The Power of Thought: The Role of Psychological Attentiveness and Emotional Support in Patient Trajectories.

In modern healthcare, the influence of a patient's mindset on health outcomes is an often neglected yet vital component of holistic care. This review explores the significant impact of positive and negative mindsets on disease progression and recovery, emphasizing the need to integrate mental wellness practices into conventional medical care. Drawing from a wide array of studies, it demonstrates how fostering a positive mindset can enhance patient trajectories across various medical specialties. The article advocates for training healthcare providers to adopt a more empathetic and patient-centered approach, bridging the gap between mind and body. By presenting compelling evidence on the correlation between patient mindset and health outcomes, this review highlights the potential benefits of incorporating psychological support and holistic strategies into standard care protocols. Practical strategies for implementing mindset-focused interventions are also proposed, including training programs for healthcare professionals and the development of interdisciplinary treatment plans. Ultimately, this article underscores the need for a paradigm shift in medical practice, advocating for a comprehensive approach that recognizes the power of thought in promoting patient wellness.

Primary Care Informatics: Vitalizing the Bedrock of Health Care.

Primary care informatics (PCI) professionals address workflow and technology solutions in a wide spectrum of health, ranging from optimizing the experience of the individual patient in the clinic room to supporting the health of populations and augmenting the work of frontline primary care clinical teams. PCI overlaps uniquely with 2 disciplines with an impact on societal health-primary care and health informatics. Primary care is a gateway to health care access and aims to synthesize and coordinate numerous, complex elements of patients' health and medical care in a holistic manner. However, over the past 25 years, primary care has become a specialty in crisis: in a post-COVID-19 world, workforce shortages, clinician burnout, and continuing challenges in health care access all contribute to difficulties in sustaining primary care. Informatics professionals are poised to change this trajectory. In this viewpoint, we aim to inform readers of the discipline of PCI and its importance in the design, support, and maintenance of essential primary care services. Although this work focuses on primary care in the United States, which includes general internal medicine, family medicine, and pediatrics (and depending on definition, includes specialties such as obstetrics and gynecology), many of the principles outlined can also be applied to comparable health care services and settings in other countries. We highlight (1) common global challenges in primary care, (2) recent trends in the evolution of PCI (personalized medicine, population health, social drivers of health, and team-based care), and (3) opportunities to move forward PCI with current and emerging technologies using the 4Cs of primary care framework. In summary, PCI offers important contributions to health care and the informatics field, and there are many opportunities for informatics professionals to enhance the primary care experience for patients, families, and their care teams.

Bolstering Access to HIV-Related Health care in Zimbabwe Among Young Mothers Living With HIV: Lessons Learned on HIV Health Promotion From Zvandiri's Young Mentor Mother Program.

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal HIV transmission are high in this population, emphasizing the need for targeted health promotion and public health programming to improve the health of young mothers living with HIV. Zvandiri, a non-profit organization in Zimbabwe, created the Young Mentor Mother (YMM) program in response to this issue. This health promotion program uses peer-led service delivery conducted by trained young mothers living with HIV, called YMMs. We conducted semi-structured virtual interviews (N = 29) among Zvandiri staff and YMMs to identify benefits and challenges, and to inform future program scaling. We applied thematic analyses to the transcriptions. Participant narratives revealed several themes, including three key benefits from the YMM program: (1) peer support, (2) holistic care, and (3) women's empowerment. Participants also shared barriers to the success of the program, reflecting two overarching dimensions: (1) barriers related to scaling up the YMM program and (2) challenges related to addressing socio-structural factors. Barriers to scale-up included limited funds and resources, and food insecurity. Socio-structural challenges included HIV-related stigma, cultural and geographic differences, and intimate partner violence (IPV). These challenges align with the social-ecological model, whereby structural factors (lack of funding, food insecurity), community factors (HIV-related stigma, socio-cultural differences in accepting HIV care), and interpersonal factors (IPV) affect the implementation and scale-up of the program. We recommend future adopters of the YMM program to tailor the model for their community, prioritize peer supporter's well-being, foster women's empowerment, and adopt a holistic care approach.

Clinical and socio-demographic profile of children receiving pediatric palliative care in a tertiary hospital of a metropolitan city in India.

Pediatric palliative care is a holistic care of children suffering from life-threatening or life-limiting illnesses and encompasses care of a child's body, mind, and spirit and involves giving support to the family. According to the Global Atlas of Palliative Care, 6% of the global need for palliative care is in children. In order to provide palliative care, one needs to identify and diagnose the conditions requiring palliative care. There has always been a confusion in identifying pediatric conditions requiring palliative care. There is a lot of inconsistency in the diagnosis of such conditions particularly in pre-verbal patients. This study attempts to generate more data about the common palliative care conditions and complaints with which the children present to tertiary care hospitals. To study the socio-demographic details, clinical profile, CCC (complex chronic conditions) designation, and the ACT/ RCPCH (Association for Children with Life-threatening or Terminal Conditions and the Royal College of Pediatrics and Child Health) classification of children suffering from chronic conditions requiring palliative care. The study was conducted as a single-center retrospective observational study of pediatric patients enrolled for palliative care at a tertiary care hospital in a metropolitan city in India from 01.06.2021 to 31.06.2022. The total sample size was 400. The socio-demographic data and the clinical profile were recorded from the case records of all the 400 patients. Classification of the conditions was done as per the CCC as well as the ACT/ RCPCH classification system. The mean age in our study was 5.15 years and there was a slighter male (59.5%) preponderance. They presented in OPDs with acute symptoms such as fatigue and fever, and they had other symptoms like tightness of the body, constipation, seizures, and difficulty in swallowing. Majority of the children (55%) were suffering from neurologic and neuromuscular conditions as per CCC followed by hematologic and immunologic conditions (10%). Category 4 (irreversible but non-progressive conditions causing severe disability, leading to susceptibility to health) was reported as the most common category according to the ACT/RCPCH.    Conclusion: Children suffering from chronic disease conditions requiring palliative care usually suffer from multiple symptoms which affect their daily life. As most of the patients belong to category 4 according to ACT/RCPCH which is an irreversible but non-progressive life-limiting condition, the course of the disease is prolonged, therefore requiring comprehensive care and services for a long time. It is necessary to establish more pediatric palliative care units to address the needs of such children. What is known: • Pediatric palliative care is a specialized area within palliative care, which focusses on the needs of children with life-limiting illnesses. • Data on pediatric palliative care has largely been limited to oncological conditions. There is a paucity of literature documenting the needs among children suffering from non-cancerous chronic conditions. What is new: • This study provides vital information with respect to palliative care burden among children mainly suffering from non-oncological conditions. • It also provides clinical and socio-demographic profile of the children suffering from chronic life-limiting conditions requiring palliative care in a tertiary hospital setting in a LMIC (low- or middle-income country).

Components of safe nursing care in the intensive care units: a qualitative study.

BACKGROUND: Patient safety is a global health issue that affects patients worldwide. Providing safe care in the intensive care units (ICUs) is one of the most crucial tasks for nurses. Numerous factors can impact the capacity of nurses to deliver safe care within ICUs. Consequently, this study was undertaken with the aim of identifying the components of safe nursing care in ICUs. METHODS: The current research constitutes a qualitative conventional content analysis study conducted from January 2022 to June 2022. The study participants comprised nurses, intensivists, nurse responsible for patient safety, paramedic, patients, and patients' family member, totaling 21 individuals selected through purposive sampling. Data collection involved individual, in-depth, and semi-structured interviews. Subsequently, data analysis was performed utilizing the approach outlined by Graneheim and Lundman (Nurse Educ Today 24(2):105-12, 2004), leading to the identification of participants' perspectives. RESULTS: Three themes were identified as components of safe nursing care in ICUs. These themes include professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). CONCLUSIONS: The findings of this study underscore the significance of advocating for safe nursing practices in ICUs by emphasizing professional conduct, holistic care, and safety-focused organizational structures. These results align with existing research, suggesting that by introducing tailored interventions and tactics informed by these elements, a safer environment for nursing care can be established for ICUs patients.

Lifestyle nursing: a leadership opportunity for UK nurses.

This article aims to consider the 'lifestyle medicine' approach to nursing, which focuses on patients with conditions that would benefit from a lifestyle nursing approach, supporting and empowering people to make lifestyle changes that would benefit their health. Lifestyle medicine in nursing is gaining momentum in the USA and could be a nursing leadership opportunity in the UK. This article explores the importance of lifestyle approaches to health care and why nurses have a pivotal role in the movement.

Unveiling the dynamics of older person care: a qualitative exploration of the intersection between formal and Informal Caregiving from the perspectives of registered nurses in Greece.

In the evolving landscape of older person care, the imperative to explore holistic approaches persists, especially in regions with distinct societal norms around informal caregiving. The deeply ingrained tradition of familial caregiving, often led by female family members, has historically compensated for healthcare system gaps in less integrated systems. Hence, societal expectations may affect registered nurses' experiences and impact the quality of care for older persons. This study aims to describe the meaning of caring for older persons in care settings in Greece. Ten in-depth interviews with registered nurses in older person care settings underwent qualitative thematic analysis. Four themes emerged from the analysis: (i) Living and bonding with older people as a basis for caring, (ii) Caring as a double-faced fulfillment, (iii) A sense of insufficiency in the caring relationship, and (iv) The encounter of existential issues creating loneliness. This research provides insights into the meaning of caring for older persons, highlighting the experiences of the closest professional caregivers of older individuals. A specific capture of the entanglement of cultural norms, societal expectations, and their impact on professional caregivers' experiences may contribute to quality care provision in systems rooted in familial caregiving traditions.

A Systematic Review of Breathing Exercise Interventions: An Integrative Complementary Approach for Anxiety and Stress in Adult Populations.

Aim: Nurses are well-qualified to deliver integrative complementary therapy interventions, a holistic approach to assist individuals experiencing anxiety and stress. Self-regulated, controlled breathing exercises (a clinical approach) are reported to decrease anxiety and increase stress tolerance. The aim of this systematic review was to evaluate the effectiveness of breathing exercise interventions on the psychological and physiologic outcomes of anxiety and stress among adults and assess the state of the science in the post-COVID-19 population. Methods: A systematic review was conducted, and four scientific databases were searched: PubMed, CINAHL, EMBASE, and Web of Science. Inclusion criteria included: (1) peer-reviewed studies, (2) adults over 18, (3) breathing exercise interventions, and (4) anxiety or stress as outcomes. Results: Out of 309 studies identified, 19 were included. Twelve reported significant improvements in anxiety and nine reported significant improvements in stress following varying breathing exercise interventions (p < .05). No adverse events were reported. Conclusions: Breathing exercises were found to be effective in reducing anxiety and stress in adults, however, there continues to be limited evidence that includes large randomized controlled trials. Breathing exercises are a holistic care approach that can be safely implemented by nurses to decrease symptomatology among adults, including the post-COVID population.

How to undertake a holistic nutritional assessment with older people.

RATIONALE AND KEY POINTS: Nutrition is a fundamental aspect of nursing care, however older people cared for in hospital, in a care home or in their own home do not always receive adequate support with their nutritional needs, which can leave them at risk of malnutrition. Using a holistic, biopsychosocial framework to support a comprehensive nutritional assessment that includes malnutrition screening can support the nurse to identify the older person's nutritional status and nutrition needs. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. • Malnutrition in older people can lead to a decline in functional ability, reduced muscle strength, fatigue, impaired immunity, suboptimal wound healing, increased risk of infection and increased risk of falls. • Screening for, and assessing the risk of, malnutrition is an important part of nursing assessments in any healthcare setting. • A holistic nutritional assessment should incorporate physiological, psychological, emotional, spiritual, social and cultural elements. REFLECTIVE ACTIVITY: ' How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking a holistic nutritional assessment with an older person. • How you could use this information to educate nursing students or your colleagues on the appropriate techniques and evidence base for undertaking a holistic nutritional assessment with an older person.

How Digital Solutions Might Provide a World of New Opportunities for Holistic and Empathic Support of Patients with Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a complex chronic relapsing inflammatory condition anchored in the hair follicle wherein painful abscesses, nodules, and tunnels form under the skin with the potential for intermittent pus drainage and tissue scarring. Current estimates of incidence are 1-4% globally with the disease three times more prevalent in women and higher rates among Black populations. Patients with HS are also more likely to suffer from depression, anxiety, and loneliness underscoring the need for carefully approached strategies on disease awareness and interventions. Delays in formal diagnosis, which have been estimated at 7-10 years on average, impede timely provision of optimal care. Despite best intent, when patients present at a physician's office, stigmas relating to physical appearance can be exacerbated by negative interactions experienced by patients. In addition to long wait times and the dearth of available HS expert dermatology professionals, patients perceive heightened physician focus on two of the HS flare risk factors (smoking and body mass index [BMI]) as negatively impacting their care. Given the need for continual, personal, and sensitive patient support, herein we advocate for re-examination of approach to care and the leveraging of highly personalized digital support solutions. New medications which can directly or indirectly control elements of the disease and its comorbidities are also entering the marketplace. Collectively, we posit that these new developments provide opportunity for a holistic approach for patients with HS, leading to long-term engagement and improved outcomes.

GLP-1 receptor agonists and their role in managing type 2 diabetes.

Until recently the focus in diabetes care was on managing blood glucose - a glucocentric view. This is changing to a more holistic model aimed at prevention, treatment and management through lifestyle interventions as well as medication. An estimated 5 million people in the UK are living with diabetes, most have type 2 diabetes which is associated with obesity. Type 2 diabetes can be prevented, treated with diet and weight loss, or managed with medication. The number of people with diabetes has reached epidemic proportions. To manage diabetes well and reduce complications of poorly managed diabetes, management of the condition can no longer be restricted to endocrinologists and diabetes specialist nurses. This article provides guidance on how glucagon-like peptide-1 receptor agonists can be used in the management of type 2 diabetes.

People Living With Mental Illness Perceptions of Physical Health, Mental Health and Well-Being.

Understanding the perspectives of regional people living with mental illness is crucial to adapting services, improving holistic care and meeting individual needs. This study explored people living with mental illness perceptions of physical health, mental health and well-being. A descriptive qualitative study design underpinned by empowerment theory was conducted. Qualitative data were collected verbally via semi-structured interviews, with demographic details provided verbally at the end of the interview. Thematic analysis was utilised to identify themes. The COREQ checklist was used for reporting. Fourteen participants admitted to regional mental health inpatient units aged between 25 and 84 years old were interviewed. Participants felt their overall well-being was good despite feeling their physical health or mental health was suboptimal, suggesting that their perceived well-being is influenced by factors beyond their physical and mental health. Most participants reported looking after their physical health, mental health and well-being and identified various behavioural lifestyle strategies they found helpful. Thematic analysis identified three themes: functioning well, feeling in control and meeting basic needs. Mental health services and clinicians play an important role in empowering people with mental illness to improve their physical health, mental health and well-being while admitted to inpatient services; however, it is acknowledged resources can be limited. Mental health services may consider referring people with mental illness to social prescribing programmes to meet their individualised needs on discharge.

The IBD Clinic of Tomorrow: Holistic, Patient-Centric, and Value-based Care.

There is increasing recognition of the associated bi-directional impact of inflammatory bowel disease (IBD) on patient well-being and the potential benefit of multidisciplinary teams to address these unique needs. At certain IBD centers, there has been an evolution towards patient-centric, holistic care to enhance well-being and improve health-related outcomes. Multiple models, incorporating various disciplines, care modalities, digital tools and care delivery, and resource support have arisen in IBD. Although most IBD centers of excellence are now incorporating such multidisciplinary care models, many practices still practice IBD-limited specialty care, limiting evaluations and interventions to the IBD itself and its direct consequences (eg, extraintestinal manifestations). In this piece, we seek to review the evolution of IBD care towards a patient-centric, holistic model (termed 360 IBD Care) including the role and impact of digital health tools, monitoring, and delivery in IBD, and a shift towards value-based care models with discussion of payor priorities in IBD. We also suggest potential opportunities for IBD practitioners to incorporate elements of holistic care on a local scale. Together, we hope such care models will enhance not only IBD-specific health outcomes, but also improve the general well-being of our patients with IBD today and tomorrow.

Oneirotherapy in Overweight and Obesity.

Oneirotherapy is a form of psychotherapy that is based on visual imagery and symbolism. In this communication. We discuss the role of oneirotherapy, or using vivid imagery, as adjuvant therapy in obesity care. Oneirotherapy can be used to promote acceptance of, and adherence to, prescribed therapy. It may also help improve quality of life and enhance self-esteem. However, oneirotherapy alone, without following a healthy lifestyle and or taking antiobesity medication, will help manage weight only in one's dreams.

Development and Pilot Test of a Multi-Component Intervention to Support Women's Recovery from Female Genital Fistula.

INTRODUCTION AND HYPOTHESIS: We evaluated a pilot multi-component reintegration intervention to improve women's physical and psychosocial quality of life after genital fistula surgery. METHODS: Twelve women undergoing fistula repair at Mulago Specialized Women and Neonatal Hospital (Kampala, Uganda) anticipated in a 2-week multi-component intervention including health education, psychosocial therapy, physiotherapy, and economic investment. We assessed feasibility through recruitment, retention, and adherence, acceptability through intervention satisfaction, and preliminary effectiveness through reintegration, mental health, physical health, and economic status. We collected quantitative data at enrollment, 6 weeks, 3 months, and 6 months. We conducted in-depth interviews with six participants. Quantitative data are presented descriptively, and qualitative data analyzed thematically. RESULTS: Participants had a median age of 34.5 years (25.5-38.0), 50% were married/partnered, 42% were separated, 50$ had completed less than primary education, and 67% were unemployed. Mean number of sessions received was 12 for health education (range 5-15), 8 for counseling (range 8-9), and 6 for physiotherapy (range 4-8). Feasibility was demonstrated by study acceptance among all those eligible (100%); comfort with study measures, data collection frequency and approach; and procedural fidelity. Acceptability was high; all participants reported being very satisfied with the intervention and each of the components. Participant narratives echoed quantitative findings and contributed nuanced perspectives to understanding approach and content. CONCLUSIONS: Our results suggest that the intervention and associated research were both feasible and acceptable, and suggested certain modifications to the intervention protocol to reduce participant burden. Further research to determine the effectiveness of the intervention above and beyond surgery alone with regard to the health and well-being of women with fistulas is warranted.

Colorectal cancer: Getting the perspective and context right.

Colorectal cancer (CRC) is a significant global health burden, being the third leading cancer globally. Its incidence has been observed to be higher in developed regions such as North America and Europe with geographical variations in mortality rates. Efforts to address this disease burden include promoting early detection through screening and implementing treatment strategies to improve patient outcomes. With the growing and aging population, the incidence of CRC will undoubtedly increase. These epidemiological trends will mean that healthcare professionals will increasingly encounter CRC in more complex patients. Hence, it becomes imperative to have a deeper appreciation of the pathophysiology of CRC and understand the intricate interplay between a patient's physiology and their goals of care before offering treatment. This review article will aim to encapsulate the important nuances and perspectives of managing this disease in the context of an elderly patient.

The Effects of Osteopathic Manipulative Treatment (OMT) on Postoperative Length of Stay: A Meta-Analysis.

Osteopathic manipulative treatment (OMT) is a therapy used by osteopathic physicians in various medical settings. Postoperatively, OMT can be utilized to optimize the body's function and recovery. This meta-analysis examines the efficacy of OMT in reducing the length of postoperative hospital stays. Given the significant implications of prolonged hospitalization for both patients and healthcare resources, research strategies to safely shorten this period are crucial. This meta-analysis examined five select studies that measured the length of hospital stay in postoperative patients who received OMT compared with postoperative patients who did not. A random effects model was applied in our statistical analysis to account for heterogeneity due to variations in surgical procedures, hospitals, and patient populations. Individually, three studies reported statistically significant reductions in hospital stay for OMT patients, while two did not. This meta-analysis, comprising five studies and 519 patients, found a mean difference of -2.37 days in favor of OMT; however, this finding did not reach a statistical significance (P = 0.06). The substantial heterogeneity observed (heterogeneity tau2 = 6.75, chi2 = 34.6, df = 4, P < 0.00001, I2 = 88%) suggests that clinical dissimilarities among the five studies may have resulted in our inconclusive findings. While OMT shows promise in postoperative care, further research with standardized protocols and more homogenous patient populations is needed to assess its true impact.