Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review.

INTRODUCTION: Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. METHODS: We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. RESULTS: We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members' true beliefs due to "uniformity pressure, closed mindedness, and illusion of invulnerability." The observation that Guidelines' indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. CONCLUSIONS: Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.

Understanding care in the past to develop caring science of the future: a historical methodological approach.

In this paper, we explore how the development of historical research methodologies during the last centuries can contribute to more diverse and interdisciplinary research in future caring science, especially towards a care focus that is more person-centred. The adding of a historical approach by professional historians to the theory of person-centredness and person-centred care can develop knowledge that enables a more holistic understanding of the patient and the development of the patient perspective from the past until today. Thus, the aim was to show how developments within historical methodology can help us to understand elements of care in the past to further develop caring science in future. Historical research methodologies have advocated a "history from below" perspective, and this has enabled the evolution of systematic approaches to historical research that can be explored and critically analysed. Linked with this, the development of a more social and cultural oriented understanding of historical research has enabled historians to explore and add knowledge from a broader societal perspective. By focusing on the life of ordinary people and taking social and cultural aspects into account when trying to reconstruct the past, we can get a deeper understanding of health, care and medical development. However, an interdisciplinary research focus on person-centredness and person-centred care that includes professional historians can be challenging. In this paper, we argue that a historical perspective is necessary to meet the challenges we face in future delivery of health care to all people, in all parts of society in an ever more global world.

Review of the history and development in the field of psychosocial oncology.

Psychosocial oncology is a multi-disciplinary field of practice and, as a recently developed speciality, covers the psychological, social and behavioural dimensions of cancer. We describe the historical background and changing ethos in medical practice in order to understand factors that contributed to the emergence of this new discipline. Modern psychosocial oncology covers a number of topics; the diagnosis and management of psychological morbidity and distress across the cancer continuum from diagnosis through survivorship and, for some patients, terminal illness, the recognition that behaviour and lifestyle contribute to cancer risk and prognosis, the need to include families and carers alongside patients in a comprehensive model of supportive cancer care. Best practice, based on evidence and nationally and internationally accepted guidelines, is being integrated into national cancer plans, and services are briefly described. Future challenges include the need to recognize that the behavioural and mental health sciences have a role to play in comprehensive cancer care and that multi-disciplinary care, which includes psychosocial care, is the best model for ensuring patients needs are comprehensively and adequately met. The return of modern medicine to a more holistic person-focused ethos is needed in order to put the patient back into patient-centred cancer care.

Light still shines in the darkness: decent care for all.

Health care is in crisis at the global, national, and local levels, with hundreds of millions living without basic care, or with insufficient care. Current health care models seem to have ignored, muted, or excluded the voices of the people they were intended to serve, resulting in health systems and care delivery models that do not respond to the needs of the people. This article describes a values-based approach to health and health care services in which the voices of the people are heard and listened to, and in which individuals and communities are informed participants in their own care. We draw parallels between contemporary concerns for decency in care giving to Florence Nightingale's path-breaking work, first with the British military medical system and then Great Britain as a whole.

Prenatal care: limitations and opportunities.

Prenatal care is a venerable tradition in the U.S. health care system and one that deserves critical examination. Inordinate amounts of public and personal resources are expended on a tradition of care that has not proven itself equal to current perinatal prevention challenges. In this article, the evolution of prenatal care is reviewed, its efficacy is critiqued, and efforts at restructuring the content and processes of care are examined. Three promising alternatives to the dominant medical model are described: the comprehensive prenatal care approach illustrated by many publicly funded prenatal clinics, the prenatal empowerment model as exemplified by midwifery care, and the prenatal group model as illustrated by CenteringPregnancy. Nurses are called upon to champion prenatal options for women.

I dressed your wounds, God healed you--a wounded person's psychology according to Ambroise Parè.

Ambroise Parè (1510-1590) was actively involved in wound treatment, studying wounds from various points of view. Many of his published works provide cutting-edge insights regarding nutrition, pain, and debridement, as well as psychological counsel for wounded persons--advanced thoughts, considering the times. Parè believed the energy of the human body and mind played an active role in wound healing. Parè's stature, as far as wound care is concerned, is a result of his judgment and wisdom in applying knowledge of human principles to medical practice. Detailing and celebrating events in his life relevant to the practice of wound care underscore the skills and compassion vital to healing regardless of the century. The article title is drawn from the engraving on his tombstone.

Careful nursing: a model for contemporary nursing practice.

BACKGROUND: Careful nursing, a system of nursing developed in Ireland by Catherine McAuley in the early years of the 19th century and used by Irish nurses at the Crimean war, has been described as Ireland's legacy to nursing. Although records of careful nursing have been preserved, it has received little attention in the nursing literature. AIM: The purpose of this study was to conduct a preliminary content analysis of the mainly primary source historical documentation of the careful nursing system and present it within the structure of a contemporary conceptual model of nursing. METHODS: The documents describing the careful nursing system were studied and re-studied to gain understanding of the philosophical assumptions underlying careful nursing and of the thinking, attitudes, actions and practice of the nurses. Content relating to the four central nursing concepts was identified and summarized. RESULTS: Careful nursing definitions of person, environment, health and nursing are presented. Ten key concepts of careful nursing practice are identified as disinterested love, contagious calmness, creation of a restorative environment, 'perfect' skill in fostering safety and comfort, nursing interventions, health education, participatory-authoritative management, trustworthy collaboration, power derived from service and nurses' care for themselves. The spiritual dimension of human life and the spiritual in nursing emerge as important characteristics of the model. CONCLUSIONS: The results of this preliminary analysis require further verification and critical examination. However, the careful nursing model illuminates important aspects of professional nursing and could be further developed to conceptualize and guide nursing practice.