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Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study.

BACKGROUND: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members)

Provider perceptions and experiences integrating depression treatment into chronic healthcare services in Neno District, Malawi: a qualitative study.

BACKGROUND: In low-resource settings, integrating mental health services into existing care platforms is critical to expanding access and improving quality of care. In Neno District, Malawi, the Integrated Chronic Care Clinic–Depression module (IC3D) clinical trial introduced depression screening and treatment, including antidepressant therapy (ADT) and group Problem Management Plus (PM+), within chronic care services. This study explored healthcare and lay providers’ experiences and perceptions of integrating depression care for patients with chronic conditions at these clinics. METHODS: We c

Assessing the Quality of the Systems of Care for Children with Congenital Zika Virus Infection and Other Neurodevelopmental Disabilities in the United States Pacific Island Territories.

Congenital Zika virus (ZIKV) infection can cause lifelong medical and developmental conditions and management needs. There is limited inform … eted an adapted version of the Assessment of Chronic Illness Care 3.5 (ACIC), which is based on the Chronic Care Model. The median Total Program Score was calculated, which ranged from limited support (0-2), basic support (3-5), reasonably good support (6-8), to fully developed support for care (9-11). Among the 17 health professionals who completed the survey, 47% …

Effect of a community-based nursing intervention on mortality in chronically ill older adults: a randomized controlled trial.

BackgroundImproving the health of chronically ill older adults is a major challenge facing modern health care systems. A community-based nursing intervention developed by Health Quality Partners (HQP) was one of 15 different models of care coordination tested in randomized controlled trials within the Medicare Coordinated Care Demonstration (MCCD), a national US study. Evaluation of the HQP program began in 2002. The study reported here was designed to evaluate the survival impact of the HQP program versus usual care up to five years post-enrollment.Methods and findingsHQP enrolled 1,736 adult

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… JAMA 298 2623 2633 18073358 10.1001/jama.298.22.2623 44 Stock R Mahoney ER Reece D Cesario L 2008 Developing a senior healthcare practice using the chronic care model: effect on physical function and health-related quality of Life. … J Am Geriatr Soc 56 1342 1348 18503521 10.1111/j.1532-5415.2008.01763.x 45 Coleman K Austin BT Brach C Wagner EH 2009 Evidence on the chronic care model in the new millennium. …

Management pathway for infants requiring chronic care in neonatal units-a scoping review of practices.

Improvements in diagnostic and therapeutic modalities of antenatal care has meant that the neonatal intensive care units (NICU) need to care for infants with complex congenital conditions who need ongoing care post discharge. This, along with improved survival of the extreme preterm infants, provides the neonatal team with a cohort of infants who require long-standing multi-disciplinary input. However, provision of dedicated teams looking after infants with complex medical needs is not commonly reported in NICU workforce structure. The objective of this study is to perform a scoping review of

A palliative care approach in treating patients with sickle cell disease using exchange transfusion.

The authors present a case report of an adult patient with sickle cell disease (SCD), who required frequent hospitalizations for sickle cell vaso-occlusive painful crisis as well as management of complications that resulted from treatment. The patient demonstrated clinical improvement after initiating palliative exchange transfusions of packed red blood cells (PRBCs) once every 4 weeks. They also promptly addressed their physical and psychosocial issues of care. The author described that because the patient was started on chronic exchange transfusions, there was a significant decrease in hospi

The Transitional Liver Clinic: Study protocol for a stepped-wedge cluster randomized trial.

BACKGROUND: Patients with complications of advanced liver disease experience high rates of hospital readmission after discharge. Transitional care models have improved outcomes in other chronic conditions, but their efficacy in liver disease care remains uncertain. This randomized trial evaluates the effectiveness of a tailored transitional care model-the Transitional Liver Clinic (TLC)-in reducing readmissions, improving quality of life, and enhancing patient satisfaction for patients with advanced liver disease. METHODS: This is a 45-month, stepped-wedge cluster randomized trial enrolling u

Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial.

BACKGROUND: Patients admitted to intensive care units (ICU) with acute respiratory failure (ARF) face chronic complications that can impede return to normal daily function. A mobile, collaborative critical care model may enhance the recovery of ARF survivors. METHODS: The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. We will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation in a 1:1 ratio to one of two arms (310 patients per arm) - m-CCRP intervention versus attention control. Those in the

A novel mouse model of chronic suppurative otitis media and its use in preclinical antibiotic evaluation.

Chronic suppurative otitis media (CSOM) is a neglected pediatric disease affecting 330 million worldwide for which no new drugs have been introduced for over a decade. We developed a mouse model with utility in preclinical drug evaluation and antimicrobial discovery. Our model used immune-competent mice, tympanic membrane perforation and inoculation with luminescent Pseudomonas aeruginosa that enabled bacterial abundance tracking in real-time for 100 days. The resulting chronic infection exhibited hallmark features of clinical CSOM, including inhibition of tympanic membrane healing and purulen

Contactless: a new personalised telehealth model in chronic pediatric diseases and disability during the COVID-19 era.

BACKGROUND: Suspending ordinary care activities during the COVID-19 pandemic made it necessary to find alternative routes to comply with care recommendations not only for acute health needs but also for patients requiring follow-up and multidisciplinary visits. We present the 'Contactless' model, a comprehensive operational tool including a plurality of services delivered remotely, structured according to a complexity gradient, aimed to cover diagnostic procedures and monitor disease progression in chronic pediatric patients. METHODS: A multidisciplinary and multiprofessional project team was

Veteran Response to Dosage in Chiropractic Therapy (VERDICT): Study Protocol of a Pragmatic Randomized Trial for Chronic Low Back Pain.

BACKGROUND: Low back pain is a leading cause of disability in veterans. Chiropractic care is a well-integrated, nonpharmacological therapy in Veterans Affairs health care facilities, where doctors of chiropractic provide therapeutic interventions focused on the management of low back pain and other musculoskeletal conditions. However, important knowledge gaps remain regarding the effectiveness of chiropractic care in terms of the number and frequency of treatment visits needed for optimal outcomes in veterans with low back pain. DESIGN: This pragmatic, parallel-group randomized trial at four

Community-Based Health Care Systems: Who are the Actors and What is the Play?

Community-based health systems integrate care within local social and geographic contexts, leveraging trust and proximity. Within local communities, pharmacists and primary care clinicians collaboratively deliver accessible, patient-centered services. Evidence from the COVID-19 pandemic and pharmacist chronic disease management programs demonstrates the effectiveness of localized, relationship-based care models in improving health outcomes.

A collaborative "THRIVE Fetus to Five" neonatal brain program review.

After Neonatal Intensive Care Unit (NICU) discharge, vulnerable babies at risk of neurodevelopmental impairment and other chronic problems often require specialized follow-up care to monitor their development and address any potential issues. Typically, this involves multiple follow-up visits usually focused on neurodevelopment and growth. With advances in obstetric care, high-risk fetuses are being identified earlier, marking another timepoint in which personalized medicine can be delivered from before birth to after discharge including neuronicu care. Our program embeds this focus into a com

Effectiveness of a stepped care intervention for anxiety and depression in people with diabetes, asthma or COPD in primary care: A randomized controlled trial.

BACKGROUND: Depression and anxiety are common in people with a chronic somatic disease. Although guidelines recommend stepped care, the effectiveness of this approach has not been evaluated in people with diabetes, asthma, or COPD in primary care. METHODS: 3559 People were sent screening questionnaires (41% response). Of 286 persons with anxiety and/or depression (Generalized Anxiety Disorder questionnaire, GAD-7, cut-off ≥ 8 and/or Patient Health Questionnaire, PHQ-9, cut-off ≥ 7), 46 were randomized into the intervention (stepped care and monitoring of symptoms; n = 23) or control (usual ca

Integrated Hemophilia Patient Care via a National Network of Care Centers in the United States: A Model for Rare Coagulation Disorders.

Rare, chronic diseases such as hemophilia and other congenital coagulation disorders require coordinated delivery of services for optimal outcomes. Hemophilia Treatment Centers (HTCs) are specialized, multidisciplinary health-care centers providing team-based care to meet the physical, psychosocial, and emotional needs of people with hemophilia (PWH) and may serve as a model for other rare coagulation disorders. Health-care purchasers, as well as the general medical community, may not appreciate the breadth and quality of services provided by HTCs. They exemplify the acculturalization and actu

A Six Year Longitudinal Study of Older Korean Women with Functional Limitations, Chronic Pain, and Depressive Symptoms Who are Living Alone or in Multi-Person Households.

OBJECTIVES: This study examines not only the effects of functional limitations and chronic pain on depressive symptoms in older South Korean women, but also the moderating effect of living arrangements on these relationships. METHODS: This study employed a Correlated Random Effects model using panel data from Wave 5 to Wave 8 of the Korean Longitudinal Study of Ageing. The final sample included 2,443 individuals and 8,360 observations. RESULTS: The more severe the degree of functional limitations and chronic pain, the higher the level of depressive symptoms in older Korean women. Furthermore

Reducing the Emergency Department Revolving Door Syndrome for the Poor, Uninsured, and Chronically Ill Patient in Los Angeles: Process Improvement Recommendations from a County Health Program Evaluation.

My Health LA (MHLA), a Los Angeles countywide health program, connects eligible uninsured poor residents with partner primary care clinics and a range of free health care services. Nevertheless, primary care nonengagement and inadequate emergency department (ED) visits remained significant in this population in fiscal year 2015-2016. This evaluation examined the structure, process and outcomes of MHLA at select participating agencies to delineate pilot improvement models. Five sites were selected for the program evaluation, including a large urban ED, its affiliated urgent care clinic, and 3 p

ANMCO position paper: ANMCO general assembly 2024-the role of the cardiologist in the management of cardiovascular chronicity.

Cardiovascular diseases remain the leading cause of mortality globally and in Italy, with a growing burden exacerbated by ageing populations and underdeveloped strategies for managing chronic cardiovascular conditions. This position paper, resulting from the 2024 ANMCO General Assembly, addresses the current state of cardiovascular chronicity management in Italy, highlighting critical gaps and proposing sustainable, integrative solutions. Despite improvements in acute cardiovascular care, the lack of structured post-acute management, insufficient adoption of secondary prevention protocols, lim

Comorbid chronic pain and opioid use disorder: literature review and potential treatment innovations.

Chronic pain (CP) and opioid use disorder (OUD) remain challenging complex public health concerns. This is an updated review on the relationship between CP and OUD and the use of stepped care models for assessment and management of this vulnerable population. A literature search was conducted from 2008 to the present in PubMed, Embase, and PsycInfo using the terms pain or chronic pain and opioid-related disorders, opiate, methadone, buprenorphine, naltrexone, opioid abuse, opioid misuse, opioid dependen*, heroin addict, heroin abuse, heroin misuse, heroin dependen*, or analgesic opioids, and s

Boosting access to evidence-based insomnia care: our experience with a stepped care approach in Canada.

Insomnia is a major issue due to its prevalence, health effects, and economic burden. In Canada, 45% of the population report trouble initiating or maintaining sleep and 16% meet criteria for insomnia disorder. Despite evidence that sedative-hypnotic medications have limited long-term effectiveness and pose risks to patient and public health, pharmacotherapy remains commonplace. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line intervention for insomnia; however, access to CBT-I is uneven and inequitable. We developed a stepped care model aimed at boosting Canadia