Academic literature on the topic 'Dementia Patients Care Case studies'
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Journal articles on the topic "Dementia Patients Care Case studies"
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Custodio, Nilton, David Lira, Eder Herrera-Perez, Liza Nuñez del Prado, José Parodi, Erik Guevara-Silva, Sheila Castro-Suarez, and Rosa Montesinos. "Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru." Dementia & Neuropsychologia 9, no. 1 (March 2015): 32–41. http://dx.doi.org/10.1590/s1980-57642015dn91000006.
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Dementia is a major cause of dependency and disability among older persons, and imposes huge economic burdens. Only a few cost-of-illness studies for dementia have been carried out in middle and low-income countries. OBJECTIVE: The aim of this study was to analyze costs of dementia in demented patients of a private clinic in Lima, Peru. Methods. We performed a retrospective, cohort, 3-month study by extracting information from medical records of demented patients to assess the use of both healthcare and non-healthcare resources. The total costs of the disease were broken down into direct (medical and social care costs) and indirect costs (informal care costs). Results. In 136 outpatients, we observed that while half of non-demented patients had total care costs of less than US$ 23 over three months, demented patients had costs of US$ 1500 or over (and more than US$ 1860 for frontotemporal dementia). In our study, the monthly cost of a demented patient (US$ 570) was 2.5 times higher than the minimum wage (legal minimum monthly wage in Peru for 2011: US$ 222.22). Conclusion. Dementia constitutes a socioeconomic problem even in developing countries, since patients involve high healthcare and non-healthcare costs, with the costs being especially high for the patient's family.
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Angelopoulou, Efthalia, Nikolaos Papachristou, Anastasia Bougea, Evangelia Stanitsa, Dionysia Kontaxopoulou, Stella Fragkiadaki, Dimosthenis Pavlou, et al. "How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer’s Disease and Related Dementias? A Narrative Review." Medicina 58, no. 12 (November 22, 2022): 1705. http://dx.doi.org/10.3390/medicina58121705.
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Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer’s disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
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Hutch, William, Trish O' Sullivan, and Tony Foley. "Dementia palliative care education and training for healthcare professionals: A scoping review protocol." HRB Open Research 5 (February 15, 2022): 13. http://dx.doi.org/10.12688/hrbopenres.13486.1.
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Background: Global mortality rates from dementia continue to rise. Evidence suggests that there is limited provision of palliative care for people with dementia and this is a cause of grave concern. The coronavirus disease 2019 (COVID-19) pandemic has further exposed the inequalities of care for this vulnerable population. Proactive palliative care, delivered by multidisciplinary healthcare professionals (HCPs), can offer significant benefits to people with dementia. However, little is known about the components of effective education and training for HCPs who care for people with advancing dementia at end of life. Objective: The aim of this scoping review is to identify effective education and training interventions for HCPs, who care for people with advanced dementia approaching end of life. Inclusion criteria: Studies that used a palliative care educational intervention for HCPs working with patients with dementia will be included. Studies that explore undergraduate or postgraduate education and training in dementia palliative care for HCPs will be included. Study designs such as quantitative, qualitative, mixed method studies, and case studies will be included. Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used for this review. The following databases will be searched: CINAHL, ERIC, Medline, SocIndex, PsycINFO. In addition, grey literature searches will be limited to the first 100 searches using Google Scholar and Open-Grey. Study selection will involve the reviewer screening titles and abstracts. Then, two independent reviewers will further assess the studies in full for those that meet the inclusion criteria. In line with the JBI framework, data will be extracted using a draft data extraction tool. This will facilitate a chronological narrative synthesis of results in line with the study’s overall aim to identify effective education and training interventions for HCPs, who care for patients with dementia, nearing end of life.
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Hutch, William, Trish O' Sullivan, and Tony Foley. "Dementia palliative care education and training for healthcare professionals: A scoping review protocol." HRB Open Research 5 (January 20, 2023): 13. http://dx.doi.org/10.12688/hrbopenres.13486.2.
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Background: Global mortality rates from dementia continue to rise. Evidence suggests that there is limited provision of palliative care for people with dementia and this is a cause of grave concern. The coronavirus disease 2019 (COVID-19) pandemic has further exposed the inequalities of care for this vulnerable population. Proactive palliative care, delivered by multidisciplinary healthcare professionals (HCPs), can offer significant benefits to people with dementia. However, little is known about the components of effective education and training for HCPs who care for people with advancing dementia at end of life. Objective: The aim of this scoping review is to identify effective education and training interventions for HCPs, who care for people with advanced dementia approaching end of life. Inclusion criteria: Studies that used a palliative care educational intervention for HCPs working with patients with dementia will be included. Studies that explore undergraduate or postgraduate education and training in dementia palliative care for HCPs will be included. Study designs such as quantitative, qualitative, mixed method studies, and case studies will be included. Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used for this review. The following databases will be searched: CINAHL, ERIC, Medline, SocIndex, PsycINFO. In addition, grey literature searches will be limited to the first 100 searches using Google Scholar and Open-Grey. Study selection will involve the reviewer screening titles and abstracts. Then, two independent reviewers will further assess the studies in full for those that meet the inclusion criteria. In line with the JBI framework, data will be extracted using a draft data extraction tool. This will facilitate a chronological narrative synthesis of results in line with the study’s overall aim to identify effective education and training interventions for HCPs, who care for patients with dementia, nearing end of life.
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Marra, Alexandre, Mireia Puig-Asensio, and Eli Perencevich. "Antibiotic Use at the End-of-Life in Patients with Advanced Dementia: A Systematic Literature Review." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s120. http://dx.doi.org/10.1017/ice.2020.627.
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Background: Improving the use of antibiotics across the care continuum will be necessary as we strive to protect our patients from antimicrobial resistance. One potential target for antimicrobial stewardship is during end-of-life care of patients with advanced dementia. We aimed to perform a systematic literature review measuring the burden of antibiotic use during end-of-life care in patients with dementia. Methods: We searched PubMed, CINAHL, and Embase through July 2019 for studies with the following inclusion criteria in the initial analysis: (1) end-of-life patients (ie, dementia, cancer, organ failure, frailty or multi-morbidity); (2) antibiotic use in the end-of-life care; with the final analysis restricted to (3) patients with advanced dementia. Only randomized controlled trials (RCTs) and cohort studies were included. Results: Of the 93 full-text articles, 17 studies (18.3%) met the selection criteria for further analysis. Most of the included studies were retrospective (n = 8) or prospective (n = 8) cohort studies. These studies in combination included 2,501 patients with advanced dementia. Also, 5 studies (698 patients, [27.9%]) were restricted to patients with Alzheimer’s disease. In 5 studies in which data were available, fewer than one-quarter of patients (19.9%, 498) with advanced dementia were referred to palliative care. In 12 studies >50% of patients received antibiotics during the end-of-life period. Also, 15 studies did not report the duration of antimicrobial therapy. Only 2 studies reported the antimicrobial consumption in days of therapy per 1,000 resident days. Only 6 studies studied whether the use of antibiotics was associated with beneficial outcomes (survival or comfort), and none of them evaluated potential adverse effects associated with antibiotic use. Conclusions: There are significant gaps in the literature surrounding antimicrobial use at the end of life in patients with advanced dementia. Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during end-of-life care in this patient population.Acknowledgement. We thank Jennifer Deberg from Hardin Library for the Health Sciences, University of Iowa Libraries on the search methods.Disclosures: NoneFunding: None
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Garrison, Susan J., George M. Ringholz, and Jeff Lindeman. "Rehabilitation Issues in Patients with Vascular Dementia: Case Studies with Commentary." Topics in Stroke Rehabilitation 7, no. 3 (October 2000): 20–28. http://dx.doi.org/10.1310/bpt1-q37e-rb6l-cnhn.
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Koch, Tamar, and Steve Iliffe. "Implementing the National Dementia Strategy in England: Evaluating innovative practices using a case study methodology." Dementia 10, no. 4 (September 13, 2011): 487–98. http://dx.doi.org/10.1177/1471301211417169.
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With dementia ever-increasing in prevalence and cost on society, and with recent reports emphasizing the need for improved and standardized diagnosis and care for patients with dementia, the National Dementia Strategy (NDS) has been published by the English Department of Health. The NDS encourages the identification of successful innovations to implement on a wider scale. This paper uses case studies to describe some examples of innovative practice in the diagnosis and management of patients with dementia in primary care. It goes on to discuss methodological problems in the evaluation and comparison of innovations in practice, focusing on the potential to compare complex with simple interventions, and recognizing the role that commissioners play in making decisions about the choice and implementation of innovation.
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Kita, Motoko, and Reiko Yoshida. "Research Trends into Support for Families Coping with Dementia in Japan." International Journal of Studies in Nursing 2, no. 1 (April 6, 2017): 15. http://dx.doi.org/10.20849/ijsn.v2i1.144.
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In Japan, there is a growing need for family support of elderly patients with dementia because the number of sufferers is expected to increase over coming years. We conducted a review of 92 studies into the support provided to the families of patients with dementia in Japan. They were reviewed by care setting, study focus, and study design. Most studies were in home settings, followed by hospital settings, with the fewest in long-term care facilities. A wide range and quality of studies were performed in home settings, including quantitative descriptive and interventional studies; however, qualitative descriptive studies and case studies predominated. We identified a need to perform additional studies to verify support programs at home. Concerning family support in hospitals, studies were mainly performed in relation to early diagnosis of dementia and early discharge from hospital, and we observed a clear need to investigate the development of new support programs. Finally, although the need for family support is estimated to be high in long-term care facilities, we found only a few studies investigating this issue. In particular, more studies are needed on the topic of end-of-life care. To offer support that meets the needs of families in various care settings, there is an urgent need to accumulate evidence about patients and their families in each setting.
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Dooley, Jemima, Matthew Booker, Rebecca Barnes, and Penny Xanthopoulou. "Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences." BMJ Open 10, no. 9 (September 2020): e037673. http://dx.doi.org/10.1136/bmjopen-2020-037673.
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ObjectivesPeople with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals.DesignScoping review. The search strategy and data synthesis were informed by people with dementia and carers.Data sourcesSearches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019.Eligibility criteriaEmpirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion.Data extraction and synthesisData were extracted using charting techniques and findings were synthesised according to content and themes.ResultsOf 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress.ConclusionsThe scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.
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Wang, Jing, and Bei Wu. "Improving Care for Persons With Cognitive Impairment in Community-Based Long-Term Care and Acute Care Settings." Innovation in Aging 5, Supplement_1 (December 1, 2021): 65. http://dx.doi.org/10.1093/geroni/igab046.251.
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Abstract The COVID-19 pandemic has highlighted the importance of providing person-centered care for our vulnerable populations across the globe. This symposium focuses on improving care for persons with cognitive impairment and dementia in various care settings. The first study explored dyadic experiences of living with early-onset dementia pre and during COVID-19 in China through a person-centered care lens. The second concept analysis presented four interrelated dimensions of Asian American caregiver support, including individual, family, community, and professional health system. The third study investigated undergraduate nursing students’ attitudes toward pursuing jobs of providing care for older adults with dementia in rapidly-aging urban areas in China and its associated factors. The fourth study examined the impact of social isolation on cognitive function and Quality of Life among acute ischemic stroke (AIS) patients in China. The last study explored an association between perceived control and cognitive function among acute ischemic stroke (AIS) patients in China. The last two studies suggested that perceived control and social isolation may be potential targets in cognitive interventions for AIS patients. This symposium presents the understanding of dementia caregiver support, the empirical evidence of living with dementia, the attitudes towards dementia care among the next generation of nursing workforce, and the impact of social factors on cognitive functions longitudinally. The presenters emphasize the importance of improving care in long-term care and acute care settings. There is a need to design person and family-centered care to improve health and wellbeing of persons with cognitive impairment.
Dissertations / Theses on the topic "Dementia Patients Care Case studies"
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Johnson, Roxanna H. "Experiences of dementia care workers in nursing homes : an exploratory study comparing Canada, Scotland, and the United States." Thesis, University of Stirling, 2014. http://hdl.handle.net/1893/21884.
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This comparative research explores the work experiences of dementia care workers in nursing homes. The aim of this study is to understand concepts central to care and to gain insights from the care workers‟ perspectives. A comparative framework and symbolic interactionist approach is used to analyse data collected using ethnographic methods from 59 dementia care workers in Canada, Scotland, and the United States. The fieldwork settings are institutionalised; dominated by for-profit ownership; and provide care for a resident population with high cognitive and physical needs. The comparative findings underscore the importance of work conditions that provide care workers with sufficient resources to do their job and enough time to complete their work. The absence of these critical components creates stressful work conditions for the care workers. The lack of time, staff and supplies such as towels, wash cloths, and continence products do not allow the residents‟ choices in their care and disregard their dignity and rights. The inability to deliver care for the residents according to the guaranteed government care standards often result in the violation of human rights for the care workers and residents. The care workers are unable to supply the quality of care they know the residents need and are capable of providing given better circumstances. There are frequently not enough care workers, resources, or time to meet the level of care that relevant standards mandate or the care workers know is possible. The analysis reveals that care workers struggle to provide more than basic physical care and are seldom able to meet essential social care needs for the residents. Unwritten rules are implemented in each setting that include separating people with dementia, placing these residents out of view of the public, not allowing the residents access to go outside, and not providing them with engaging and meaningful interactions. While policies are frequently developed with good intentions, many are counter-productive without dementia knowledge. This comparative research reveals care practices and routines share strong similarities across the fieldwork sites while the care worker characteristics as a workforce vary the most between countries. Some differences involve the training required, average age, pay and mode of dress or appearances. Too often researchers frame stress issues for care workers as problems with attitudes, motivation, training and incentives. Yet, the broader social structures and conditions that set the context in which these problems have their origins are commonly ignored. Good working conditions for care workers are precursors to good care for the residents. This thesis concludes with recommendations for practice, research and policy development.
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Paulsson, Petra, and Madeleine Perman. "Sjuksköterskors erfarenhet av att vårda patienter med demenssjukdom : En litteraturbaserad studie." Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-14267.
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Background: Today, 160,000 people with dementia live in Sweden. With increasing age, the risk of suffering from dementia is higher. Many of those who seek hospital care and other healthcare facilities have dementia in addition to other disorders. Caring for people with dementia demands that the nurse has the knowledge and skills required to be able to provide adequate and safe care. Aim: The aim of this study is to describe nurse´s experiences in taking care of patients with dementia disease. Method: A literature-based study was performed, analyzing ten qualitative articles Results: The results consist of two main themes with four subthemes each. The first theme is nurses experience of barriers to good dementia care with four subthemes, the organization as an obstacle, lack of time, lack of knowledge, education and experience, non-adapted care environment. The second main theme was nurse's experience with conditions to good dementia care with four sub-themes, working in teams, working person-centered, knowledge of dementia diseases and caring environment. These highlight nurses experience to care for people with dementia. Conclusion: To care for patients with dementia, according to the result, time and knowledge are mainly required. Working person-centered gives the patient quality of care. Building a relationship with the patient and learning how to interpret signals takes time but is necessary for good care and good working environment. Resources are needed from management in form of time, staffing and knowledge development
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Furlini, Linda. "Living with chronic dementia from the caregiver perspective : a case for educational support." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=85161.
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Caregiving for two parents affected by chronic dementia was the original impetus for this study. My negative experiences led to a quest for insight and solutions through volunteer, professional and academic pursuits. It culminated in this exploration of caregivers' experiences and their decision-making to expose the educational support they need. Caregivers tend to be family members, and overwhelmingly women. Studies from various disciplines confirm that caregivers need educational support to make decisions. Yet, little is known about what type of educational support they need and how it is to be provided. Caregivers' voices are seldom included in research and they are frequently blamed for the problems they confront. This qualitative study honours caregivers' voices. Through in-depth semi-structured interviews, the perspectives of five women form my primary source of data. Personal documentation, archival materials, and interviews with experts in the field supplement these data. To analyze the data two complementary analytic approaches are used: categorization and contextualization. A categorization approach organizes the data into conceptual themes. These themes include activities of multitasking, being locked into a state of heightened alert, interpreting the disease, and managing care. These activities reveal physical and psychological suffering. Contextualization approaches situate the dilemmas the women face in particular contexts. These dilemmas highlight their lack of authority. The analyses indicate that the women engage in a wide range of decision-making and that they need both similar and specific types of educational support. These types of support include (1) lessening their burdens and their frustrations of decision-making; (2) facilitating ethical decision-making; (3) providing information about medical treatments; and (4) assisting with the access to and with the assessment of suitable resources. Overall, caregiving is a ve
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Nowik, Iwona. "Sjuksköterskors erfarenhet av samtal med närstående till personer med demenssjukdom vid övergången till sen palliativ fas : en kvalitativ studie." Thesis, Sophiahemmet Högskola, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2696.
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Demens är en obotlig sjukdom som leder till döden. En stor andel personer som bor i permanenta särskilda boendeformer i Sverige lider av demenssjukdom. Det ligger ett stort ansvar för omvårdnaden av personer med demenssjukdom på sjuksköterskan, som bland annat informerar och samtalar med närstående när livet hos den demenssjuke närmar sig slutet. Identifiering av hinder och förutsättningar för genomförande av dessa samtal bidrar till en bättre förståelse och utveckling av detta område. Syftet med denna studie var att belysa sjuksköterskors erfarenheter av att samtala med närstående till personer med demenssjukdom i samband med övergången till sen palliativ fas på särskilda boenden.En kvalitativ studie med semistrukturerade intervjuer genomfördes, där sju sjuksköterskor som arbetade vid demensenheter inkluderades. Data analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultatet utgörs av 8 kategorier: vårdplanering, personcentrerad vård, information och kommunikation, kunskap och utbildning, övergång till sen palliativ fas, teamarbete, LCP och att dö hemma.Denna studie påvisar hinder som kan uppstå i genomförande av brytpunktsamtal med närstående till personer med demenssjukdom. Några av dem är bristande kunskaper om demenssjukdomar hos närstående, brist på tidig planering av vården vid den sista tiden och osäkerhet bland sjuksköterskorna kring att hantera svåra samtal. Vidare presenteras förbättringsförslag som kan öka tryggheten och säkerheten i vården och på så sätt kan förbättra situationen för sjuksköterskor vid brytpunktssamtal. De två viktigaste förbättringsförslagen är dels att skapa en bättre kontinuitet i omvårdnadsarbetet och dels att organisera kontinuerliga utbildningar för att höja kompetensen hos omvårdnadspersonalen.Dementia is an incurable disease that leads to death. A large proportion of people living in nursing homes in Sweden have dementia. Nurses have a great responsibility for the care of people with dementia since they, among other things, carry out informative communication with the family when the resident approaches the end of life. Identification of barriers and facilitators for such communication could lead to a better understanding and development of this matter. The purpose of this study was to illuminate nurses’ experiences of conversations with families of people with dementia in the transition to end-of-life care in nursing homes.A qualitative study with semi-structured interviews was conducted, where seven nurses, working in nursing homes specialized in dementia, were included. A qualitative content analysis with an inductive approach was performed. The result consists of 8 categories: planning of care, person-centred care, information and communication, knowledge and education, transition to end-of-life care, teamwork, LCP and to die home.This study identified challenges that might hinder breakpoint communication with families of people with dementia. Some of them are families’ lack of knowledge about dementia, lack of early planning of end-of-life care and uncertainties among nurses on how to handle difficult conversations. Furthermore, improvement suggestions are presented that can increase the safety in care and improve the situation for the nurses in breakpoint communication. The two most important suggestions are the creation of a better continuity in the nursing and to organize continuous educations to increase the competence among staff.Keywords:
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Kelly, Fiona. "Well-being and expression of self in dementia : interactions in long-term wards and creative sessions." Thesis, University of Stirling, 2007. http://hdl.handle.net/1893/207.
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This is a multi-method ethnographic study, grounded in symbolic interactionism and social constructionism, which seeks to explore the social worlds of people with dementia in institutional long-term care. Carried out over six months, it uses non-participant observation, Dementia Care Mapping, video-recording, focused conversations and extensive fieldnotes to document types of interactions that fourteen people with dementia received in everyday ward life and during weekly creative sessions facilitated by occupational therapy (OT) staff. Using Kitwood’s (1997) work on person-centred care and Sabat’s (2001) work on selfhood (Selfs 1-3) it identifies their responses to such interactions in terms of their well or ill-being and expressions of Self. The study shows that everyday staff interactions with participants, while sometimes positive, were more often limited in their potential for maintaining or increasing well-being. Sometimes staff interactions were abusive; causing participant ill-being. Participants expressed Selfs 1-3 verbally and visually, although some of these expressions were subtle, fleeting and fragile. During creative sessions, OT staff engaged in sustained positive interactions, raising participant well-being and facilitating Self-expression; a fragile expression of Self could become a robust expression of Self, a past Self could be reclaimed and a desired Self co-constructed. My findings suggest that, in their interactions during creative sessions, OT staff generally recognised and supported Self of participants, raising well-being. However, ward staff did not fully recognise and therefore could not support Self in their interactions with participants, resulting in participant ill-being. This is a crucial finding, which could partially explain the differences in interaction types I observed, and the corresponding differences in participant well-being and Self-expression. This thesis argues for integrating the selfhood and person-centred approaches into an innovative staff-training programme, in order to bring about transformational change in practice. This might encourage care staff to reach out, recognise and respond to aspects of Self as they carry out care; promoting more positive ways of interacting with their patients, increasing patient well-being and fostering staff satisfaction.
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Choy, Yin-san Catherine. "An exploratory study on anticipatory grieving : case studies of spouses of terminally ill patients /." [Hong Kong : University of Hong Kong], 1987. http://sunzi.lib.hku.hk/hkuto/record.jsp?B12341575.
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Scheldeman, Griet. "Performing diabetes : balancing between 'patients' and 'carers', bodies and pumps, Scotland and beyond." Thesis, University of St Andrews, 2006. http://hdl.handle.net/10023/11085.
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This study is about young people (age 11-16) with diabetes. Based on fieldwork in a paediatric diabetes centre in Scotland, it describes the ways diabetes is lived and done by young people, their health carers and insulin pumps. This enactment is contrasted with other ways of doing diabetes, as observed on short fieldwork trips to paediatric centres in Brussels, Gothenburg and Boston. I explore the dynamics of diabetes care on two levels. I consider the interaction between health carers and patients. Comparative data from various paediatric centres make apparent how culturally and socially informed approaches towards adolescence, health and illness shape both care practices and patients' experiences, resulting in different medical outcomes. Concretely in the Scottish centre, a non-hierarchical holistic care approach by health carers emphasizing quality of life over health, informs the young people's perspective on diabetes. Being a free adolescent takes priority over managing diabetes, with the results of ill health and possible future complications. The existing dynamics in this care framework change as a third actor enters the scene: the insulin pump, a pager-sized technological device continuously attached to the body. I explore the balancing act between young people and their pumps. As the adolescents actively engage with their pumps not to search for better health but rather to pursue a better quality of life, the guiding question becomes: how can a technological device for insulin injection double as a tool towards a desired identity and a different illness? This work then, can be read as a concrete case study of how a uniform technological device is embedded and used in a specific cultural and social context. It can also be read as an argument for a re-orientation of paediatric diabetes care in the Scottish centre: care centred on collaboration and inclusion rather than focused on merely containing underlying conflict (between adults and adolescents, diabetes and life, health and quality of life). Centres in Brussels, Gothenburg and Boston, and the insulin pump concretely, show how collaboration can lead to good health and quality of life. To leave us to wonder: is 'doing diabetes differently' synonymous with 'doing a different diabetes'?
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Choy, Yin-san Catherine, and 蔡妍珊. "An exploratory study on anticipatory grieving: case studies of spouses of terminally ill patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1987. http://hub.hku.hk/bib/B31247799.
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Rees, Christopher Lewis. "An examination of patients' responses to framework breaks in psychotherapy in an institutional context." Thesis, Rhodes University, 1998. http://hdl.handle.net/10962/d1002551.
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This study examines the workings of the ground rules which make up the framework of psychotherapy, in an institutional context, by analysing transcripts of twelve audio taped sessions of therapy conducted in a psychiatric hospital. The breaks in the ground rules of the sessions are noted and the patients' responses to these breaks are analysed using Langs's (1982, 1988) method for decoding patients' material, suitably modified for use as a hermeneutic research method. Although all of the ground rules are broken in the institutional context, only one of the ten ground rules appears to be essentially affected by this particular institutional context. Other ground rules are broken out of choice of technique or through error. The institutional context has a structural impact only on the ground rule requiring a one to one relationship with privacy and confidentiality and this ground rule is transgressed in a number of ways in all twelve sessions examined in this study. However the patients' responses to this breach only occur in ways predicted by communicative theory when the break in the ground rule involves actual entry into the therapy space by another person. Other contraventions to this ground rule that do not involve such an entry do not elicit the predicted patient responses. The many other ground rule breaks occurring in the institutional context evoke the predicted responses in the patients' material. In the study, no therapist interventions are found to comply with the communicative therapy requirements for sound interventions; concomitantly it was found that no therapist interventions receive the required derivative validation. The results indicate that it is possible to conduct therapy of a substantially secure frame variety in this institutional context with minimum effort on the part of therapists and given proper training and supervision of therapists in the techniques of communicative psychotherapy. Furthermore the results lend weight to the importance of the communicative methodology for listening to patients' material in psychotherapy in an institutional context. However, further rigorous study of competently performed therapy, executed within the context of a secure frame within an institutional context, is needed in order to demonstrate the benefits of the communicative psychotherapy interventions and interpretations in this context.
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Ataie, Jutta Elisabeth. ""Who Would Have Thought, With a Diagnosis Like This, I Would be Happy?": Portraits of Perceived Strengths and Resources in Early-Stage Dementia." PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/1107.
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This study used photovoice methodology to explore how people with early-stage dementia use their perceived strength and resources to cope with the illness. Purposive sampling was used to recruit participants. Thirteen women and seven men age 57 to 90 (mean 73.4) with MMSE scores ranging from 20 to 28 (mean 25.6) participated in the project. Participants were provided with a disposable camera and invited to take photographs relevant to their well-being. The photographs provided the means for participants to take the lead in dialogue sessions about their coping response.
Grounded theory analysis revealed that initially, early-stage dementia precipitated a disruption in well-being. For the participants in this study, learning to live with the illness was an ongoing, continually shifting process of adjustment, where the participants moved from a familiar sense of well-being to an alternative sense of well-being. In this process the participants used a variety of strengths and resources ranging from those that supported them in reconstructing identity, regaining control, and rebuilding relationships to those that assisted them in reestablishing a healthy lifestyle and restoring meaning and purpose. Striving toward well-being while acknowledging the inconceivable notion of losing one's cognitive abilities was the central strength that the participants brought to this process. It captured the paradox the participants faced in living with early-stage dementia, which was to relegate the illness to the background of their lives while managing its symptoms in the foreground.
Books on the topic "Dementia Patients Care Case studies"
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Innes, Anthea. Dementia studies: A social science perspective. Los Angeles: SAGE, 2009.
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Innes, Anthea. Dementia studies: A social science perspective. Los Angeles: SAGE, 2009.
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Dementia studies: A social science perspective. Los Angeles: SAGE, 2009.
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Hanʾguk chʻimae kajok yŏnʾgu: Puyang pudam sajŏng togu mit kyŏlchŏng mohyŏng kaebal. Sŏul Tʻŭkpyŏlsi: Hongikchae, 1997.
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Anthea, Innes, ed. Dementia care mapping: Applications across cultures. Baltimore: Health Professions Press, 2003.
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Donna, Gilmour, and McIntosh Iain, eds. Dementia care: A professional handbook. 2nd ed. London: Age Concern England, 2001.
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Woodard, John S. Correlative observations in dementia. Orange, Calif: California Medical Publications, 1985.
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Assistive technology in dementia care: Developing the role of technoogy in the care and rehabilitation of people with dementia, current trends and perspectives. London: Hawker Pub., 2006.
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Dodd, Karen. Resource pack for carers of adults with Down's Syndrome and dementia. Kidderminster: BILD, 2002.
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McLean, Athena. The person in dementia: A study of nursing home care in the US. Peterborough, ON: Broadview Press, 2007.
Find full textBook chapters on the topic "Dementia Patients Care Case studies"
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Walker, Barbara B., Peter A. Brawer, Andrea C. Solomon, and Steven J. Seay. "Managing Chronic Pain Through Collaborative Care: Two Patients, Two Programs, Two Dramatically Different Outcomes." In Collaborative Medicine Case Studies, 59–70. New York, NY: Springer New York, 2008. http://dx.doi.org/10.1007/978-0-387-76894-6_6.
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Pohlmann, Elizabeth, David Howells, and Diane Buchanan. "How to Care for Dementia Patients: Case Management Models in Long-Term Home Health Care." In Advances in Experimental Medicine and Biology, 127–33. Boston, MA: Springer US, 1990. http://dx.doi.org/10.1007/978-1-4613-0665-8_12.
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Harris, Ulrika, Inger Jönsson, and Cecilia Fagerström. "A Case Study in Sweden: The Need for Person-Centred Methods in the Care of Dementia Patients with Severe Aggressive Behaviour." In Personality and Brain Disorders, 145–59. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-90065-0_7.
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Gappa, Henrike, Yehya Mohamad, Martin Breidenbach, Pedro Abizanda, Wolfgang Schmidt-Barzynski, Antje Steinhoff, Timothy Robbins, et al. "Making Person-Centred Health Care Beneficial for People with Mild Cognitive Impairment (MCI) or Mild Dementia – Results of Interviews with Patients and Their Informal Caregivers." In Lecture Notes in Computer Science, 468–74. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-08648-9_54.
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AbstractIn the health care sector, person-centred treatment approaches have shown the potential to improve treatment outcomes and quality of life of patients. In particular, this applies where patients are living with complex conditions like multimorbid older patients with Mild Cognitive Impairment (MCI) or mild dementia. Such treatment approaches quite often include input from modern health technologies like health/home monitoring platforms which also offer services to patients for self-management of their conditions. This approach is also followed in the research project CAREPATH (An Integrated Solution for Sustainable Care for Multimorbid Patients with Dementia). To achieve acceptance of such complex health technologies, their services must be beneficial in the eyes of target end users which included in the case of CAREPATH, the patient’s informal caregivers. Therefore, understanding the user requirements of patients and their informal caregivers is of utmost importance which was achieved in CAREPATH by interviews. These revealed that patients’ preferences in regard to what services and information shall be provided to them shall be limited to what they deem necessary which is highly personal. Informal caregivers as opposed to patients, are much interested in receiving most possible information about their care-dependent’s health status. Thus, provision of services and information for these user groups need to be highly customizable to their personal preferences and needs.
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Singh, Arti, and Ashutosh Singh. "Unveiling the Clinical Face of COVID-19." In Health Dimensions of COVID-19 in India and Beyond, 65–81. Singapore: Springer Singapore, 2022. http://dx.doi.org/10.1007/978-981-16-7385-6_4.
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AbstractThe clinical aspects of COVID-19 are discussed. A picture of what happens in a hospital—the ward and the intensive care unit (ICU)—is described. The impact of the disease on patients, medical professionals, and other staff, and case studies of patients who recovered as well as those who did not, are presented. The lived experience, over the ten-months period of the pandemic, of these individuals is portrayed.The lived experience of the author and that of her team is portrayed from the inception of the pandemic to date. The author traces changes made to diagnose and treat COVID-19 patients over time. Patient treatment and management regimens were refined and streamlined during this period. And the health system was re-designed to cope with the influx of huge numbers of COVID-19 patients. During this time, diagnostic tools and treatment regimens evolved. Doctors and their teams of nurses and technicians worked tirelessly day and night to cope with the onslaught. The public, however, stigmatized healthcare workers as they were overcoming with the fear of getting infected.Ten months ago, the medical profession knew very little about the virus or the disease as both were new. But with its dedication and commitment, the medical fraternity managed to cope with the rising number of patients with whatever tools it had. This period witnessed a rapid learning curve.
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Redmalm, David, Marcus Persson, and Clara Iversen. "Robotic Animals in Dementia Care." In The Oxford Handbook of Animal Organization Studies, 409—C27.P103. Oxford University Press, 2022. http://dx.doi.org/10.1093/oxfordhb/9780192848185.013.27.
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Abstract Robotic animals in the shape of cats, dogs, and seals are increasingly used in dementia care. The robots are built to respond to users’ touch and talk for various purposes such as calming, activating, or entertaining patients. Drawing on media representations, marketing materials, reports of experts, and interviews with care workers we take a closer look at the ideas of animality that shape the robots and their application in care organizations. We find that the robots’ animality is described as connecting with a fundamental mammal aspect of our humanity. At the same time, concerns are raised that patients risk being dehumanized when robots replace human-to-human interaction, and the robots are thus treated as a threat to patients’ human dignity. The chapter discusses how notions of animality and a biopolitical understanding of the human as mammal play an integral role in robotized care organizations.
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Pournik, Omid, Bilal Ahmad, Sarah N. Lim Choi Keung, Omar Khan, George Despotou, Angelo Consoli, Jaouhar Ayadi, et al. "CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia." In Studies in Health Technology and Informatics. IOS Press, 2022. http://dx.doi.org/10.3233/shti220771.
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CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients’ independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.
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Peavie, Shawn, and Mercedes Falciglia. "Case 63: Failure to Coordinate Diabetes Care between Hospital and Ambulatory Settings: A Threat to Safe and Quality Patient Care." In Diabetes Case Studies: Real Problems, Practical Solutions, 237–39. American Diabetes Association, 2015. http://dx.doi.org/10.2337/9781580405713.63.
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A 61-year-old man with a history of type 2 diabetes, chronic kidney disease, stroke, vascular dementia, hypertension, coronary artery disease, and depression presented to the hospital from a nursing home with altered mental status and weakness. The patient had been residing in a nursing home due mainly to dementia. On admission, he and his wife reported he had been experiencing altered mental status with increasing confusion over the past few months. On admission to the hospital, his ambulatory insulin regimen from the nursing home was continued. This regimen consisted of glargine 15 units subcutaneous every night and lispro 4 units subcutaneous with each meal, as well as a correction scale of 1 unit for every 50 mg/dL (2.8 mmol/L) >150 mg/dL (8.3 mmol/L).
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Wagner, Evangeline, and Elizabeth M. Borycki. "The Use of Robotics in Dementia Care: An Ethical Perspective." In Studies in Health Technology and Informatics. IOS Press, 2022. http://dx.doi.org/10.3233/shti210934.
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Dementia and other related diseases are becoming increasingly diagnosed and are placing a serious strain on the healthcare system. Robotic technology research is currently underway to provide the much needed support to patients, caregivers, and health providers. This includes examining the ethical implications of robots use in healthcare. This scoping review explores the current state of the literature regarding robotics and dementia with a special lens on ethics. More specifically, this paper strives to gain an understanding of the current ethical considerations, and propose an intervention for evaluating ethical considerations prior to implementation. This research was conducted using PRISMA guidelines, extracting data from articles. Our findings revealed that further attention to policies and guidelines that are currently in place for general use of the technology should be utilized, and applied specifically to the context where the technology will be used.
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Anjos, Caroline, Katherine Dambrowski, Antonio Godoy, and Paula Barrioso. "Feeding at the End of Life in Brazilian Amazon: Qualitative Analysis of Medical Indications." In Supportive and Palliative Care for Cancer Patients [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.104509.
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Background: Death is preceded by several medical decisions that impact the dying process. One of the challenges faced by the multidisciplinary team regarding the care for patients at the end of life process is the indication or interruption of enteral feeding. The aim of this study was to describe the decision experience of the indication of artificial nutrition for seriously ill patients at the end of life by physicians working in a private oncology clinic in Manaus-Amazonas (AM), and their perceptions about end-of-life process. Material and Methods: A cross-sectional and observational study based on a qualitative approach. A clinical case involving a hypothetical patient with advanced dementia, not a candidate for disease-modifying therapy, evolving with signs of end of life was applied. The doctors answered in a discursive manner a question about which nutritional option would be the most adequate. Content analysis was used to analyze the data. Results: A total number of 15 specialists physicians acting in a private oncologic clinic in Manaus-AMwere included. Approximately 42.84% of respondents opted to indicate the placement of a nasoenteric feeding tube or a gastrostomy. A large portion of them believed that the patient had the opportunity to treat severe dementia. Conclusions: There is little scientific evidence of the benefits of using artificial feeding in elderly patients with advanced dementia. Further studies are needed in addition to continuing educating initiatives to inform prescribing professionals about the potential related risks of artificial diet at the end of life.
Conference papers on the topic "Dementia Patients Care Case studies"
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Ferretti, Ceres, Ricardo Nitrini, and Sonia Brucki. "VIRTUAL SUPPORT IN DEMENTIA A POSSIBLE VIABLE STRATEGY FOR CAREGIVERS." In XIII Meeting of Researchers on Alzheimer's Disease and Related Disorders. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1980-5764.rpda046.
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Background: In the last 10 months, amid the Covid-19 pandemic, several studies have demonstrated the viability of health education and virtual support strategies for caregivers of dementia patients to provide home care. Low and middle-income countries in particular, have sought to use these approaches to reduce the daily burden of caregivers, through virtual meetings providing education and support. Objectives: To present the feasibility of a pilot study on the use of a care support action under the CAAD Project - indirect costs of dementia – run by the HC-FMUSP. Methods: An observational study of 93 caregivers invited to participate in virtual 1-hour meetings three times a week was conducted. Results: Of the 93 family members who took part, 42 answered the eight questions about the effectiveness of the action after 3 months. The rate of positive responses for program satisfaction was high, ranging from 86% to 100%. Conclusion: The study results of this simple intervention suggest the utility of the program for caregivers of dementia patients in primary care. The intervention can provide a better understanding of difficulties faced by caregivers in their daily care of dementia patients and daily management guidance on a case-by-case basis. The program also promoted the implementation of an education strategy on the importance of understanding and recognizing anatomical-physiological changes in the aging process and their implications for the invisible line between senescence and senility. This process empowers the caregiver to feel able to protect both the patient and themselves by preventing the emergence of common diseases in this age group. Further studies are needed to explore this non-pharmacological support approach.
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Pereira, Marcos, Vannessa Sá, Paulo Henrique Rocha, João Pedro Oliveira, Rafael Amorim, Elvis Silva, Vinícius Delboni, et al. "THE IMPACT OF TREATING REVERSIBLE CAUSES OF COGNITIVE DECLINE: A LONGITUDINAL STUDY IN PRIMARY HEALTH CARE." In XIII Meeting of Researchers on Alzheimer's Disease and Related Disorders. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1980-5764.rpda079.
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Background: Evidence from longitudinal studies points to the syndromic continuum of dementia. Individuals with mild cognitive impairment (MCI) are at increased risk of progressing to dementia over time, as well as older adults with subjective cognitive decline (SCD). Objective: To assess the impact of treating reversible causes of dementia on the outcome of patients with cognitive decline. Methods: Data were collected between 2017 and 2020 (mean follow-up = 44.52 ±6.85 months) in primary health care in Patos de Minas, MG. Subjects were screened using the MMSE, Figure Memory Test, Verbal Fluency, Clock Drawing Test, Geriatric Depression Scale, Geriatric Anxiety Inventory, and the Functional Activities Questionnaire. Results: Of 15 patients with SCD, 26.7% progressed to MCI. Of 45 patients with MCI, 13.4% progressed to dementia, 4.4% died and 26.7% regressed to SCD. Of 31 individuals with dementia, 6.5% regressed to SCD, 22.6% regressed to MCI and 19.4% died. Clinical improvement can be explained by the treatment of reversible causes, such as hypothyroidism, hypovitaminosis B12, and mood and anxiety disorders. Conclusion: Two-thirds of people who meet the criteria for MCI do not convert to dementia during the follow-up. These results reinforce the need of adequate screening and treatment of reversible causes of dementia in the primary care.
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Melo, Isadora Vieira de, Eduardo Guimarães Lacerda, Gustavo de Freitas Mendonça Gontijo, Hugo Haran Souza Andrade, Marlon Séles de Paula, Matheus Fernandes Alves dos Reis, Renato Tales Gomes, et al. "Case report: Takotsubo cardiomyopathy in a patient with Alzheimer’s disease." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.425.
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Context: The Takotsubo cardiomyopathy (TTC) is an acute cardiac dysfunction, clinically similar to myocardial ischemia, more common in postmenopausal women and related to emotional stress. Case report: A 71-year-old female patient, with Alzheimer’s disease (AD), sought emergency care after severe chest pain. Electrocardiogram showed ST segment elevation in the anteroseptal wall. Physical exam: HR=108bpm, PA=126x78mmHg, SaO2=6%. Complementary exams showed a mild lesion in the middle third of the anterior descending artery, moderate impairment of left ventricular (LV) function by apical aneurysm without thrombi, mitral prolapse with mild reflux and an ejection fraction of 37%, suspecting of TTC. Conclusions: TTC is defined as a transient, usually reversible and segmental LV dysfunction, configuring a differential diagnosis of acute coronary syndrome. An overactivation of the sympathetic autonomic nervous system can cause catecholamine toxicity to the heart. Although several studies show a lower emotional response capacity in patients with cognitive impairment, more recent studies suggest that this emotional responsiveness is not so affected by dementia. Therefore, patients with AD may be susceptible to developing TTC, both because of the multiple drugs that they are exposed, increasing catecholamine levels, and because of the disease itself, that represents a stressful context. Thus, TTC is often associated with emotional stress and should not be overlooked in patients with AD.
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Fernandez, Paulo Eduardo Lahoz, Guilherme Diogo Silva, and Eduardo Genaro Mutarelli. "Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I)." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.680.
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Background: Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I). Clinical scales (CS) are important tools for outcome measures in clinical care. However, which CS in FTF-I can be used in teleneurology is unclear. Objectives: Define the most used CS in studies comparing TM with FTF-I in different SON. Design and Setting/Methods: We searched PubMed and Embase for randomized controlled trials, published from 2011 to April 2021, with Key words ‘’telemedicine’’ cross-referenced with ‘’neurology’’ or neurological diseases, considering the synonyms. Results: 43 eligible studies in 400 records, from 12 countries, with 5600 patients and 8 SON: stroke (10), headache (4), epilepsy (6), cognitive disorders (7), demyelinating diseases (8), movement disorders (3), neuromuscular diseases (3), and vestibular diseases (2). The most used CS: National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) for stroke impairment and limitation; Headache Impact Test (HIT-6) and Migraine Disability Assessment Scale (MIDAS) for headache disability; Quality Of Life in Epilepsy Inventory (QOL-31) for seizure burden; Mini-Mental State Exam (MMSE) and Zarit Burden Interview (ZBI) for cognitive function and caregiver burden in dementia care; Expanded Disability Status Scale (EDSS) and Fatigue Impact Scale (FIS) for disability and fatigue in Multiple Sclerosis; Parkinson’s disease Questionnaire (PDQ-39) and Unified Parkinson’s Disease Rating Scale (UPDRS) for QOL and disability in PD; Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) for severity in ALS; and Vertigo Symptom Scale Short form (VSS-SF) for vertigo. Conclusions: We present feasible CS usually applied in teleneurology that can be used as important tools for future findings in TM research and practice.
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Luís-Ferreira, Fernando, João Gião, Pedro Corista, Jorge Calado, and Joao Sarraipa. "Monitoring, Risk Assessment and Actuation for Alzheimer Patients: A Case Study." In ASME 2018 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2018. http://dx.doi.org/10.1115/imece2018-88166.
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Alzheimer is one of the most frequent types of dementia. With the increasing extension of life expectancy, and an increasing incidence above sixty-five years. Near to thirteen million cases are foreseen in 2050 with an estimate cost above two hundred billion dollars in associated care expenses. It becomes important to take measures to ensure quality of life to patients, carers and promote the sustainability of public and personal finances. The major concerns with those patients are memory faults with the tendency for wandering and get lost. The present work proposes a solution for permanent monitoring, risk assessment and reaction, when needed, while extending battery autonomy for the worn device. Data is periodically uploaded to be processed and analysed in a remote infrastructure such as FIWARE. The aim is to establish profiles that better adapt to each citizen of the evergrowing community of dementia patients, including those with Alzheimer disease.
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Guerra, Leonardo Cortez, Alessandra Luiza Lara Poloni, and Marcela Maria Mattos Almeida. "Multidisciplinary Care in Huntington’s Disease: Case Report." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.463.
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Context: Huntington’s disease (HD) is a degenerative neurological disorder with autosomal dominant inheritance resulting from the loss of GABAergic neurons in the striatum. The prevalence of HD is 10.6 to 13.7 individuals per 100,000 in the Western population. Case report: DRO is a 57- year-old female admitted to a Long-Term Care Facility in 2018 due to the diagnosis of Huntington’s Disease (HD) four years ago. The patient presented right-side hemiplegia, choreic movements in the upper extremities, postural instability, dysarthria, visual hallucinations, behavioral changes, alert and communicative. During institutionalization, the occupational therapist, physical therapist and the speech therapist performed cognitive stimulation activities, motor physiotherapy with balance training, gait and muscle strengthening, interventions for dysarthria and dysphagia prevention. After a year, there was a disease progression with episodes of fall and deterioration of choreic movements, cognitive function and coordination; then, the physical therapist intensified motor rehabilitation and bracing in the left hand in the occupational therapy sessions due to the onset of deformities. In 2020, the patient reported stabilizing her clinical condition and continued the rehabilitation sessions. Conclusions: Physiotherapeutic interventions demonstrated improvement in muscle strength and gait in HD patients. However, the results are heterogeneous due to the morbidity and phenotypic variety of the disease. The response to occupational therapy and speech therapy lacks previous studies on this disease. Thus, the multidisciplinary therapeutic approach is indicated due to its importance in the patient’s overall assessment and prevention of comorbidities.
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Fatu, Ana Maria, Ana-Maria Pâslaru, Cristina Stefanescu, Iulia Chiscop, Stefana Maria Moisa, Ciprian Adrian Dinu, Valerica Creangă-Zărnescu, Madalina Matei, Gabriela Balan, and Anamaria Ciubara. "THE PREVENTION OF DEMENTIA BEFORE AND AFTER STROKE." In The European Conference of Psychiatry and Mental Health "Galatia". Archiv Euromedica, 2023. http://dx.doi.org/10.35630/2022/12/psy.ro.22.
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Introduction: Dementia is an important public health problem, the only cause of death that can not be treated or cured. The number of people who are diagnosed with dementia is increasing, over 55 million patients in 2021(about 5% of the world population), more than that a new case is diagnosed every 3 seconds, according World Health Organization. Prevalence of dementia is increasing, both before and after stroke. Aim: The purpose of this paper is to emphasize the importance of early identification of the risk factors associated with cognitive decline and the role of the complex health care approach. Method: The retroactive study involved analyzing the medical record of 60 subjects with stroke and cognitive impairments, hospitalized between july -december 2021. Furthermore we searched the latest PubMed database and Cochrane Library regarding the risk factors common for this two pathologies. The outcome showed that more women are affected by this debilitating disease, of which 72% were over 80 years old. The following modifiable risk factors were identified: 63% of patients had hypertension, 42% had recurrent stroke, 37% atrial fibrillation, 26% type II diabetes, 22% dyslipidemia, and 10% obesity. It is believed that one third of cases can be prevented by early identification of risk factors, especially cardiovascular, and by increasing the efficiency recovery after stroke. This can be done before the onset of the disease, growing the mental and emotional health, specificaly the cognitive abilitiy, including the executive function and the memory of people prone to neurodegeneration or cerebrovascular lesions. In elderly subjects, healthy diet, moderate physical activity, chronic stress reduction, social interaction along with improvement in cardiovascular risk factors, could be considered the first line of defense against the development and progression of dementia. Conclusions: The pathological process begins long before it manifests itself clinically, thus providing the opportunity to identify or combat the prodromal stages of the disease forward. We recommend multifactorial intervention to prevent cognitive impairment and dementia.
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Coles, Garill A. "Prospective System Assessments Used to Enhance Patient Safety: Case Studies From a Collaboration of Engineers and Hospitals in Southwest Washington State." In ASME 2007 International Mechanical Engineering Congress and Exposition. ASMEDC, 2007. http://dx.doi.org/10.1115/imece2007-42740.
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It is no secret that healthcare, in general, has become an increasingly complicated mixture of technical systems, complex processes and intricate skilled human interactions. Patient care processes have followed this same trend. The healthcare industry, itself, has acknowledged that it is fraught with high-risk and error prone processes and cite medication management systems, invasive procedures and diagnostic methods. Complexity represents opportunity for unanticipated events, process failures and undesirable outcomes. Traditionally when a patient care process fails, accountability was focused on the individual clinician error. However, increasing, healthcare is following the lead of other high-risk industries (e.g. chemical, aerospace, nuclear, etc.) that give attention to the characteristics the overall system that contribute to the failure. The focus has shifted to identification of systemic weaknesses and vulnerabilities. Increasing the healthcare industry is using prospective system assessment methods to evaluate the high-risk systems and processes. This paper describes results of collaboration between engineers and community hospitals in Southwest Washington State between 2002 and 2007 in applying prospective system assessment methods to a range of the high-risk healthcare systems and processes. The methods used are Failure Mode Effects and Criticality Analysis and Probabilistic Risk Assessment. The two case studies presented are: 1) an interhospital FMEA on patient transfer and 2) a risk assessment of mental health patients who present themselves in a hospital Emergency Department.
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Kawaguchi, Yaeko, and Yasunobu Ito. "The Invisible Work and its Value of Outpatient Nurses: A Case Study of an Internal Medicine Clinic in Fukuoka, Japan." In 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002551.
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In recent years, the environment surrounding medical care in Japan has been changing drastically with the development and sophistication of medical care and the declining birthrate and aging of the population. In response to the changes in medical care, nurses are now required to provide high quality direct care to patients with various diseases and living environments. For this reason, work that does not involve patients, such as clerical work, has been regarded as less valuable as a nurse’s job. However, in practice, many of the nurses’ jobs do not involve patients. These jobs are not valued by society and the nursing community, making them “invisible”. In order to visualize the nurses' work based on facts, it is necessary to clarify the invisible work of nurses and its value. Until now, there have been a few ethnographic studies that have attempted to reveal the invisible work of Japanese nurses. The purpose of this paper is to clarify the invisible work of outpatient nurses and what their value is through a case study of an internal medicine clinic in Japan. As a result of the study, it was found that outpatient nurses not only assist with medical treatment, which is defined by law as nurses’ work, but they play an important role in the functioning of outpatient clinics by performing other duties. This is where the value of the invisible work performed by outpatient nurses is thought to exist.
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Nagy, Diána. "Possibilities of Digitalization and Service Design in the Development of Patient Adherence." In New Horizons in Business and Management Studies. Conference Proceedings. Corvinus University of Budapest, 2021. http://dx.doi.org/10.14267/978-963-503-867-1_05.
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In parallel with the development of modern health systems and the growth of the welfare state, diseases have shifted towards chronic diseases. Today, instead of rapid-onset infections, most resources are focused on the long-term treatment of mostly lifelong chronic conditions. The condition for the effective use of therapies is to take the specified dose with the prescribed frequency and for the required period of time. If these parameters are met, we can talk about patient collaboration or adherence. For certain diseases and treatments, adherence is critically low. In the case of complex preparations to be taken several times a day, or diseases that do not cause serious, noticeable complaints, the initial number of patients treated is reduced to a fraction within a short time. As a result, economic harm is perceived not only by the patient but also by all those involved in the health care system, including pharmaceutical companies. However, the factors influencing patient collaboration vary widely. In order to achieve high adherence, the goal is to develop health services that coordinate the actors involved, the infrastructure, the communication, the material components to improve the user experience. As a user-centered methodology, service design can play a prominent role in the design of therapeutic services, contributing to the reduction of uncertainties in innovation processes. In my study, I assess the digital toolkit of patient education in Hungarian society. The aim is to explore digital tools and technologies that can contribute to the development of health awareness and education so that both science and the pharmaceutical and technology companies that exploit it can apply the results of research.
Reports on the topic "Dementia Patients Care Case studies"
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Madu, Laura, Jacqueline Sharp, and Bobby Bellflower. Efficacy of Integrating CBT for Mental Health Care into Substance Abuse Treatment in Patients with Comorbid Disorders of Substance Abuse and Mental Illness. University of Tennessee Health Science Center, April 2021. http://dx.doi.org/10.21007/con.dnp.2021.0004.
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Abstract: Multiple studies have found that psychiatric disorders, like mood disorders and substance use disorders, are highly comorbid among adults with either disorder. Integrated treatment refers to the treatment of two or more conditions and the use of multiple therapies such as the combination of psychotherapy and pharmacotherapy. Integrated therapy for comorbidity per numerous studies has consistently been superior to the treatment of individual disorders separately. The purpose of this QI project was to identify the effectiveness of Cognitive Behavioral Therapy (CBT) instead of current treatment as usual for treating Substance Use Disorder (SUD) or mental health diagnosis independently. It is a retrospective chart review. The review examines CBT's efficacy for engaging individuals with co-occurring mood and substance u se disorders in treatment by enhancing adherence and preventing disengagement and relapse. Methods: Forty adults aged 26-55 with a DSM-IV diagnosis of a mood disorder of Major Depressive Disorder and/or anxiety and concurrent substance use disorder (at least weekly use in the past month). Participants received 12 sessions of individual integrated CBT treatment delivered with case management over a 12-week period. Results: The intervention was associated with significant improvements in mood disorder, substance use, and coping skills at 4, 8, and 12 weeks post-treatment. Conclusions: These results provide some evidence for the effectiveness of the integrated CBT intervention in individuals with co-occurring disorders. Of note, all psychotherapies are efficacious; however, it would be more advantageous to develop a standardized CBT that identifies variables that facilitate treatment outcomes specifically to comorbid disorders of substance use and mood disorders. It is concluded that there is potentially more to be gained from further studies using randomized controlled designs to determine its efficacy.
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Jalil, Yorschua, and Ruvistay Gutierrez. Myokines secretion and their role in critically ill patients. A scoping review protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, September 2021. http://dx.doi.org/10.37766/inplasy2021.9.0048.
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Review question / Objective: 1-How and by which means stimulated muscle from critically ill patients can liberate myokines?, 2-Which are the main characteristics of the critically ill population studied and if some of these influenced myokine´s secretion?, 5-Can myokines exert local or distant effects in critically ill patients?, 5-Which are the potential effects of myokines in critically ill patients? Eligibility criteria: Participants and context: We will include primary studies (randomized or non-randomized trials, observational studies, case series or case report) that consider hospitalized critically ill adult patients (18 years or older) in risk for developing some degree of neuromuscular disorders such as ICU-AW, diaphragmatic dysfunction, or muscle weakness, therefore the specific setting will be critical care. Concept: This review will be focused on studies regarding the secretion or measure of myokines or similar (exerkines, cytokines or interleukin) by any mean of muscle activation or muscle contraction such as physical activity, exercise or NMES, among others. The latter strategies must be understood as any mean by which muscle, and there for myocytes, are stimulated as result of muscle contraction, regardless of the frequency, intensity, time of application and muscle to be stimulated (upper limb, lower limb, thoracic or abdominal muscles). We also will consider myokine´s effects, local or systemic, over different tissues in terms of their structure or function, such as myocytes function, skeletal muscle mass and strength, degree of muscle wasting or myopathies, among others.
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James-Scott, Alisha, Rachel Savoy, Donna Lynch-Smith, and tracy McClinton. Impact of Central Line Bundle Care on Reduction of Central Line Associated-Infections: A Scoping Review. University of Tennessee Health Science Center, November 2021. http://dx.doi.org/10.21007/con.dnp.2021.0014.
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Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use. Methods A literature review was completed of nine critically appraised articles from the years 2010-2021. The association of the use of central line bundles and CLABSI rates was examined. These relationships were investigated to determine if the adherence to a central line bundle directly reduced the number of CLABSI rates in critically ill adult patients. A summary evaluation table was composed to determine the associations related to the implementation or current central line bundle care use. Results Of the study sample (N=9), all but one demonstrated a significant decrease in CLABSI rates when a central line bundle was in place. A trend towards reducing CLABSI was noted in the remaining article, a randomized controlled study, but the results were not significantly different. In all the other studies, a meta-analysis, randomized controlled trial, control trial, cohort or case-control studies, and quality improvement project, there was a significant improvement in CLABSI rates when utilizing a central line bundle. The extensive use of different levels of evidence provided an excellent synopsis that implementing a central line bundle care would directly affect decreasing CLABSI rates. Implications for Nursing Practice Results provided in this scoping review afforded the authors a diverse level of evidence that using a central line bundle has a direct outcome on reducing CLABSI rates. This practice can be implemented within the hospital setting as suggested by the literature review to prevent or reduce CLABSI rates. Implementing a standard central line bundle care hospital-wide helps avoid this hospital-acquired infection.
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Candrilli, Sean D., and Samantha Kurosky. The Response to and Cost of Meningococcal Disease Outbreaks in University Campus Settings: A Case Study in Oregon, United States. RTI Press, October 2019. http://dx.doi.org/10.3768/rtipress.2019.rr.0034.1910.
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Invasive meningococcal disease (IMD) is a contagious bacterial infection that can occur sporadically in healthy individuals. Symptoms are typically similar to other common diseases, which can result in delayed diagnosis and treatment until patients are critically ill. In the United States, IMD outbreaks are rare and unpredictable. During an outbreak, rapidly marshalling the personnel and monetary resources to respond is paramount to controlling disease spread. If a community lacks necessary resources for a quick and efficient outbreak response, the resulting economic cost can be overwhelming. We developed a conceptual framework of activities implemented by universities, health departments, and community partners when responding to university-based IMD outbreaks. Next, cost data collected from public sources and interviews were applied to the conceptual framework to estimate the economic cost, both direct and indirect, of a university-based IMD outbreak. We used data from two recent university outbreaks in Oregon as case studies. Findings indicate a university-based IMD outbreak response relies on coordination between health care providers/insurers, university staff, media, government, and volunteers, along with many other community members. The estimated economic cost was $12.3 million, inclusive of the cost of vaccines ($7.35 million). Much of the total cost was attributable to wrongful death and indirect costs (e.g., productivity loss resulting from death). Understanding the breadth of activities and the economic cost of such a response may inform budgeting for future outbreak preparedness and development of alternative strategies to prevent and/or control IMD.
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Tipton, Kelley, Brian F. Leas, Nikhil K. Mull, Shazia M. Siddique, S. Ryan Greysen, Meghan B. Lane-Fall, and Amy Y. Tsou. Interventions To Decrease Hospital Length of Stay. Agency for Healthcare Research and Quality (AHRQ), September 2021. http://dx.doi.org/10.23970/ahrqepctb40.
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Background. Timely discharge of hospitalized patients can prevent patient harm, improve patient satisfaction and quality of life, and reduce costs. Numerous strategies have been tested to improve the efficiency and safety of patient recovery and discharge, but hospitals continue to face challenges. Purpose. This Technical Brief aimed to identify and synthesize current knowledge and emerging concepts regarding systematic strategies that hospitals and health systems can implement to reduce length of stay (LOS), with emphasis on medically complex or vulnerable patients at high risk for prolonged LOS due to clinical, social, or economic barriers to timely discharge. Methods. We conducted a structured search for published and unpublished studies and conducted interviews with Key Informants representing vulnerable patients, hospitals, health systems, and clinicians. The interviews provided guidance on our research protocol, search strategy, and analysis. Due to the large and diverse evidence base, we limited our evaluation to systematic reviews of interventions to decrease hospital LOS for patients at potentially higher risk for delayed discharge; primary research studies were not included, and searches were restricted to reviews published since 2010. We cataloged the characteristics of relevant interventions and assessed evidence of their effectiveness. Findings. Our searches yielded 4,364 potential studies. After screening, we included 19 systematic reviews reported in 20 articles. The reviews described eight strategies for reducing LOS: discharge planning; geriatric assessment or consultation; medication management; clinical pathways; inter- or multidisciplinary care; case management; hospitalist services; and telehealth. All reviews included adult patients, and two reviews also included children. Interventions were frequently designed for older (often frail) patients or patients with chronic illness. One review included pregnant women at high risk for premature delivery. No reviews focused on factors linking patient vulnerability with social determinants of health. The reviews reported few details about hospital setting, context, or resources associated with the interventions studied. Evidence for effectiveness of interventions was generally not robust and often inconsistent—for example, we identified six reviews of discharge planning; three found no effect on LOS, two found LOS decreased, and one reported an increase. Many reviews also reported patient readmission rates and mortality but with similarly inconsistent results. Conclusions. A broad range of strategies have been employed to reduce LOS, but rigorous systematic reviews have not consistently demonstrated effectiveness within medically complex, high-risk, and vulnerable populations. Health system leaders, researchers, and policymakers must collaborate to address these needs.
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Gutierrez-Arias, Ruvistay, Ximena Neculhueque-Zapata, Raul Valenzuela-Suazo, and Pamela Seron. Assessing people's functioning through rehabilitation registries systems. A rapid scoping review protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, February 2022. http://dx.doi.org/10.37766/inplasy2022.2.0006.
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Review question / Objective: 1.- To systematize the available scientific evidence on rehabilitation models and rehabilitation registries systems, which allow for the assessment of people's functioning; 2.- To describe rehabilitation data registries systems used internationally and the "minimum data set" that relate to the functioning of persons. Eligibility criteria: - Population: Studies that have enrolled adult or paediatric patients, with any condition or pathology that could potentially result in low functioning or disability, related to impairments, activity limitation or restriction in participation, according to the International Classification of Functioning, Disability and Health (ICF) framework will be included. - Concept: Studies that submitted data from a rehabilitation registry, bank, or database containing a minimum data set will be included. These registries may include clinical and administrative information that can be used to improve the quality of care, monitor or answer research questions. - Context: Studies that have been conducted in a context of rehabilitation programs and assessment of function or disability, at any level of care, and that have directly or indirectly addressed aspects or variables that can account for functioning, capacity, or participation according to the ICF framework will be included. The inclusion of studies will not be limited by their methodological design, since they will be used to identify rehabilitation registries or databases, so primary studies (cohort studies, case-control studies, among others) and secondary studies (systematic reviews, exploratory reviews, among others) will be considered.
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Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, Ahmed Hassoon, Najlla Nassery, Donna Parizadeh, Lisa M. Wilson, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2022. http://dx.doi.org/10.23970/ahrqepccer258.
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Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.
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Egypt: Expand access to postabortion care. Population Council, 2000. http://dx.doi.org/10.31899/rh2000.1023.
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The Population Council has supported a series of studies to improve the quality of postabortion care (PAC) in Egypt. A 1994 pilot study in two Egyptian hospitals showed that upgrading PAC and training physicians in manual vacuum aspiration (MVA), infection control, and counseling led to significant improvements in the care of postabortion patients. The 1997 study, conducted by the Egyptian Fertility Care Society with support from the Population Council, sought to institutionalize improved postabortion medical care and counseling procedures in ten hospitals. Five senior physicians from each hospital attended a five-day training course in MVA, infection control, and family planning (FP) counseling. The physicians then supervised four months of on-the-job training of doctors and nurses at the ten hospitals. A case management protocol, including emergency medical treatment, pain control, and FP counseling, was also introduced. As reported in this brief, training providers and introducing a case management protocol led to improved PAC at ten government and teaching hospitals in Egypt.