Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model:A qualitative study on embrace

<div><p>Background</p><p>Due to the rise in the number of older adults within the population, healthcare demands are changing drastically, all while healthcare expenditure continues to grow. Person-centered and integrated-care models are used to support the redesigning the provision of care and support. Little is known, however, about how redesigning healthcare delivery affects the professionals involved.</p><p>Objectives</p><p>To explore how district nurses and social workers experience their new professional roles as case managers within Embrace, a person-centered and integrated-care service for community-living older adults.</p><p>Methods</p><p>We performed a qualitative study consisting of in-depth interviews with case managers (district nurses, n = 6; social workers, n = 5), using a topic-based interview guide. Audiotaped interviews were transcribed verbatim and analyzed using qualitative content analysis.</p><p>Results</p><p>The experiences of the case managers involved four major themes: 1) the changing relationship with older adults, 2) establishing the case-manager role, 3) the case manager’s toolkit, and 4) the benefits of case management. Within these four themes, subthemes addressed the shift to a person-centered approach, building a relationship of trust, the process of case management, knowledge and experience, competencies of and requirements for case managers, and the differences in professional background.</p><p>Discussion</p><p>We found that this major change in role was experienced as a learning process, one that provided opportunities for personal and professional growth. Case managers felt that they were able to make a difference, and found their new roles satisfying and challenging, although stressful at times. Ongoing training and support were found to be a prerequisite in helping to shift the focus towards person-centered and integrated care.</p></div

Dynamics and distribution of paxillin, vinculin, zyxin and VASP depend on focal adhesion location and orientation

Focal adhesions (FAs) are multiprotein structures that link the intracellular cytoskeleton to the extracellular matrix. They mediate cell adhesion and migration, crucial to many (patho-) physiological processes. We examined in two cell types

Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model:A Qualitative Study

Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2) Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging

Growth factor dependent changes in nanoscale architecture of focal adhesions

Focal adhesions (FAs) are flat elongated structures that mediate cell migration and link the cytoskeleton to the extracellular matrix. Along the vertical axis FAs were shown to be composed of three layers. We used structured illumination microscopy to examine the longitudinal distribution of four hallmark FA proteins, which we also used as markers for these layers. At the FA ends pointing towards the adherent membrane edge (heads), bottom layer protein paxillin protruded, while at the opposite ends (tails) intermediate layer protein vinculin and top layer proteins zyxin and VASP extended further. At the tail tips, only intermediate layer protein vinculin protruded. Importantly, head and tail compositions were altered during HGF-induced scattering with paxillin heads being shorter and zyxin tails longer. Additionally, FAs at protruding or retracting membrane edges had longer paxillin heads than FAs at static edges. These data suggest that redistribution of FA-proteins with respect to each other along FAs is involved in cell movement

Interdisciplinary education: a case study at the University of Twente

The ability to cross boundaries is considered fundamental to the ability of scientists, engineers and others to solve modern real-world problems. As with other educational fields engineering higher education needs to find suitable interdisciplinary approaches to meet these requirements. While there is much current study of interdisciplinary learning it remains a challenge to formulate general strategies for implementing interdisciplinary education in a way that students become skilled collaborative problem-solvers. At the University of Twente there are currently opportunities to explore different responses educators have to this challenge, through the study of the High Tech Human Touch minors: a programme which offers minor courses to meet interdisciplinary learning objectives. This case study performs a comparison between the 10 HTHT minor courses relying on the education model ADDIE, to elicit similarity and diversity, and related challenges, with respect to how instructors in each course have responded to their interdisciplinary task. To make this comparison the student-perspective has been taken into account through interviews and evaluations, in addition to desk-research and semi-structured interviews with teachers. In current literature there is little information about how students perceive interdisciplinary education, yet such information can help understand the complexity needed for an interdisciplinary ‘pedagogy’. Comparing the 10 HTHT minors, a range of different interdisciplinary educational designs can be identified, with distinct challenges to each, beyond the canonical model of collaboration-based designs. Especially noteworthy is the fact that students consciously opt for these HTHT minors to learn from other disciplines, but that this is not often the learning outcome, signalling a frequent gap between student expectations and educational outcomes