Notes

Delivered in Brussels verification device: the introduction of the screening process device measuring antenatal psychosocial being exposed.
In Quebec, the strategic leadership of nursing directorates remains poorly documented despite its importance for the performance of their organizations. Using three focus groups and 31 individual semistructured interviews, a qualitative descriptive study was conducted, including 35 participants from 18 of the Quebec 34 health institutions created in 2015 by the last reform. Seven themes emerged (1) taking ownership of the strategic positioning, (2) developing and communicating a vision, (3) making strategic, systematic, and measured choices, (4) reframing roles, (5) getting involved in the strategic decision-making processes, (6) developing the political capacity, and (7) building alliances. Four professional and organizational components influenced the nursing directorates' leadership capacity clinical credibility, a sufficient number of people educated at the graduate level, organizational culture, and size of the institution. It is expected that these results regarding nursing directorates' exercise of strategic leadership will lead to better governance and quality of nursing care.The recent COVID-19 pandemic has highlighted limitations in current healthcare systems and needed strategies to increase surgical access. This article presents a team-based integration model that embraces intra-disciplinary collaboration in shared clinical care, professional development, and administrative processes to address this surge in demand for surgical care. Implementing this model will require communicating the rationale for and benefits of shared care, while shifting patient trust to a team of providers. For the individual surgeon, advantages of clinical integration through shared care include decreased burnout and professional isolation, and more efficient transitions into and out of practice. Advantages to the system include greater surgeon availability, streamlined disease site wait lists, and promotion of system efficiency through a centralized distribution of clinical resources. We present a framework to stimulate national dialogue around shared care that will ultimately help overcome system bottlenecks for surgical patients and provide support for health professionals.Many healthcare organizations have adopted the quadruple aim to create system-level improvements for delivering enhanced experience and outcomes to patients, healthier populations, reduced per-capita costs, and better provider experiences. With a maturing health technology sector, virtual care is gradually being adopted in Canada and proving to be a viable tactic for achieving the quadruple aim. Despite increased acceptance of virtual innovations and their related benefits to patients and providers, implementation of virtual care can be challenging in a Canadian healthcare system. The Ottawa Hospital developed an innovation strategy to guide the adoption and maturity of virtual care as a means of supporting the pursuit of the quadruple aim and achievement of the organization's mission and vision. A case example presenting the strategy and recommendations for health leaders and providers considering implementation of virtual care is discussed.
This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery.

Six focus groups were conducted over two months. learn more Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants.

Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resourct of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.Aim This study aims to investigate the significance of a micropapillary pattern in stage IIIA-N2 lung adenocarcinoma after adjuvant chemoradiotherapy. Patients & methods A total of 257 patients with stage IIIA-N2 lung adenocarcinoma were enrolled in this study. Patients were classified into three groups based on the proportion of micropapillary components micropapillary negative, micropapillary minor component and micropapillary predominant component. Results The micropapillary predominant group had the shortest median disease-free survival and overall survival times compared with the micropapillary minor component and micropapillary negative groups (median overall survival time 54 months vs 64 months vs not reached; p = 0.004). Furthermore, the micropapillary pattern was an independent prognostic factor for disease-free survival and overall survival (p less then 0.05). Conclusion The micropapillary pattern of IIIA-N2 lung adenocarcinoma is related to worse prognosis.Aim To analyze responses to first-line metastatic renal cell carcinoma (mRCC) treatment stratified by risk criteria. Patients & methods Clinical trials and observational studies of patients aged ≥18 years, published January 2005-May 2019, were identified via Ovid from MEDLINE, EMBASE, the Cochrane Central Trials Register and the Cochrane Database of Systematic Reviews. Data extracted included progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). Results 47/1269 articles met eligibility criteria. Most studies stratified patients by International Metastatic RCC Database Consortium (n = 19) or Memorial Sloan Kettering Cancer Center (n = 21). PFS, OS and ORR varied according to risk group. Conclusion Pembrolizumab + axitinib, ipilimumab + nivolumab and avelumab + axitinib were most effective across all risk groups. Favorable-risk patients benefit from sunitinib treatment.
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