Clinics in Integrated Care最新文献

Improved diagnosis and advances in cancer treatment options has resulted in an increased demand for enhanced cancer pain management. An assortment of pharmacotherapy, especially opioids, helps to achieve significant pain relief in the terminally ill by following the established WHO analgesic ladder algorithm. Advanced and invasive interventions within appropriate multidisciplinary set up further helps to attain analgesia with low morbidity and better quality of life. This article lays out an overview of potential treatment options available for terminally ill cancer patients.

Childhood obesity is a serious global health problem associated with increased risk of disease in the short- and long-term. Excess weight gain begins early, during the preschool years, and many children remain overweight throughout childhood and adult life. Once established, obesity is difficult to reverse and costly to manage. In the UK, direct treatment costs the NHS £4.2 billion a year and without fast action, this could rise to £10 billion by 2050. Treatment options in childhood are limited. Lifestyle intervention is the first line treatment recommended by the National Institute for Care excellence (NICE) in the UK. In younger children (<6 years) this is the only management option. In older children, pharmacological intervention is possible under specialist medical supervision. Evidence for the safety and success of bariatric surgery in children is limited. However, there is enough evidence to consider making the treatment available for a small number of highly selected children, with severe and complex obesity. Prevention is the best strategy. Lifestyle interventions are feasible and effective in both the prevention and treatment of childhood obesity. These require evaluation in rigorous trials and if successful should be integrated into healthcare and widely available.

COVID-19 is a complex disease which has challenged the way in which care is provided. Cardiopulmonary resuscitation (CPR) is recognized as a potential aerosol-generating procedure, in consequence, a modified advanced life support approach needs to be followed. This article describes the actions for an adult in cardiac arrest with suspected of confirmed COVID-19 disease in a hospital setting.

Patients who develop severe COVID-19 disease can develop respiratory failure and subsequently Acute Respiratory Distress Syndrome (ARDS). However, it has to be noted that these patients may not follow the typical ARDS disease trajectory. The causes of this paradox are complex and not yet fully understood, with the result that varying pathophysiological hypotheses have been proposed. This article describes ARDS in COVID-19 patients and the use of the conscious and unconscious prone position as an intervention to improve oxygenation.

The number of older adults in the United States and much of the world is rapidly increasing as individuals continue to live longer, healthier lives, and is expected to continue growing over the next several decades. As a result, healthcare settings are constantly adapting to meet the specialized needs of this aging population. One major adaptation in the delivery of healthcare services is a shift toward integrated healthcare settings wherein older adults can seek services for a variety of physical and mental health needs within a single system. This article addresses several pertinent issues unique to working with older adults within integrated care settings to prepare practitioners for effectively serving older adult patients. We begin with an overview of key demographics of aging in the United States and of professional geropsychology. This is followed by a discussion of key issues relevant to serving older adults in integrated care settings, such as the roles of behavioral health professionals, common comorbidities among older adults, intervention effectiveness, and standards for professional competency. We conclude with a discussion of evidence-based psychological and cognitive assessment of older adults, highlighting measures that may be considered for use in integrated care settings.

Heart failure (HF) is a clinical syndrome characterized by reduced exercise tolerance, dyspnoea and peripheral oedema, which is confirmed with imaging evidence of ventricular dysfunction and, if available, cardiac biomarkers. HF is one of the major cardiovascular causes of morbidity and mortality worldwide. It has a prevalence of 1–2%, rising with age to >10% in those over 70 years old.

Pharmacological and device-based therapy for HF with reduced ejection fraction (HFrEF) has dramatically improved over the last 30 years, resulting in significantly better outcomes for patients, in terms of improvements in quality of life, and reduction in morbidity and mortality. However, some patients remain highly symptomatic despite these measures and for a select few, advanced therapies (e.g. mechanical circulatory support devices and cardiac transplantation) might be suitable. This article provides an overview of contemporary management of patients with HFrEF.

Medical professionalism is an increasingly commonly used term and the subject of undergraduate education. It is seen as a ‘good’ both amongst health professionals and the public. But what exactly does it mean and how did it develop? This article looks at how medical professionalism originated and how it has led to similar debate and constructs in other areas of healthcare. The article starts with a brief synopsis of how medicine developed as a profession but broadens out to professionalism in general and how professionalism interacts with integrated health care. One will see how history has shaped the conception and subsequent iterations of medical professionalism. Ultimately, medical professionalism can be seen as a response to both external and internal threats to both the individual's identity and the group's identity. Medical professionalism is the mechanism for identifying and developing core unifying characteristics that allow a profession to weather challenges and change.