RESUMO
Systemic sclerosis (SSc) is a multi-organ autoimmune disease with complex interactions between immune-mediated inflammatory processes and vascular pathology leading to small vessel obliteration, promoting uncontrolled fibrosis of skin and internal organs. Interstitial lung disease (ILD) is a common but highly variable manifestation of SSc and is associated with high morbidity and mortality. Treatment approaches have focused on immunosuppressive therapies, which have shown some efficacy on lung function. Recently, a large phase 3 trial showed that treatment with nintedanib was associated with a reduction in lung function decline. None of the conducted randomized clinical trials have so far shown convincing efficacy on other outcome measures including quality of life determined by patient reported outcomes. Little evidence is available for non-pharmacological treatment and supportive care specifically for SSc-ILD patients, including pulmonary rehabilitation, supplemental oxygen, symptom relief and adequate information. Improved management of SSc-ILD patients based on a holistic approach is necessary to support patients in maintaining as much quality of life as possible throughout the disease course and to improve long-term outcomes.
Assuntos
Necessidades e Demandas de Serviços de Saúde/tendências , Saúde Holística/tendências , Doenças Pulmonares Intersticiais/terapia , Qualidade de Vida , Escleroderma Sistêmico/terapia , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/epidemiologia , Transplante de Pulmão/tendências , Cuidados Paliativos/métodos , Cuidados Paliativos/tendências , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/epidemiologiaAssuntos
Envelhecimento Saudável/fisiologia , Planejamento de Assistência ao Paciente , Saúde Pública , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/genética , Envelhecimento/patologia , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , Senescência Celular/genética , Política de Saúde , Saúde Holística/legislação & jurisprudência , Saúde Holística/tendências , Humanos , Doenças Neurodegenerativas/genética , Planejamento de Assistência ao Paciente/legislação & jurisprudência , Planejamento de Assistência ao Paciente/tendências , Dinâmica Populacional/tendências , Saúde Pública/legislação & jurisprudência , Saúde Pública/normas , Encurtamento do Telômero/fisiologiaRESUMO
We wanted the best, but it turned out like always. Victor Chernomydrin) 1 According to literary legend, Shangri-La is an idyllic and harmonious place. Mental health is aspiring to its own Shangri-La in the shape of better integrated care. But do current reforms make integrated practice more or less likely? And what can be done to increase the chances of success? The aim of this article is to review the current state of mental health reforms in Australia now under way across Primary Health Networks, the National Disability Insurance Scheme, psychosocial support services and elsewhere. What are these changes and what are the implications for the future of integrated mental health care? Is Shangri-La just over the horizon, or have we embarked instead on a fool's errand?
Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Saúde Holística/tendências , Serviços de Saúde Mental/tendências , Saúde Mental/tendências , Austrália , Reforma dos Serviços de Saúde , Humanos , Relações Metafísicas Mente-CorpoAssuntos
Saúde Holística/tendências , Enfermagem Holística/tendências , Assistência Centrada no Paciente/tendências , Melhoria de Qualidade/tendências , Atenção à Saúde/tendências , Enfermagem Holística/organização & administração , Humanos , Assistência Centrada no Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Reembolso de Incentivo/tendênciasAssuntos
Prática Avançada de Enfermagem , Competência Clínica/normas , Saúde Holística/tendências , Enfermagem Holística , Liderança , Prática Avançada de Enfermagem/organização & administração , Prática Avançada de Enfermagem/tendências , Reforma dos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Enfermagem Holística/organização & administração , Enfermagem Holística/tendências , Humanos , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Pesquisa Metodológica em Enfermagem , Autonomia Profissional , Inquéritos e QuestionáriosRESUMO
Increasingly nurses use various telehealth technologies to deliver health care services; however, there has been a lag in research and generation of empirical knowledge to support nursing practice in this expanding field. One challenge to generating knowledge is a gap in development of a comprehensive conceptual model or theoretical framework to illustrate relationships of concepts and phenomena inherent to adoption of a broad range of telehealth technologies to holistic nursing practice. A review of the literature revealed eight published conceptual models, theoretical frameworks, or similar entities applicable to nursing practice. Many of these models focus exclusively on use of telephones and four were generated from qualitative studies, but none comprehensively reflect complexities of bridging nursing process and elements of nursing practice into use of telehealth. The purpose of this article is to present a review of existing conceptual models and frameworks, discuss predominant themes and features of these models, and present a comprehensive conceptual model for telehealth nursing practice synthesized from this literature for consideration and further development. This conceptual model illustrates characteristics of, and relationships between, dimensions of telehealth practice to guide research and knowledge development in provision of holistic person-centered care delivery to individuals by nurses through telehealth technologies.
Assuntos
Saúde Holística , Enfermagem Holística/tendências , Telemedicina , Atenção à Saúde/normas , Saúde Holística/normas , Saúde Holística/tendências , Humanos , Pesquisa Metodológica em Enfermagem , Avaliação de Programas e Projetos de Saúde , Telemedicina/organização & administração , Telemedicina/tendênciasAssuntos
Diabetes Mellitus/psicologia , Diabetes Mellitus/terapia , Prioridades em Saúde , Saúde Mental , Estresse Psicológico/prevenção & controle , Austrália , Barreiras de Comunicação , Prioridades em Saúde/organização & administração , Prioridades em Saúde/normas , Prioridades em Saúde/tendências , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/tendências , Saúde Holística/normas , Saúde Holística/tendências , Humanos , Saúde Mental/normas , Psicoterapia , Qualidade de VidaRESUMO
In the last four decades, we have witnessed vast and important transitions in the social, economic, political, and health contexts of the lived experiences of gay men in the United States. This dynamic period, as evidenced most prominently by the transition of the gay rights movement to a civil rights movement, has shifted the exploration of gay men's health from one focusing primarily on HIV/AIDS into a mainstream consideration of the overall health and wellbeing of gay men. Against this backdrop, aging gay men in the United States constitute a growing population, for whom further investigations of health states and health-related disparities are warranted. In order to advance our understanding of the health and wellbeing of aging gay men, we outline here a multilevel, ecosocial conceptual framework that integrates salient environmental, social, psychosocial, and sociodeomgraphic factors into sets of macro-, meso-, and micro-level constructs that can be applied to comprehensively study health states and health care utilization in older gay men.
Assuntos
Envelhecimento/psicologia , Saúde Holística/tendências , Homossexualidade Masculina/psicologia , Adulto , Idoso , Previsões , Soropositividade para HIV/psicologia , Soropositividade para HIV/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/tendências , Homofobia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Mudança Social , Estigma Social , Estados UnidosAssuntos
Pesquisa Biomédica/tendências , Pediatria/tendências , Sociedades Médicas/tendências , Pesquisa Biomédica/economia , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/tendências , Pré-Escolar , Comportamento Cooperativo , Difusão de Inovações , Saúde Holística/tendências , Humanos , Lactente , Recém-Nascido , Comunicação Interdisciplinar , Mentores , Pediatria/economia , Pesquisadores/tendências , Apoio à Pesquisa como Assunto/tendênciasRESUMO
OBJECTIVE: To develop an automated algorithm to quantify background EEG abnormalities in full-term neonates with hypoxic ischemic encephalopathy. APPROACH: The algorithm classifies 1 h of continuous neonatal EEG (cEEG) into a mild, moderate or severe background abnormality grade. These classes are well established in the literature and a clinical neurophysiologist labeled 272 1 h cEEG epochs selected from 34 neonates. The algorithm is based on adaptive EEG segmentation and mapping of the segments into the so-called segments' feature space. Three features are suggested and further processing is obtained using a discretized three-dimensional distribution of the segments' features represented as a 3-way data tensor. Further classification has been achieved using recently developed tensor decomposition/classification methods that reduce the size of the model and extract a significant and discriminative set of features. MAIN RESULTS: Effective parameterization of cEEG data has been achieved resulting in high classification accuracy (89%) to grade background EEG abnormalities. SIGNIFICANCE: For the first time, the algorithm for the background EEG assessment has been validated on an extensive dataset which contained major artifacts and epileptic seizures. The demonstrated high robustness, while processing real-case EEGs, suggests that the algorithm can be used as an assistive tool to monitor the severity of hypoxic insults in newborns.
Assuntos
Algoritmos , Asfixia Neonatal/diagnóstico , Asfixia Neonatal/fisiopatologia , Eletroencefalografia/métodos , Saúde Holística , Asfixia Neonatal/terapia , Eletroencefalografia/tendências , Saúde Holística/tendências , Humanos , Recém-NascidoRESUMO
Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP.