing due to a number of major trends. Just to mention a few: demographic change, the increasing number of non-communicable diseases, the consequences of our modern urban lifestyle, the use of digital technologies becoming prominent in all phases of care provision as well as becoming essential for horizontal and vertical integration of care, the ambition to reduce the environmental impact of the health sector activities, etc. To respond to these challenges and to manage these changes, health professionals need different sets of skills if they want to keep the quality of care provision consistently high. Appropriate education, lifelong learning, continuing professional development are the key in this equation.

BeWell offers to design, develop and implement a digital and green strategy in partnership with a large number of stakeholders representing VET providers, research, professional organisation, social partners, policy-makers, industry and many others. Having mapped the current and future skill needs, emerging occupations, education and training programmes towards the green and digital transitions will be developed and piloted first of all to provide solutions to health professionals, and second of all to help patients to have access to better care. The strategy will ensure that sporadic training initiatives will be coordinated under a long-term common vision addressing not only current skill needs but will also prepare the workforce for the unknown. The strategy will be implemented at local, national and European level through a large-scale partnership under the Pact for Skills.

All in all, this oral poster session aims to illustrate how health professionals working in primary, secondary, tertiary or informal care settings could benefit from the outputs of the project. Skills matching labour market demands in the context of digital and green transitions will enable health professionals to provide better integrated care services in all settings.
"Does One Size Fit All? - People’s expectations of future health and welfare services "
Authors: Fineide Mona Jerndahl , Håvold Ole Kristian Sandnes , Wenstøb Bengt Morten Maximilian
Published: January 2024

Background: Recent schemes address the challenge that patients’ needs for quality and coordinated services are not sufficiently met in the welfare state. In recent years, a number of measures have been carried out to support integration among the organisations in the health and welfare service organisations and one of the main strategies developed is streamlining of health care through standardised tools and techniques. Neo-liberal ideology focusing on effectiveness and modernisation of the public sector seems to be adopted into the Nordic welfare model. At the same time as this streamlined approach, the need for “tailored” services is emphasised as important in addressing the issues of empowerment.

By analysing people’s expectation of future health and welfare services this paper discusses how the two contradictory core values unfolds within the framework of a Nordic welfare state.

Methods: This is a qualitative study.  We conducted individual interviews with one woman and one man in each 10-year, thus representing ages from 20 to 80. We also interviewed two senior experts at research centres and two politicians.   The participants were asked three questions:

If you could decide, how would the welfare services be organized 20 years from now? 2. How do you think it will actually be organized? 3. If I asked you the same questions 10 years ago, would you give me the same answers? If not, what has changed?

We used NVivo for thematic content analysis in coding categories and themes.

Results and Lessons learned: This is an ongoing study and the results will be presented and discussed at the conference. The preliminary analysis shows tailored welfare services as important in addressing issues of people’s individual needs, empowerment and daily well-being.  On the other side; cost effective streamlined “one size fit all” services are perceived as potential future model of the welfare state. Cooperative models including people’s perspective emerges as an important issue to reach ideals of integration from the people’s perspective.

Limitations and suggestions for future research: From people’s perspective, quality of integrated services relies on tailoring.  To a certain extent, the upcoming results will be of relevance for a better understanding of the complexity of organising welfare services. 

Keywords: Welfare state, expectations, scenarios, integration, empowerment
Profiles and pathways of care in situations of vulnerability: what we learn from the journey of refugees and asylum seekers within the refugee clinics (RC) in Quebec
Authors: Maillet Lara , Tchango Ngalé Georges Alain , Goudet Anna , Godbout Isabelle , Déry Johanne , Charest Stéphanie , Malham Sabina Abou
Published: January 2024

Although primary and secondary access to healthcare and services for migrants is considered an essential component of their integration into host societies, their pathways through the health system remain marked by obstacles. However, the migrant population is not a homogeneous group, and the barriers observed in access to care may be exacerbated within certain vulnerable subgroups. This is particularly the case for refugees and asylum seekers.

As part of this proposal, we benefit from the existence of valuable administrative data (iCLSC) that has informed the progress of refugees and asylum seekers within RC in Quebec since January 1, 2012, to describe and analyze their profiles and service pathways.

We mainly try to assess to what extent the trajectories observed in the consultations of refugees and asylum seekers (both in terms of healthcare professionals consulted and reasons for consultation) reflect or not the relevance, coherence and adaptation of services and pathways to meet their needs.

We mobilize a quantitative approach through three methods of analysis: (i) a descriptive analysis of the profiles of care making it possible to associate the socio-demographic characteristics of refugees and asylum seekers with two indicators of the course of care (healthcare professionals consulted and reasons for consultations); (ii) an analysis of the sequences making it possible to describe and identify the standard profiles of care pathways; (iii) a multinomial regression analysis to identify the factors associated with the different types of pathways.

Finally, our proposal wishes to answer the question structuring theme 5 of the Conference: How can we reach the most vulnerable groups to ensure an inclusive approach?
Governance in times of turbulence: how has management by pathway facilitated the adaptation of the health and social services system in the context of Covid-19?
Authors: Maillet Lara , Goudet Anna , Godbout Isabelle , Thiebaut Georges-Charles , Nassera Touati , Malham Sabina Abou , Duhoux Arnaud , Breton Mylaine
Published: January 2024

In Quebec, the notion of pathway integrates social and health dimensions, user-centered and is conceived as an intertwining of several episodes of care and services over long periods with an intersectoral perspective. A reform in Quebec's health system ‎‎2015‎‎ put the implementation of such pathways at the agenda.

We conducted a developmental evaluation to study the implementation of integrated care pathways in 3 healthcare organizations and their network in Quebec (2017-2019). And we currently conduct another one to follow up with these 3 organizations (+ 2) in the turbulent context of COVID-19. In parallel, we gathered observational notes during meetings of various crisis cells set up to address the COVID-19 pandemic in its very early days in one of the territories of the study (April-May 2020).

We seek to understand how change in governance occurred during the development of the integrated care pathways and its impact of leadership and decision taking inside and outside through healthcare organizations. Ultimately, we try to understand whether these governance practices have effectively facilitated the response to the pandemic crisis.

The analysis used a conceptual framework based on the Complex Adaptive Systems ‎‎(CAS)‎‎ approach of multi-level governance and the model for robust governance strategies in a turbulent context developed by Ansell, Sorensen and Torfing (2020). Qualitative empirical data were collected through documentation (N=12) and observation (N=80h).

Our results show that implementation of health and social pathways is based on a double innovation in terms of governance: based on a strategic community approach and introducing a matrix structure in the organization. Although pathway-based management has not been fully implemented in the healthcare organizations studied, our observations show that the change of vision has taken place and certain reflexes have been adopted. For example, the pandemic crisis cells were based on the perspectives put forward by the field (operational level), and the decision, action and feedback loops were very short. The COVID-19 pandemic showed that the health system is capable of great agility, particularly when it relies on a matrix dynamic for decision- making. Management by care and services pathways provides a systemic vision of the issues faced by the organization, in addition to being a cross-functional management tool between the various departments and between the operational, tactical and strategic levels of governance.
Digital assistance to support integrated healthcare.
Authors: Araja Diana , Berkis Uldis , Murovska Modra
Published: January 2024

This abstract is devoted to digital assistance as a supportive tool of integrated healthcare. According to the World Health Organization, developing more integrated people-centred care systems has the potential to generate significant benefits to health and healthcare of all people, including improved access to care, improved health and clinical outcomes, better health literacy and self-care, increased satisfaction with care, improved job satisfaction, improved efficiency of services, and reduced overall costs [1]. At the same time, the concept of Digital Health supports the implementation of a person-centred integrative approach in healthcare. The European Commission published a Communication on the digital transformation of health and care, which identified the priorities, including personalised medicine through shared European data infrastructure, allowing researchers and other professionals to pool resources, and citizen empowerment with digital tools for user feedback and person-centred care using digital tools to empower people to look after their health, stimulate prevention and enable feedback and interaction between users and healthcare providers [2].

A project to develop a digital assistance platform for long-COVID and associated myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) patient healthcare is planned in Latvia. The current main challenge is diagnosis, stratification and monitoring of long-COVID and associated ME/CFS at the point of care, as well as patients’ self-awareness and proper practical navigation within the health system. A technology-grounded solution for m-Health based screening and self-management of ME/CFS will be developed within the patient-centred App model. The objectives of this model are: 1) Patient-centred, societally-oriented, real-time decision-support using an innovative App; 2) Using artificial intelligence to support decision-making on patients and treatment options; 3) Learning opportunities for patients, caregivers and health professionals about the illness. Sustainability of project activities will be supported by integrating of the new databases with the national e-Health and Electronic Health Records (EHRs) systems and national research institutions’ IT systems with the future option to become a base for further developing a common long-COVID and ME/CFS Patients’ Registry.

The project intends to actively involve patients and clinicians in the development of a fully-fledged digital assistance platform that will support the development of digital health literacy and the implementation of integrated healthcare principles.

 

 

 

References:

1. World Health Organization. (‎2015)‎. WHO global strategy on people-centred and integrated health services: interim report. World Health Organization. https://apps.who.int/iris/handle/10665/155002

2. European Commission. Shaping Europe’s digital future – eHealth. https://digital-strategy.ec.europa.eu/en/policies/ehealth
The many roles of people with lived experience and how these can be better supported within integrated care policy and implementation: a world cafe discussion.
Authors: Miller Robin , Stein Viktoria , Wojtak Anne , Jackson Caroline , Van der Vlegel-Brouwer Wilma , Ehrenberg Nieves
Published: January 2024

Introduction: This workshop will explore the many roles that people with lived experience of health and social care can play in shaping the vision, planning and implementation of integrated care and consider what supports would enable them to fulfil these roles.

Why are you conducting a workshop? Whilst it is widely accepted that integrated care policy and programmes should be based on the needs and interests of people with lived experience of health and social care and their communities, this is rarely achieved in practice. The workshop team have led two international projects regarding co-production within integrated care ( ‘citizen leader research’ by the Universities of Birmingham, Leiden and Toronto and the Changemakers project within Transform). A common issue identified is that people involved in such activities are asked to take on different roles – for example as a champion, ambassador, advocate, partner, advisor, connector, or leader – with the nature of these roles affecting the expectations of them and the identities that they adopt. We would like to run a workshop to give participants an opportunity to explore what is meant by these roles, how people can be supported to do so effectively, and how organisations and professions can provide a receptive context.

Who is it for? The workshop is for people with lived experience of health and social care (including family carers) and professionals, policy makers, managers and academics who are committed to co-production as the basis of integrated care.

What are you going to do?

8 minutes introduction & overview of the roles that people with lived experience play (as identified in the projects)

5 minutes response from WHO based on their meaningful engagement framework

2 minutes explanation of the engagement exercise

40 minutes (or ideally longer if we are able to have a 90 minute session) world café discussion

5 minutes summary feedback from each table 

How are you going to engage with the audience? Participants will have opportunity to move around the world café table – each one will focus on a different role that people take on. A facilitator will remain at each table to encourage discussion on the nature, support, and context for such a role. The discussion will be visually recorded to enable participants to build on what has come before to enable a rich and diverse conversation.

How are you going to summarize the take home messages?There will be short feedback from each table on main points discussed – the facilitation team will then write up the discussions into a short and accessible summary which will be shared through social media, integrated care networks and relevant WHO routes.
RecoveryAcademies, we show how we do it in Fanlders and Brussels!
Authors: Derison Toon , Sitskroon Nina , Goethals Ilse
Published: January 2024

A Recovery Academy (RA) provides an open course offer on various themes related to recovery and resilience.

The offer is open to any citizen with a desire to learn around their mental recovery, their loved ones (neighbor, family, caregiver) are welcome as well.

The offer is unique, and stands for  co-creation at all its levels!

- People with lived experience and a caregiver, teach a course together.

- They run the academy in co-creation.

- Partners in a region do subscribe the key-principles of an Recovery Academy and work together based on the principle of susidiarity.

Based on our course "yourself and recovery," we show in

the workshop, how we work in a course around the themes of: Connectedness, Hope, Identity, Meaning, Making choices and dealing with life's difficulties.

The workshop will be given by a professional and a PEER worker, it will be a moment of learning together and sharing experiences.

We will briefly discuss the critical success factors of an RA and address the questions of the participants.
"Palliare" surrounded with care.
Authors: Wauters Martine , Kohl S , De Laet F , Gios J , Janssens A , Vandamme Timon
Published: January 2024

Introduction: Despite scientific evidence about the benefits of Advance Care Planning (ACP) for patients with non-curative treatment, ACP is rarely discussed in practice. Why is it difficult for health professionals to mention ACP? How can patients and their family caregivers take control of their own care process and be actively engaged?

The aim of this project is to empower patients and their family caregivers to discuss their wishes and care goals in a palliative phase, and to provide health professionals with communication techniques and skills to use in a palliative conversation. A common language is introduced so that all parties can communicate more comfortably with each other.

Target groups: We focus on oncology patients with non-curative therapy, their relatives and their professional care providers.

To identify these palliative patients, physicians will have to indicate via MOC (multidisciplinary oncologic consultation) registration if the therapy of an oncology patient is curative or non-curative. If the patient can’t be cured, early palliative care needs to be integrated into daily oncology practice by offering an interactive meeting in group. The group of care providers is a multidisciplinary team with oncologists, oncology nurses, palliative care specialists, bedside nurses, social workers, psychologists, etc.

Methodology: We started with a kick-off session in which the members of the project (oncologists, oncology nurse, palliative care specialist and palliative care nurse) explained the purpose of the project to healthcare professionals. We explained a number of concepts and suggested the specific language we want to maintain.

After this first session, we organized interactive workshops for patients and their relatives to provide them with tools to establish and communicate about their end of life wishes and care goals. In this workshop, we explained the concept of ‘palliative care’ and the importance of an active involvement of the patient and his/ her relatives during this palliative phase. By performing a role play, we elaborated on the questions that are important to ask the physician, and how patients and relatives can ask these questions.

In parallel we organized workshops for different teams of health professionals to provide them with more advanced communication skills and to learn them how to sense when patients are ready for a palliative care conversation. In these interactive workshops we also interspersed communication theory with role plays.

Results: Surveys based on the validated PAM-13 questionnaire will be provided to all participants (patients and healthcare professionals). Because the project is still in full development at the moment, we don’t have results yet. We hope to present our results during the ICIC23 in May 2023 and to enthuse and inspire other healthcare professionals about the importance of patient empowerment during a palliative phase.
The lived experiences of complex care of families with complex problems: A realist evaluation of Integrated Social Care
Authors: Van Eck Marcel , De Jong Anneke , Cloin Mariëlle , Ettema Roelof , Van Regenmortel Tine
Published: January 2024

Introduction/Background: An ongoing realist evaluation of the implementation of the program [Amsterdam Customization method] in social welfare in Amsterdam (NL), focussing on multi-problem families, revealed among others, that participating organisations within the program tend to focus on their own tasks, without shared decision making. This becomes extremely clear in the context of safety for the children: parents are not seen as partners to guarantee this safety but as causer of the problem. And this view from the perspective of one organisation seems to diminish all efforts to offer the parents help in finding ways to create a safe environment for their children. Instead parents are more or less threatened by the risk that the children will be taken away from them. The mechanism is a lack of interdisciplinary adjustment of observations and a lack of shared decision making, the outcome for the parents is fear and withdrawal from involved professionals. This is in contrast with the principles of the implemented program.

Why a workshop? A 90 minutes workshop is a good way to share experiences with the delegates and find ways to handle a well-known problem within the implementation of integrated care programs.

Who is it for? Participants from the area of social work as well as participants in implemented integrated care programs as such are a welcome audience to share ideas and experiences.

What we are going to do?

•A 15 minute

ointroduction on the context of the implemented program and the findings of one part of the research: client interviews [first researcher]

oFocus on one finding: the missing collaboration between all stakeholders in the context of safety for the children in multi-problem families [first researcher]

•Depending on the number of participants: 60 minutes discussion in one or more groups around two questions (1. do you recognise the situation [examples]; 2. What did you do / are you planning to do/ could be done to stimulate shared decision making that involves all stakeholders)

•15 minutes report and (an attempt to) conclusions

•10 minutes wrap up and eventually exchange of contact addresses

 

How are you going to engage with the audience? Fitting to the concept of a workshop the meeting will be interactive, participants in the subgroups are asked to appoint a speaker to present the core of the group discussion, results of the plenary will be written down and per email shared with interested participants.

How are you going to summarize the take home messages? We end up with lessons learned and sum these up in take home messages. Attendees are invited to write these down and take these with them.
We’re All the Same: Collective Narcissists’ Cross-National Support for Putin and Russian Military Attacks
Authors: Brown Genavee , Marinthe Gaëlle
Published: January 2024

National narcissism is associated with support for nationalist and anti-democratic leaders and decisions in one’s own country. We hypothesize that it might also relate to more favorable judgments of outgroup nationalist leaders and actions, even if the latter may pose a threat to the ingroup. Using the context of the Russian attack on Ukraine, we hypothesize that people with a higher level of national narcissism would be more supportive of Russian attacks, Russian President Vladimir Putin, and the Russian people. This may be due to a higher perception of belief similarity to Putin and Russians. We also considered the moderating role of the explicit target of the attack (Ukraine vs. ingroup). We tested our hypotheses in two studies (Study 1: N = 339 French; Study 2: N = 400 Americans). In both studies, national narcissism was related to a judgment of the attack (on Ukraine or the ingroup) as less immoral and to a better opinion of Putin. These effects were mediated by perceived belief similarity. In both studies however, these less negative judgments of the attack and of Putin did not extend to Russian people. Our results highlight that national narcissists are inclined to support a nationalist outgroup leader and their violent actions, although these may ultimately harm the ingroup.
Utilizing Dipsticks to Measure Leukocyte Esterase in Urine to Detect UTIS
Authors: Memon Kiran , Jatoi Shazia Ahmed , Bhutto Yasmeen Rasheed , Soomro Abdul Saboor , Saboor Rukhsana , Devi Durgha , Ramzan Aamir , Aamir Kiran
Published: January 2024

Objective: The more expedient, less labor-intensive dipstick has come to be the tool of choice for diagnosing UTIs in the majority of primary care settings. The purpose of this study was to assess the usefulness of dipsticks in UTI diagnosis. Study Design: Descriptive study Place and Duration: Pathology Department Civil Hospital LUMHS. January 2021 to December 2021 Methods: Total 230 patients of both gender were presented in this study. The study included every urine sample that was received for urine culture by the Microbiology Department. The leukocyte esterase content of each specimen was measured using a urine dipstick. On Cysteine Lactose Electrolyte Deficient (CLED) agar, all of the urine samples were also used for culture. Every data was analysed using SPSS 24.0. Results: There were majority 125 (54.3%) females and 105 (45.7%) females among all cases. There were 75 (32.6%) LE positive and 120 (52.2%) were LE negative. Culture positive cases was 87 (37.8%) and 143 (62.2%) were culture negative. We found sensitivity (78.2%), specificity (86%), PPV (55.7%) and NPV (90.4%). The overall effectiveness of the LE Test with dipsticks was observed (84.3%). Conclusion: Under resource-constrained environments, the leukocyte esterase dipstick test is a quick and affordable screening method. Determining whether a urinary tract infection is present is very helpful. A negative test, however, gives a more accurate indication that a UTI is absent. Keywords: Urine culture, Urinary Tract Infection, Leukocyte esterase dipsticks
Significance of Reticulocyte Count in Assessment of Pancytopenia at Tertiary Care Hospital
Authors: Shaikh Maria , Shaikh Humera , Javed Safiya , Kalhoro Raima , George Anita , Memon Kiran , Ramzan Aamir , Aamir Kiran
Published: January 2024

Aim: To determine the significance of reticulocyte count in assessment of pancytopenia. Study Design: Retrospective study Place and Duration: Department of Pathology, Diagnostic and research Laboratory LUMHS, Hyderabad. Jan 2017-Oct 2018. Methods: The study comprised a total of one hundred pancytopneia patients. The comprehensive demographics of the enrolled cases were collected upon obtaining informed written consent. The diagnostic utility of absolute reticulocyte count was determined by correlating it with bone marrow biopsy. SPSS 22.0 was used to analyze the data. Results: Among all, 43% were males and 57% were females. Age of the presented cases was 35.3±2.54 years. 62% patients were married and 37% cases were literate. Majority 59% patients were from rural areas. Megaloblastic anemia was the most common etiology found in 52% cases with reticulocyte count 0.2%, aplastic anemia in 22% cases with reticulocyte count 0.1%, mixed deficiency anemia in 17% reticulocyte count 0.4%, acute leukemia in 6% with reticulocyte count 0.7% and 3% cases had myelodysplastic syndrome with reticulocyte count 0.2%. The most frequent clinical features that were present were pallor (88%), generalized weakness (81%), dyspnea (62%), and fever (60%). Conclusion: Reticulocyte count plays an important role in differentiating various causes of pancytopenia and hence should be routinely included in pancytopenia work up in order to avoid unnecessary bone marrow aspirations. Keywords: Pancytopneia, Reticulocyte count, Fever, Pallor, Biopsy
Defining the Planning Tumor Volume by analyzing Setup of Head & Neck (H&N) Carcinoma in Radiotherapy
Authors: Shafiq Sunnia , Manzoor Hina , Ahmad Hafiz Khush Naseeb , Rehman Awais ur , . Sadiqullah , Arif Imran , Saeed Hashir , Naheed Hamida , Basit Abdul , Shuja Jamila , Ahmad Qadeer , Iftikhar Shehla
Published: January 2024

Aim: To find out the setup error of Head and Neck patients treated with Intensity modulated radiation therapy (IMRT) on CLINAC-IX at Center for Nuclear medicine and Radiotherapy (CENAR) Quetta by using inbuilt electronic portal imaging device (EPID) to obtain the setup margin for clinical investigation. Methods: A total of 35 patients of head & neck carcinoma were treated with Intensity modulated radiation therapy (IMRT) total dose of 69.96Gy in 33 fractions at CENAR from 1st January 2021 to 31st December 2022 were consider this retrospective study. PTV margin for different directions (Vertical, lateral &Longitudinal) were analyzed by Van Herk’s formula Results: Data analyzed for calculating the mean displacement in X (Lateral), Y (Longitudinal) and Z (Vertical) directions, from where the mean systematic and random errors derived. These shifts (displacements) used for calculation of the final PTV margins by using Van Herk’s formula. The calculated mean (±SD) systematic errors in the Z (Vertical), X (Lateral) and Y (Longitudinal) and directions were 0.10cm, 0.06cm, and 0.07cm and the mean(±SD) random errors were 0.01cm, 0.004cm and 0.01cm respectively. Conclusion: In our study, less than3 mm is an optimal margin for GTV- PTV for head and neck cancer patients. The reduction in setup margin helps in prognosis of treatment results, reduce radiation related complication in normal tissue and reduce the local recurrence. Imaging guidance techniques is effective tool for setup margin. Keywords: Electronic Portal Imaging Device, Van Herk Equation, Systematic Error, Random Error, Head & Neck Carcinoma,
Pneumonia in Children under five years old in KPK: Symptoms and presentation
Authors: Gul Mujtaba , Shehzad Muhammad , Khan Kashif Ali , Abbas Muhammad , Fawad Muhammad
Published: January 2024

Background: The lung parenchyma is affected by pneumonia, an acute infectious disease that can be brought on by fungus, bacteria, or viruses. By vaccination, a healthy diet, and the abolition of environmental variables, pneumonia can be avoided. All worldwide deaths of children under the age of five are due to it. Aim: To prevent pneumonia with easy steps, and can be treated with easy, affordable medications with adequate care, early detection, and prompt admission of sick children to hospitals. Methods: This case series study was carried at pediatric department of district kohat hospital from august 2022 to Feb 2023. Ethical acceptance certificate was obtained from the hospital. Informed written consent was taken from those parents who were willing to answer and were fully qualified the inclusive criteria. Total 139 patients were enrolled in the study. The results were analyzed through spss-ver 24 Results: In clinical sign and symptoms highest ratio was seen in lethargy 33(23.74%) and lowest ratio seen in cyanosis 4 (2.87%), in gender wise the male 82(59%) presentation was more than females 57(41%). Lowest ratio of vaccination was seen in 2(28%) dose 6 and highest in non-vaccination was 21(44%) in dose 1. Conclusion: The health planners should concentrate on the missed epi schedule. Efficacy, we must employ media like radio, television, and newspapers Keywords: Pneumonia, education, health, presentation, Kohat
Prevalence of stress and anxiety among university students during COVID-19 pandemic
Authors: Arshad Hafsah , Anwar Kinza , Khattak Hafsah Gul , Batool Namra , Farhat Bibi , Sana Ayesha , Ali Syed Shumaim , Ejaz Asad
Published: January 2024

Aim: To determine the level of stress and anxiety in university students during COVID-19 pandemic Methodology: A web based cross sectional survey was conducted from November 2020 to January 2021. Undergraduate students of either gender, aged 18-25 years, were included in the study. Sample size was calculated by using open Epitools online calculator and raised through non-probability snowball sampling technique. E-questionnaire was designed by using Google Form. Informed written consent was attached to e-survey. Semi structured questionnaire was used to take demographic data, for stress and anxiety; PSS-10 and GAD-7 were used. Data was analyzed by SPSS 26. Results: Out of 656 responses, 97(14.8%) were males and 559 (85.2%) were females. Most students reported moderate to high level of stress 603(91.92%) and anxiety 571(87.04%) .Higher prevalence of perceived stress and anxiety was found in age group of 20-23 years and associated with various factors including living with family, daily internet use of >8hrs, and not involved in any physical activity. Regarding Coorelation of anxiety with with GPA was (r=0.105, p=0.007) and physical exercise was (r=0.107, p=0.005). However coorelation of stress with GPA was (r=0.115, p=0.003) and physical exercise was (r=0.085, p=0.030). Conclusion: Majority participants showed moderate to severe level of stress and anxiety, which was more in females. Various factors including age group of 21-23 years, living with family, screen time> 8 hours and lack of physical activity were more prevalent among university students during the Covid-19 pandemic. Keywords: Anxiety, Covid-19, Stress, Physical Inactivity