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Gill, Michael. "Managing patients in care homes". InnovAiT: Education and inspiration for general practice 13, n.º 2 (13 de janeiro de 2020): 102–8. http://dx.doi.org/10.1177/1755738019890118.
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Older people in care homes deserve the best health and social care we can offer. Their care needs are usually high and they are vulnerable either physically, cognitively or both. They are likely to have several long-term conditions and be in the last year or so of life. Although some may have families and friends supporting them with regular visits and advocacy, others may be more alone and socially isolated. Care homes are traditionally classed as either residential homes or nursing homes, with some being dual registered. The main difference is the presence of 24-hour on-site qualified nursing support in nursing homes. This means that, in general, the residents of nursing homes are more dependent and complex. This article will first describe how to approach the planning and delivery of primary care services to nursing homes, and then consider some of the most common problems and conditions. Much of this also applies to residential home residents.
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Martínez-Redondo, Javier, Carles Comas, Cristina García-Serrano, Montserrat Crespo-Pons, Pilar Biendicho Palau, Teresa Vila Parrot, Francisco Reventoz Martínez et al. "Population Older than 69 Had Similar Fatality Rates Independently if They Were Admitted in Nursing Homes or Lived in the Community: A Retrospective Observational Study during COVID-19 First Wave". Geriatrics 8, n.º 3 (28 de abril de 2023): 48. http://dx.doi.org/10.3390/geriatrics8030048.
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The aim of this study is to assess the influence of living in nursing homes on COVID-19-related mortality, and to calculate the real specific mortality rate caused by COVID-19 among people older than 20 years of age in the Balaguer Primary Care Centre Health Area during the first wave of the pandemic. We conducted an observational study based on a database generated between March and May 2020, analysing COVID-19-related mortality as a dependent variable, and including different independent variables, such as living in a nursing home or in the community (outside nursing homes), age, sex, symptoms, pre-existing conditions, and hospital admission. To evaluate the associations between the independent variables and mortality, we calculated the absolute and relative frequencies, and performed a chi-square test. To avoid the impact of the age variable on mortality and to assess the influence of the “living in a nursing home” variable, we established comparisons between infected population groups over 69 years of age (in nursing homes and outside nursing homes). Living in a nursing home was associated with a higher incidence of COVID-19 infection, but not with higher mortality in patients over 69 years of age (p = 0.614). The real specific mortality rate caused by COVID-19 was 2.270/00. In the study of the entire sample, all the comorbidities studied were associated with higher mortality; however, the comorbidities were not associated with higher mortality in the infected nursing home patients group, nor in the infected community patients over 69 years of age group (except for neoplasm history in this last group). Finally, hospital admission was not associated with lower mortality in nursing home patients, nor in community patients over 69 years of age.
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Martin, Katy, Laura Johnston e Natalie Archer. "Oral conditions in the community patient: part 2—systemic complications of poor oral health". British Journal of Community Nursing 25, n.º 11 (2 de novembro de 2020): 532–36. http://dx.doi.org/10.12968/bjcn.2020.25.11.532.
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Oral health has a symbiotic relationship with general health, with oral disease recognised to have an adverse effect on the overall systemic health of a patient. Deterioration in oral health has been shown to have an impact on the severity of chronic systemic diseases, nutrition, hydration and psychological and social wellbeing. Part 1 of this mini-series explored the common oral conditions that community patients may present with, and the role of the nursing team in aiding the prevention, diagnosis and management of these conditions. Following on from that, this article discusses the links between oral and general health, and preservation of a patient's quality of life. This article also aims to support nurses' knowledge on how to assess the oral health needs of patients, support oral care provision, how to access acute and elective dental services and signpost to additional supportive resources.
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Chayati, Nur, Christantie Effendy e Ismail Setyopranoto. "Validity and reliability testing of home care stroke quality indicators". International Journal of Public Health Science (IJPHS) 10, n.º 4 (1 de dezembro de 2021): 873. http://dx.doi.org/10.11591/ijphs.v10i4.20846.
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<p>It is disconcerting that until today there are no agencies or research to recommend the appropriate indicators of home nursing care of stroke patients according to Indonesian conditions. Hence, this research aimed to verify the validity and reliability of quality indicators of home nursing care for stroke patient that resulted from Delphy process. Confirmatory factor analysis was carried out for validity and reliability testing with data collected from 350 respondents. Based on the value of loading factors, 62 indicators were declared valid and five indicators were invalid. This study successfully proved the validity of 62 indicators of quality home care for stroke patients. Further research is needed to pilot project this indicator in a larger area.</p>
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Löfgren, Ann-Christine, Gösta Bucht, Sture Eriksson e Bengt Winblad. "A Comparative Study of the Social Conditions of Spouses of Long Term Patients Cared For Either in Nursing Homes or Home Care". Scandinavian Journal of Caring Sciences 6, n.º 1 (março de 1992): 45–52. http://dx.doi.org/10.1111/j.1471-6712.1992.tb00122.x.
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Arensberg, Mary Beth, Cory Brunton, Susan Drawert e Brenda Richardson. "Prevalence Rates and Characteristics of Malnutrition, Frailty, and Other Nutrition and Muscle Mass-Related Conditions Document Potential Quality of Care Gap for Medicare Patients in US Skilled Nursing Facilities". Geriatrics 7, n.º 2 (31 de março de 2022): 42. http://dx.doi.org/10.3390/geriatrics7020042.
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Changes to the payment structure of the United States (U.S.) healthcare system are leading to an increased acuity level of patients receiving short-term skilled nursing facility care. Most skilled nursing facility patients are older, and many have medical conditions that cannot be changed. However, conditions related to nutrition/muscle mass may be impacted if there is early identification/intervention. To help determine the diagnosis and potential impact of nutrition/muscle mass-related conditions in skilled nursing facilities, this study evaluated 2016–2020 US Medicare claims data. Methods aimed to identify a set of skilled nursing facility claims with one or more specific diagnoses (COVID-19, malnutrition, sarcopenia, frailty, obesity, diabetes, and/or pressure injury) and then to determine length of stay, discharge status, total charges, and total payments for each claim. Mean values per beneficiary were computed and between–group comparisons were performed. Results documented that each year, the total number of Medicare skilled nursing facility claims declined, whereas the percentage of claims for each study diagnosis increased significantly. For most conditions, potentially related to nutrition/muscle mass, Medicare beneficiaries had a shorter length of skilled nursing facility stays compared to those without the condition(s). Furthermore, a lower percentage of these Medicare beneficiaries were discharged home (except for those with claims for sarcopenia and obesity). Total claim charges for those with nutrition/muscle mass-related conditions exceeded those without (except for those with sarcopenia). We conclude that although the acuity level of patients in skilled nursing facilities continues to increase, skilled nursing facility Medicare claims for nutrition/muscle mass-related conditions are reported at lower levels than their likely prevalence. This represents a potential care gap and requires action to help improve patient health outcomes and skilled nursing facility quality metrics.
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Hickman, Susan, Edward Miech, Timothy Stump, Laramie Mack, Wanzhu Tu e Kathleen Unroe. "CONDITIONS ASSOCIATED WITH SUCCESSFUL IMPLEMENTATION OF AN ADVANCE CARE PLANNING INTERVENTION IN NURSING HOMES". Innovation in Aging 7, Supplement_1 (1 de dezembro de 2023): 1009–10. http://dx.doi.org/10.1093/geroni/igad104.3244.
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Abstract Implementing evidence-based interventions in nursing homes is challenging in part because clinical trials requiring a controlled experimental environment are difficult to sustain. In contrast, pragmatic clinical trials develop and evaluate evidence-based interventions in the “real world” with the goal of streamlining implementation after study completion. However, there is minimal information available identifying conditions associated with successful implementation of pragmatic interventions in the nursing home setting. The “Aligning Patient Preferences - a Role Offering Alzheimer’s patients, Caregivers, and Healthcare Providers Education and Support” (APPROACHES) project is a pragmatic trial designed to test and evaluate a staff-led advance care planning (ACP) intervention for residents with ADRD in 131 nursing homes (64 intervention, 67 control) between September 1, 2021 and August 31, 2022. ACP Specialists received training on ACP facilitation and implementation of the ACP program in the facility. Twenty of 65 (31%) sites successfully implemented the APPROACHES intervention and had > 75% of residents with documented ACP conversations. Using configurational analysis, we found two solutions directly linked with successful pragmatic implementation: (1) no executive director turnover during the observation period combined with site participation in monthly intervention support calls with ACP staff at other facilities; and (2) higher rates of hospitalization (3.96 – 7.2 per 1000 resident days) combined with a low number of certified beds. Findings suggest that leadership stability and engagement with peers were essential drivers of successful implementation. Having greater improvement opportunities as well as a more manageable caseload for the ACP Specialist may also help explain successful implementation.
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Rojo, Á., e E. Fernandez. "Towards an improvement of medical and psychological care in a nursing home". European Psychiatry 26, S2 (março de 2011): 850. http://dx.doi.org/10.1016/s0924-9338(11)72555-x.
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IntroductionValle Inclán Nursing Home is a multifunctional centre of Gerontology, that offers social and health services to elderly people, either with physical independence or with physical and psychic disabilities. Mental illness is studied from a multidisciplinary point of view, and these different therapeutic programs are implemented: psychological support for adjustment disorders, cognitive-behavioural therapy for mood disorders and overall medical examination of dementia. The total sample of patients that are studied is 445, chronologically distributed according the next data: N: 234 (2006), N: 264 (2007), N: 258 (2008) y N: 243 (2009).ObjectivesTo know the prevalence of the main psychiatric pathologies and to compare to data found in scientific literature.To find data that can be used in order to improve the quality of medical care and psychosocial attention.MethodThe prevalence of different psychiatric conditions treated by this mental health department, and the variation of these data for the last four years are showed. These data are compared with those in scientific literature.ResultsMental illness prevalence distribution is similar to the prevalence that is found in scientific literature. Dementia is the most prevalent pathology, and mood disorders are in the second place.ConclusionsThe decrease in the prevalence of mood disorders is probably on account of the implementation of specific psychotherapeutic programs. An increase in the prevalence of dementia can be explained by the improvement of screening of this illness and/or the increasing social request for admission to these nursing homes.
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Shoaib, Muhammad. "Social and Cultural Norms; Still a Resistance to Nursing Care Homes for Older Patients in KPK, Pakistan". National Journal of Health Sciences 8, n.º 4 (28 de dezembro de 2023): 142–43. http://dx.doi.org/10.21089/njhs.84.0142.
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Abstract: The percentage of the elderly population is increasing worldwide. The same trend is also observed in Pakistan. The elderly face many health problems in their advanced age. Elderly those who have chronic conditions like stroke need special and long-term care. So, for the provision of long-term care nursing care homes are crucial in a community. But, unfortunately in the province of Khyber Pakhtunkhwa, there is strong resistance to nursing care homes due to cultural and social norms.
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Carrasco-Ribelles, Lucía A., Margarita Cabrera-Bean, Marc Danés-Castells, Edurne Zabaleta-del-Olmo, Albert Roso-Llorach e Concepción Violán. "Contribution of Frailty to Multimorbidity Patterns and Trajectories: Longitudinal Dynamic Cohort Study of Aging People". JMIR Public Health and Surveillance 9 (27 de junho de 2023): e45848. http://dx.doi.org/10.2196/45848.
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Background Multimorbidity and frailty are characteristics of aging that need individualized evaluation, and there is a 2-way causal relationship between them. Thus, considering frailty in analyses of multimorbidity is important for tailoring social and health care to the specific needs of older people. Objective This study aimed to assess how the inclusion of frailty contributes to identifying and characterizing multimorbidity patterns in people aged 65 years or older. Methods Longitudinal data were drawn from electronic health records through the SIDIAP (Sistema d’Informació pel Desenvolupament de la Investigació a l’Atenció Primària) primary care database for the population aged 65 years or older from 2010 to 2019 in Catalonia, Spain. Frailty and multimorbidity were measured annually using validated tools (eFRAGICAP, a cumulative deficit model; and Swedish National Study of Aging and Care in Kungsholmen [SNAC-K], respectively). Two sets of 11 multimorbidity patterns were obtained using fuzzy c-means. Both considered the chronic conditions of the participants. In addition, one set included age, and the other included frailty. Cox models were used to test their associations with death, nursing home admission, and home care need. Trajectories were defined as the evolution of the patterns over the follow-up period. Results The study included 1,456,052 unique participants (mean follow-up of 7.0 years). Most patterns were similar in both sets in terms of the most prevalent conditions. However, the patterns that considered frailty were better for identifying the population whose main conditions imposed limitations on daily life, with a higher prevalence of frail individuals in patterns like chronic ulcers &peripheral vascular. This set also included a dementia-specific pattern and showed a better fit with the risk of nursing home admission and home care need. On the other hand, the risk of death had a better fit with the set of patterns that did not include frailty. The change in patterns when considering frailty also led to a change in trajectories. On average, participants were in 1.8 patterns during their follow-up, while 45.1% (656,778/1,456,052) remained in the same pattern. Conclusions Our results suggest that frailty should be considered in addition to chronic diseases when studying multimorbidity patterns in older adults. Multimorbidity patterns and trajectories can help to identify patients with specific needs. The patterns that considered frailty were better for identifying the risk of certain age-related outcomes, such as nursing home admission or home care need, while those considering age were better for identifying the risk of death. Clinical and social intervention guidelines and resource planning can be tailored based on the prevalence of these patterns and trajectories.
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Fletcher, Nicholas, Lydia Vallance, Julie Riley, Andrew Nicolson e Martin Wilson. "026 The walton centre integrated neurology nurse service". Journal of Neurology, Neurosurgery & Psychiatry 90, n.º 12 (14 de novembro de 2019): A17.1—A17. http://dx.doi.org/10.1136/jnnp-2019-abn-2.54.
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A training program was developed for an integrated neurology nurse service (INNS) dealing with common issues in long term neurological conditions, particularly Parkinson’s disease, MS, epilepsy and MND. After a successful pilot scheme, the INN team was increased from one to seven nurses. From 2017 to 2018, 1452 patients were seen in INN community clinics and 937 at home. Each week, INNs provided 34 clinics at 27 community locations plus 13 telephone clinics and (where necessary) domiciliary and care/nursing home visits. INNs also visit 7 local A&E departments to advise on pathway utilisation, neurological management and offer clinical review of frequent neurological attenders. Training (for example emergency management of seizures) is also provided in the community. INNs liaise with other agencies regarding social care, appliances, physiotherapy, occupational therapy, speech and language therapy, continence services or district nursing. They can also quickly obtain advice from the patient’s WCFT consultant. The INNS was well received; 96% of patients were satisfied or very satisfied with their experience; 67% that the INNS empowered them to make decisions about their health care; 86% that the INNS strengthened shared decision making; 96% reported increased physical and emotional support and 82% that the INNS helped communication between patients and specialist neurology nurses. INNs can work effectively in the community to support patients and reduce demand on primary and secondary care.
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Šakienė, Lina, Natalja Istomina e Sanna Salantera. "ATTITUDE OF THE PATIENTS WITH DIGESTIVE TRACT SURGERY TOWARDS INFORMATION NEEDS DURING THE PERIOPERATIVE CARE". Sveikatos mokslai 24, n.º 5 (20 de fevereiro de 2014): 26–30. http://dx.doi.org/10.5200/sm-hs.2014.088.
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In Lithuania, still not enough attention is paid to patients who are under the conditions of digestive tract surgery, perioperative rehabilitation and social integration. There is a lack of reasonable patient-oriented disease-related information about procedures, problems, complications and vital skills for hospitalized and discharged patients to obtain. Realizing what these patients know, need to know and from whom they should receive information is essential to ensure both quality care and decent everyday life. The purpose of the study was to explore patients’ information needs before or after digestive tract surgery in order to find out the ways how to met those needs. Methods. Qualitative descriptive study design was conducted. Patients over 18 age old (n-52) have participated in the interview during their hospitalisation. Data were collected in three big Klaipeda city hospitals. Data were analyzed by using content analysis and SPSS (IBM SPSS Statistics 20) analysis. All ethical standards were obtained. Results: patients lack knowledge about nursing and treatment; they would like to be included in the processes of nursing and treatment. Patients are not included in nursing planning process. Patients would like to have the opportunity to choose nursing and treatment. Patients need information about their disease symptoms management and self-care at home after surgery. Patients should be provided with all important information in writing. Conclusion. According to patients with digestive tract surgery, they do not but they would like to get information as well as be involved in the process of making solutions concerning their nursing and treatment. Developing recommendations the medical staff (nurses and physicians) should take into account their need for information and the opportunity to choose their nursing and treatment.
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Szatkowska, Karolina. "Burden among family caregivers of mechanically-ventilated patients". Psychiatria i Psychologia Kliniczna 20, n.º 4 (31 de dezembro de 2020): 291–97. http://dx.doi.org/10.15557/pipk.2020.0036.
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The constant progress of medicine makes it possible to create safe and comfortable conditions for home treatment for mechanically ventilated patients with chronic respiratory failure. The specificity of such care presents caregivers with challenges related to many nursing and organizational activities. Caring for patients using respiratory therapy is associated with taking responsibility for its course, reorganising everyday life and changing the way of performing the current roles, including limiting social roles. Therefore, it requires caregivers to be able to cope with various, very often new tasks, which can be physically and mentally burdening. The burden of care is the entirety of experiences and difficulties that a family member encounters when caring for a loved one. The article aims to characterise the concept of the feeling of being burdened with care and to present a research review showing its specificity in the group of caregivers of mechanically ventilated patients in a home setting. Also, the study will present research reports indicating a group of factors that may increase this negative consequence of care. The risk factors include health deterioration in the mechanically ventilated person and the decreasing level of patient’s independent functioning, as well as factors associated with the mechanical ventilation used: the method of ventilation (invasive vs. non-invasive), longer time of using the ventilator per day and the total duration of mechanical ventilation as a treatment method. Moreover, the results of the research conducted so far indicate that the burden among caregivers of these patients may manifest in all spheres of life: emotional, cognitive, somatic and social.
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Heidari, Mohammad, Parviz Nadimi Harandi, Jaefar Moghaddasi, Soleiman Kheiri e Amirhossein Azhari. "Effect of Home-Based Cardiac Rehabilitation Program on Self-Efficacy of Patients With Implantable Cardioverter Defibrillator". SAGE Open Nursing 9 (janeiro de 2023): 237796082311664. http://dx.doi.org/10.1177/23779608231166473.
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Introduction For more effective control and treatment of cardiac dysrhythmias caused by diseases, ischemia, or other causes, an implantable cardioverter defibrillator (ICD) is used. One of the effective ways for secondary prevention is the home-based cardiac rehabilitation (HBCR) which nurses have an effective role in its implementation. Objective The study aimed to investigate the effect of implementing HBCR programs on the self-efficacy of patients with ICD. Methods This is a semi-experimental study conducted on 70 patients who received ICD in Shahid Chamran Heart Center of Isfahan University of Medical Sciences (IUMS) in 2021. The patients were randomly assigned to intervention and control groups and were introduced to the practical concepts of HBCR during four training sessions. In the following, 3-month follow-up and trainings were continued by home visits, telephone follow-up, and use of social messaging networks due to the conditions of coronavirus disease 2019 (COVID-19) pandemic. The data were analyzed with SPSS/21. Results The findings showed that performing HBCR programs was effective in improving the self-efficacy of patients with ICDs. A significant trend in the implementation of the HBCR programs in two groups was shown using chi-square test and independent t-test and variance with repeated measurements ( p < .001). There was no significant difference in self-efficacy score in both groups at the beginning of the study ( p < .056). Conclusion Considering the effectiveness of HBCR programs on improving the self-efficacy of patients with ICDs, it can be used in the educational care programs of healthcare workers and in the strategic policies of health care services.
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Barnason, Susan. "FACTORS ASSOCIATED WITH OLDER ADULTS’ READINESS FOR DISCHARGE FROM POST ACUTE CARE TO HOME". Innovation in Aging 7, Supplement_1 (1 de dezembro de 2023): 1039–40. http://dx.doi.org/10.1093/geroni/igad104.3342.
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Abstract Following acute hospitalization, older adults are often transferred to post-acute care (PAC) for rehabilitation and nursing care. Most PAC admissions are comprised of adults with multimorbidity (>2 chronic diseases). After PAC discharge many patients are rehospitalized within 30 days. The goal of this study was to evaluate factors associated with older adult’s readiness for PAC discharge to home. A prospective one-arm descriptive correlation study was conducted. Older adults (N=19) discharged from PAC to home participated. Subjects were recruited over a 3-month period from a large midwestern facility. Participants completed the Patient Readiness for Hospital Discharge -Short Form (PR RHDS-SF) and Patient Activation Measure (PAM). Medication burden, measured by the medication regimen complexity index (MRCI) calculated from discharge medication record. Participants included 12 females and 5 males, mean age of 73 (SD 8.2)) years. The PT RHDS -SF mean score was 49.3 (SD 16.8). The PAM mean score was 54.7 (SD 7.4). Medication burden was high, mean MRCI was 31.5 (SD 11.6). There was a significant correlation [r (17) .48, p=.04] between total PT RHDS-SF score and patient activation levels. Preparing PAC patients to self-manage their multimorbid conditions may enhance their self-confidence with transition from PAC to home. Evaluating self-management preparedness of older adults prior to PAC discharge is vastly understood. Research is needed to prepare multimorbid older adult patients transitioning from PAC to home focused on perceived readiness and self-management confidence.
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SHAFER, DREW, e MELISSA MILLER. "Research on Coordinating Care for Patients with Chronic Conditions". Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 27, n.º 7 (julho de 2009): 403–9. http://dx.doi.org/10.1097/01.nhh.0000358271.00811.a5.
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Kang, Sunny. "RACIAL AND ETHNIC DIFFERENCES HOSPITAL DISCHARGE DISPOSITIONS FOR OLDER ADULTS: A PUBLIC POLICY PERSPECTIVE". Innovation in Aging 7, Supplement_1 (1 de dezembro de 2023): 887. http://dx.doi.org/10.1093/geroni/igad104.2855.
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Abstract This paper presents two empirical studies regarding racial disparities in older individuals’ hospital discharge. The first study targeting factors associated with older Black patients’ readmission to ambulatory care, examined 7,619 older patients from the 2016 National Ambulatory Medical Care Survey; the second study focused on race and mental disorders’ impact on older patients’ nursing home (NH) admissions upon hospital discharge, analyzing 186,646 older patients from 2007 to 2010 National Hospital Discharge Survey. We mainly used Binary Logistic Regression Analyses (1) to examine the impact of racial disparities in ER readmission within one week to two months’ discharge and (2) to study the racial disparities in NH admissions upon hospital discharge. Based on the studies, policy efforts are called upon to address the specific needs of racial minorities using Medicaid as a primary payment method; as well as for individuals residing in facilities with higher concentrations of Medicaid beneficiaries. Discharge diagnoses such as lower-limb fractures, chronic ulcers, and mental health conditions, especially among Black individuals with mental health conditions increased the odds of NH admission. Other factors such as the Medicare as the primary payer for the hospitalization, being unmarried, and prior residence in a skilled nursing facility are also important predictors for NH admissions. Black individuals appear to increasingly be disproportionately represented in the NH population. This may relate in part to the greater morbidity they experience related to chronic conditions such as diabetes and heart disease, which warrants further investigation as to the reasons for their high presence.
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Kier, Melanie Wain, Tuyet-Trinh Truong, Elena Baldwin, Tianxiang Sheng, Ania Wajnberg, Albert L. Siu e Cardinale B. Smith. "Acute oncology care at home for post-chemotherapy monitoring in patients with multiple myeloma." JCO Oncology Practice 19, n.º 11_suppl (novembro de 2023): 58. http://dx.doi.org/10.1200/op.2023.19.11_suppl.58.
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58 Background: Hospitalization at Home (HaH) has demonstrated clinical efficacy and improved patient experience in general medicine inpatients. Mount Sinai Health System (MSHS) HaH enrolls oncology patients with active disease admitted for acute general medical conditions and for active chemotherapy. We performed a case-control study of our institution’s experience with HaH in multiple myeloma (MM) patients admitted for elective chemotherapy. Methods: We conducted a retrospective chart review of MM patients who received inpatient chemotherapy with dexamethasone, cyclophosphamide, etoposide, and cisplatin with or without bortezomib ((V)-DCEP) and then enrolled in HaH from September 2020 to May 2023. HaH eligibility required meeting established institutional HaH admission criteria, including geographical limitations. The control group were randomly selected MM patients admitted for (V)-DCEP who lived in a zip-code excluded from HaH’s catchment zone. Demographics, social situation, indication for inpatient stay, and HaH admission were extracted from the electronic health record. Primary endpoint was 30-day readmission from final place of discharge. A key secondary endpoint was rate of successful HaH admission, defined as discharge from HaH for complete recovery from the acute condition. Results: Twenty-two patients with MM, with 24 episodes of care, enrolled on HaH for post-chemotherapy monitoring. Our control cohort had 32 patients with 32 episodes of care. In the HaH population, the median age was 57, 73% (n = 16) male, 23% (n = 5) White, 41% (n = 9) Black, 14% (n = 3) Asian, 18% (n = 4) Hispanic, and 55% (n = 12) had either Medicaid or were dual Medicare/Medicaid eligible. In the HaH ineligible group, the median age was 67.5, 63% (n = 20) male, 56% (n = 18) White, 13% (n = 4) Black, 6% (n = 2) Asian, 19% (n = 6) Hispanic, and 32% had either Medicaid or were dual Medicare/Medicaid eligible. In the HaH population, the median inpatient length of stay was 6.5 days compared to 17.5 days in the HaH ineligible cohort (p < 0.001). Mean length of HaH stay was 8.83 days, which saved our health system 212 inpatient-bed days. In the HaH cohort, there were 33% (n= 8) 30-day readmissions, 38% (n = 3) of which were unplanned; similarly, in the HaH ineligible population, there were 38% (n = 12) 30-day readmissions, with 33% of these readmissions unplanned (p = 0.97). Successful HaH admissions occurred for 92% of care episodes. No significant adverse outcomes or issues related to the care delivery or social support. Conclusions: The MSHS HaH program demonstrated safety and feasibility in caring for oncology patients admitted for elective chemotherapy. Hospital readmission frequency was the same across both cohorts. We were able to successfully care for the majority of patients with MM and had significant inpatient bed day savings. HaH should be expanded to other groups of specialized patients, leveraging disease-specific clinical pathways.
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Burdgorf, Julia, Mingche Wu e Chanee Fabius. "PREVALENCE AND TYPES OF PATIENT PORTAL USE AMONG OLDER ADULTS RECEIVING HOME HEALTH CARE". Innovation in Aging 7, Supplement_1 (1 de dezembro de 2023): 177. http://dx.doi.org/10.1093/geroni/igad104.0577.
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Abstract Home health care (HHC) delivers skilled nursing and therapy services in the patient’s home and is a valuable source of care for community-living older adults, particularly those living with complex conditions such as dementia. However, lack of visibility into patients’ clinical records and difficulty communicating with other providers are perennial challenges to HHC quality. Patient portals― provider-sponsored online applications that allow patients to perform care management tasks including viewing health information and messaging providers―present a promising opportunity to bridge this gap. However, no prior work has examined patterns of portal use among HHC patients. We leveraged a unique dataset containing electronic health record and patient portal utilization data for 10,212 older adults who received HHC between 2017-2019. We found that 25% of HHC patients had an active patient portal prior to HHC and, of those with an active portal, 85% used their portal during HHC. Among those who used their portal during HHC, the most common portal activities were reviewing the clinical record (82%), managing appointments (60%), and seeking provider advice (45%). Compared to community-referred patients, hospital-referred patients were more likely to use their portal to manage appointments or review their clinical record. Compared to patients without dementia, patients with dementia were more likely to use their portal to message their provider but less likely to view their clinical record. Findings suggest that portal users are actively engaging with their portal during HHC, indicating an opportunity to empower patients to facilitate information transfer between HHC and other providers.
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Reeves, Mathew J., Bernadette Boden-Albala e Dominique A. Cadilhac. "Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations". Stroke 54, n.º 2 (fevereiro de 2023): 386–95. http://dx.doi.org/10.1161/strokeaha.122.039565.
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In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person’s recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Pompili, Alfredo, Stefano Telera, Veronica Villani e Andrea Pace. "Home palliative care and end of life issues in glioblastoma multiforme: results and comments from a homogeneous cohort of patients". Neurosurgical Focus 37, n.º 6 (dezembro de 2014): E5. http://dx.doi.org/10.3171/2014.9.focus14493.
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Object Glioblastoma multiforme (GBM) is a rare tumor whose prognosis has remained poor over the years despite innovative radio- and chemotherapies, and important technical advances in neurosurgery such as intraoperative imaging, fluorescence, Cavitron ultrasonic surgical aspirator, and neuronavigation. Particular attention has been dedicated in the last years to the end of life (EOL) period in cancer patients for both ethical and socioeconomic issues. Good palliative care at home avoids improper and expensive hospitalizations, and helps and trains families, caregivers, and patients in facing a difficult situation. Methods In 2012–2013 the authors' group cared for 197 patients with brain tumors. Of these there were 122 with GBMs: 64 died and 58 are still receiving assistance. The clinical conditions are periodically evaluated with the following scales: Barthel Index, Karnofsky Performance Scale, and Mini-Mental State Examination. Home care staff includes 2 neurologists, 5 nurses, 2 psychologists, 3 rehabilitation therapists, and 1 social worker. The intensity of care changes at the different stages of disease, ranging from low to medium levels of intensity at the progression stage (more than 1 access weekly) to high levels of intensity at the EOL stage (at least 3 accesses weekly). Control MRI studies are obtained every 3 months before terminal progression. Results Overall in this sample of patients there were 2838 home visits and 11,714 days of assistance. Thirty-four patients (14 female and 20 male) died at home (53.1%); 22 (13 female and 9 male) at the hospice (34.4%); and 8 (4 female and 4 male) at the hospital (12.5%). A positive impact on caregivers for home assistance was recorded in 97% of cases, for nursing in 95%, communication in 90%, rehabilitation at home in 92%, and social work help in 85%. Also, 72% had an improvement in their quality of life scores due to rehabilitation. End of life palliative sedation with midazolam was necessary in 11% of cases to obtain good control of symptoms such as uncontrolled delirium, agitation, death rattle, or refractory seizures. Intramuscular phenobarbital is the authors' drug of choice for the severe seizures that occurred in 30% of cases. The reduction of steroid dosage is also used to decrease wakefulness. Steroids were withdrawn in 45% of patients dying at home, mild hydration was done in 87%, and tube feeding in 13%. The decision-making process at the EOL stage is time consuming, but the degree of distress of the family is inversely proportional to the extent of the preparatory period. Conclusions A previous paper showed the positive cost-effectiveness of home assistance for a larger group of patients dealing with any kind of malignant brain tumors. The same is enhanced for patients with GBM. This requires a well-trained neuro-oncology team that manages neurological deterioration, clinical complications, rehabilitation, and psychosocial problems with a multidisciplinary approach.
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Dimkovic, Nada, e Dimitrios G. Oreopoulos. "Chronic Peritoneal Dialysis in the Elderly: A Review". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 20, n.º 3 (maio de 2000): 276–83. http://dx.doi.org/10.1177/089686080002000302.
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During the past few decades, the pattern of end-stage renal disease has changed significantly with the emerging predominance of elderly patients. Because this heterogeneous population is characterized by a physiological decline in function of all organs, the nephrologist must contemplate the special needs of individual patients when they develop end-stage renal disease. Before the initiation of dialysis, these patients must be given detailed information to help them select the particular mode that will maximize their quality of life. According to available data, peritoneal dialysis offers some advantages for elderly patients, such as hemodynamic stability, steady-state metabolic control, good control of hypertension, independence from hospital, and avoidance of repeated vascular access. Early referral promotes the establishment of peritoneal access and minimizes the consequences of uremia, subsequent morbidity, and frequent hospitalization. Elderly patients are compliant and highly motivated to cooperate with their treatment. They have no higher modality-related complications than younger patients and their quality of life is satisfactory. Although most have comorbid conditions that interfere with self-performance of dialysis, such as impaired vision and reduced physical and mental activity, they can perform peritoneal dialysis successfully if they have a high level of family support. Patients who do not have family support may have successful peritoneal dialysis if they have access to a network of medical and social support, that is, private home nurses, rehabilitation and chronic care dialysis units, or nursing homes.
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Baum, Neil, e M. Cisneros. "The Influence of Music on Brain Health". Healthcare Administration Leadership & Management Journal 2, n.º 1 (fevereiro de 2024): 18–21. http://dx.doi.org/10.55834/halmj.7407459824.
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Music has been used for therapeutic purposes for centuries. More than 2000 years ago, Aristotle and Plato mentioned that music therapy was valuable. Music therapy is especially valuable for older patients. Music benefits patients’ physical, emotional, cognitive, and social needs. The use of music therapy has been effective in various settings, including hospitals, schools, nursing homes, and rehabilitation centers. Music therapy treats various conditions, from depression and anxiety to Parkinson’s disease and dementia. This article will review the history of music therapy and its application to contemporary medicine especially its application to geriatric patients.
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Hans, Guy, Brigitte Claes, Talia Sener, Joris Wille, Dries Oeyen e Kristel Moons. "An integrated, holistic, evidence-based, interdisciplinary approach to digital monitoring and remote care in patients with highly infectious diseases: TeleCovid." International Journal of Integrated Care 23, S1 (28 de dezembro de 2023): 320. http://dx.doi.org/10.5334/ijic.icic23454.
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During the first waves of the SARS-CoV-2 pandemic, hospitals were overrun with patients. To cope with this high influx of infectious patients, hospitals needed to postpone elective care. Additional ICU beds had to be opened, and the number of isolation units had to be increased. All of this placed considerable strain on the nursing and medical staff. At that time, the idea was launched to keep as many patients as possible at home and prevent their hospital admission through the use of a remote care program. Based on our previous experience with transmural care programs, we quickly developed a digital monitoring program to track the health status of Covid-19 infected patients at home.
Patients could be registered for follow-up by their primary care physician or specialist. After registration, patients received access to a secured digital platform. They first had to complete an extensive survey in order to identify their medical and surgical history, as well as the symptoms present at that time. The severity of symptoms was also evaluated at the moment of the initiation of the digital monitoring. On the basis of the responses to the introductory questionnaire, a global personalized risk score was compiled. After this initial step was concluded, the patient was contacted by the medical monitoring team to arrange for the delivery of telemetric devices (such as peripheral oxygen saturation). Patients were monitored through a 4-layer system, consisting of diaries, validated surveys, telemonitoring of vital signs, and a digital communication system included in the digital platform. This resulted in close cooperation with GPs, home nurses, physiotherapists, and other caregivers. The remote care team monitored the condition of the patients on a 24/7 basis. If needed, they contacted the home caregivers with specific demands or instructions (e.g. administration of oxygen at home, blood sampling, administration of medication).
In the spring of 2022, Paxlovid became available in Belgium for ambulatory treatment of Covid-19 symptoms in high-risk patients. It was quickly decided that we would also include the follow-up of Paxlovid treatment regimens within our care pathway. This created an entirely new approach to our remote monitoring since we had to tackle specific problems like drug-drug interactions but also therapeutic monitoring of certain specific drugs.
TeleCovid was perceived as an integrated, comprehensive remote care program for Covid-19 patients. At first, this digital care program was perceived in such a way that we could prevent the hospitalization of Covid-19 patients. But very soon after its activation, GPs started to include patients so that they focus their attention and time on other patients. They could rely on the remote care program to be notified when the medical conditions of their patients deteriorated. The care program provided support and guidance to the patients AND their families so they felt safe while staying at home. We provided all possible care right at the home of the patients. This was only possible through intensive and continuing cooperation between many different healthcare providers, such as nurses, physiotherapists, social workers, GPs, and hospital specialists.
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Harvey, Clare Lynette, Jonathan Sibley, Janine Palmer, Andrew Phillips, Eileen Willis, Robert Marshall, Shona Thompson, Susanne Ward, Rachel Forrest e Maria Pearson. "Development, implementation and evaluation of nurse-led integrated, person-centred care with long-term conditions". Journal of Integrated Care 25, n.º 3 (3 de julho de 2017): 186–95. http://dx.doi.org/10.1108/jica-01-2017-0003.
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Purpose The purpose of this paper is to outline a conceptual plan for innovative, integrated care designed for people living with long-term conditions (LTCs). Design/methodology/approach The conceptual plan delivers a partnership between the health system, the person with LTCs (chronic), their family, and the community. The partnership aims to support people at home with access to effective treatment, consistent with the New Zealand Government Health Strategy. This concept of people-owned care is provided by nurses with advanced practice skills, who coordinate care across services, locations and multiple LTCs. Findings With the global increase in numbers of people with multiple chronic conditions, health services are challenged to deliver good outcomes and experience. This model aims to demonstrate the effective use of healthcare resources by supporting people living with a chronic condition, to increase their self-efficacy and resilience in accordance with personal, cultural and social circumstance. The aim is to have a model of care that is replicable and transferable across a range of health services. Social implications People living with chronic conditions can be empowered to manage their health and well-being, whilst having access to nurse-led care appropriate to individual needs. Originality/value Although there are examples of case management and nurse-led coordination, this model is novel in that it combines a liaison nursing role that works in partnership with patients, whilst ensuring that care across a number of primary and secondary care services is truly integrated and not simply interfaced.
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SIMON, Pierre. "The Telemedicine applied to the follow up of patients with End Stage Renal Failure". Bulletin de la Dialyse à Domicile 1, n.º 2 (25 de setembro de 2018): 51–58. http://dx.doi.org/10.25796/bdd.v1i2.44.
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Abstract
In the 21st century, renal failure is a chronic disease that affects several millions people in France and around 600 millions worldwide. Its prevalence in the general population increases with the lengthening of the life expectancy that characterizes the developed countries and which begins to appear in the developing countries. Chronic hemodialysis is a treatment that saved many children and young adults in the 20th century whose kidneys were destroyed by several infectious and toxic agents and by untreated malignant hypertension. These causes have been controlled by hygiene measures, anti-infective agents or protective pharmacological agents of the cardiovascular system. Today the causes of end stage renal failure are dominated by degenerative diseases due to aging, such as diabetes and chronic vascular disease. The prevention of the worsening of chronic renal failure is now possible due to better control of high blood pressure and diabetes which are the two main causes of kidney destruction. Hemodialysis treatment cannot always be relayed by renal transplantation. Many patients remain on chronic hemodialysis until they die. It is important to adapt the conditions of treatment to the social life of patients affected by this chronic disease so that these are the best possible. This is the goal of telemedicine that allows to remotely monitor the main clinical and biological factors associated with the worsening of the disease. Teledialysis (hemodialysis and peritoneal dialysis) allows to perform dialysis sessions at home or at the nearest in home substitutes (nursing home) or in satellite units of hemodialysis. Similarly, when the patient is transplanted, it makes possible to either lighten or intensify the surveillance according to the risk or not of graft rejection through home teleconsultation.The tools of the digital era such as telemedicine, health connected with connected objects and mobile apps for medical purposes, the performance of which is increasing with the algorithms of artificial intelligence (machine learning, deep learning), can improve the relationship between the patient and his doctor. An ethical reflection must be associated with all these innovations. New exercise of the medicine will be greatly enriched due to medical time more devoted to the relationship with the patient. The new care organizations made possible by digital technologies must be taught to the new generations of nephrologists.
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Kollerup, Mette, Tine Curtis e Birgitte Schantz Laursen. "Improving visiting nurses’ post-hospital medication management". Journal of Integrated Care 26, n.º 1 (12 de fevereiro de 2018): 65–76. http://dx.doi.org/10.1108/jica-05-2017-0011.
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Purpose Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices. Design/methodology/approach Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality. Findings The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management. Research limitations/implications The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made. Practical implications Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management. Originality/value This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.
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Barbosa, L., J. Santos, A. Cordeiro, M. J. Santos e E. Pereira. "AB1814-HPR RHEUMATOLOGY NURSING OUTPATIENT CLINIC IN PORTUGAL". Annals of the Rheumatic Diseases 82, Suppl 1 (30 de maio de 2023): 2139.1–2140. http://dx.doi.org/10.1136/annrheumdis-2023-eular.5036.
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BackgroundSystemic inflammatory rheumatic diseases are characterized by being chronic diseases. These diseases affect the person, in their various dimensions and are often associated with pain, loss of mobility and function, fatigue, anxiety and depression (Matcham, Norton, Scott, Steer & Hotopf, 2016; Primdhal & Esbensen, 2020; Ryan, 2020). The complex needs of these patients require and benefit of an advanced nursing practice and a guided and specialized attention that can be provided in a nursing clinic. The awareness of rheumatic patient needs and lack of this type of care led, to our knowledge, to the development of the first rheumatology nurse clinic in Portugal.ObjectivesCharacterize a guided nursing clinic with the aim to support patients with systemic inflammatory rheumatic diseases, mainly initiating subcutaneous (sc) classic and biological DMARDs.MethodsSummarized description of first guided rheumatology nurse clinic in Portugal.ResultsThis nurse clinic was created and developed during the pandemic period of SARS-CoV 2 (starting February 2020). For the last three years a total of 556 appointments was performed. The targeted patients had systemic inflammatory rheumatic diseases, mainly rheumatoid arthritis, psoriatic arthritis and spondylarthritis treated with sc classic and biological DMARDs. Appointments are scheduled at week 0 and 4 of starting these therapeutics and also whenever needed, at the request of the patient or the treating physician, in order to ensure a good nurse availability to clarify doubts at the beginning of these treatments. In the specific case of sc methotrexate, a protocol was created by the Rheumatology multidisciplinary team, defining the parameters eligible for evaluation, and the respective procedures of care. During appointments nurses also assess specific disease implications in the person’s daily life, both physical, emotional and social domains. Additionally, this is an opportunity to reinforce reliable information on disease management, coping strategies, including information how to manage medication side effects.ConclusionThe rheumatology nursing outpatient clinic provides key additional care and monitorization to patients with systemic inflammatory rheumatic diseases, treated with sc classic and biological DMARDs. Nurses improve the management of chronic diseases, namely by promoting autonomy of the patient in self-administration of sc therapies at home, counselling and informing about possible adverse effects and respective management strategies, constituting a valid contribution to disease control and patient engagement and education.References[1] Matcham, F., Norton, S., Scott, D. L., Steer, S., & Hotopf, M. (2016). Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial.Rheumatology (Oxford, England),55(2), 268–278.[2] Primdahl, J. & Esbensen, B.A. (2020). Rheumatoid arthritis. In S. Ryan (Ed.),Nursing older people with arthritis and other rheumatological conditions(pp.17–30). Switzerland: Springer Nature.[3] Ryan, S. (2020). Pain management. In S. Ryan (Ed.),Nursing older people with arthritis and other rheumatological conditions(pp. 97-111). Switzerland: Springer Nature.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Goggins, Suzanne. "The importance of a comprehensive geriatric assessment for older people admitted onto a virtual ward". British Journal of Nursing 32, n.º 18 (12 de outubro de 2023): 882–89. http://dx.doi.org/10.12968/bjon.2023.32.18.882.
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A comprehensive geriatric assessment (CGA) provides a holistic assessment for the frail and older person. The CGA considers physical and mental conditions as well as function, environmental and a person's social circumstances. Virtual wards are a new concept within the NHS, and use of virtual wards during the COVID-19 pandemic reduced hospital admissions by 50%. The British Geriatrics Society has set clear guidelines on how virtual wards should be developed within integrated care services via multidisciplinary community rapid response teams to improve patient outcomes. This article considers a logical approach to assessing suitability for admission onto a virtual ward for a patient who required hospital-at-home services. It does this through the use of a theoretical patient case study, in this case involving delirium and urinary tract infection. Frailty and frailty scoring tools are discussed, as are the advantages and disadvantages of a CGA, considering a clear progression through the five domains. It shows how conducting a CGA allows for the development of a problem list to help prioritise the patient's problems and plan accordingly. A critical review of the literature around virtual wards, hospital-at-home services and admission avoidance identified that community rapid response teams were the logical choice to provide a multidisciplinary holistic approach to the older person admitted onto a virtual ward.
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Rodríguez-Álvaro, Martín, Domingo Ángel Fernández-Gutiérrez, Antonio Cabeza-Mora, Rosario Barrios-Torres e Pedro Ruymán Brito-Brito. "Care Needs of Highly Complex Chronic Patients in the Canary Islands: An Observational Study". Nursing Reports 13, n.º 1 (20 de dezembro de 2022): 1–16. http://dx.doi.org/10.3390/nursrep13010001.
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In the last few decades, the impact of chronic health conditions on health systems, as well as on the quality of life, frailty, and dependence of those affected, has been brought to light. The objective of this study was to describe the population care needs of highly complex chronic patients (HCCPs). Methods: An epidemiological observational study was conducted. Results: A total of 13,262 patients were identified, 51% of which were elderly women. Among all patients, 84.4% had received a nursing assessment related to health patterns. Three diagnoses were established in 25% of the sample: readiness for enhanced health management, impaired skin integrity, and risk for falls. There were significant differences according to age, most importantly in terms of impaired skin integrity (39% of patients under 80 years old). Risk for falls, social isolation, situational low self-esteem, chronic low self-esteem, impaired home maintenance, anxiety, ineffective health management, ineffective coping, impaired memory, insomnia, and self-care deficits were more common in those living alone. A total of 37 diagnoses featured differences according to frailty/dependence. Approximately 23% of HCCPs suffered from frail elderly syndrome. Conclusions: This study presents the most common care needs of HCCPs, describing the sociodemographic profile of this part of the population. The planning of HCCP care varies in nature. Factors such as the dependence level and frailty of these people should be taken into consideration.
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Karam, Marlène. "Care coordination across health care and social services sectors: patient and provider perspectives". International Journal of Integrated Care 23, S1 (28 de dezembro de 2023): 168. http://dx.doi.org/10.5334/ijic.icic23384.
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Introduction: This project is the result of a partnership between a research team including a patient partner, a clinical setting, and patients. The Nursing Department of the Integrated Health and Social Services Center (IHSSC) in Laval (Quebec, Canada) has implemented several care coordination functions for several years for patients with complex needs. These functions include those of liaison nurses in geriatrics, palliative care, home care and support, oncology, and many others. To date, no evaluation of these functions has been established.
The aim of this study is to establish a diagnosis of these current coordination practices, their effects from the perspective of the patients who benefit from them, and the facilitating factors and barriers according to the nurse coordinators. The Nursing Department’s request for this partnership is part of their process of continuous improvement of the quality of care and services offered to patients with complex needs.
Methods: A qualitative research method following an experience-based co-design approach is used. The Rainbow Model of Integrated Care (Valentijn et al., 2013) is the conceptual framework guiding this study. Between November 2022 and February 2023, individual interviews with 10 coordinators and 10 patients with complex health and social care needs will be conducted in order to explore their experiences and the facilitating factors and obstacles to coordination. Patients aged 65 and older, who had 3 or more hospitalizations or visits to the emergency department within the last 12 months, and suffer from one or more chronic conditions will be included. Interviews will take place at the time and place of their choice and last one hour. Nurses with 6 months or more of experience in their current position as care coordinator will be included.
Subsequently, two group interviews that bring together participating nurses and patients will identify joint improvement priorities in order to meet the needs expressed by the patients and the difficulties encountered by the coordinators.
Mixed thematic analysis combining inductive and deductive analysis (following the Rainbow Model of integrated care) will be conducted so as to allow us to collect stories and experiences, facilitating factors, barriers and areas for improvement according to the different levels (macro, meso and micro).
Expected Results: The expected results of this co-design approach include better alignment of the IHSSC care and services with the needs expressed by its target patients, leading to a better experience and better quality of care for them.
Discussion and conclusion: Partnering with clinical settings facilitates the knowledge translation and guides the decision-making of the partner organization in its process of restructuring the coordination services and reviewing this function.
Limitations: The relatively small number of participants limits the generalizability of the results to other settings and patient populations.
Suggestions for future research: Future research should include informal caregiver perspectives and identify unmet needs of specific subgroups of patients with complex needs.
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Tse, Mimi, Shamay Ng, Xue Bai, Paul Lee, Raymond Lo, Daphne Sze Ki Cheung, Kin Cheung e Suey Yeung. "Lesson Learned from Peer Volunteers in a Peer-Led Pain Management Program among Nursing Home Residents". International Journal of Environmental Research and Public Health 16, n.º 17 (26 de agosto de 2019): 3097. http://dx.doi.org/10.3390/ijerph16173097.
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Background: Chronic pain is common among older adults and is associated with adverse physical and psychological outcomes. Given the burden of pain and limited healthcare resources, devising innovative and cost-effective ways of managing chronic pain is of high priority. The aim of this paper is to explore the experiences and perceptions of peer volunteers (PVs) in a peer-led pain management program among nursing home residents in Hong Kong. Methods: Forty-six PVs were recruited and trained to lead a pain management program (PAP). The PAP consisted of one 1 hour session per week for 12 weeks. It included 20 min of physical exercises performed under the supervision of PVs, followed by 30 min of pain management education, including information on pain situations, the impacts of pain, the use of drugs and non-drug strategies for pain management, demonstrations, and return demonstrations of various non-drug pain management techniques. Quantitative data were collected from questionnaires (demographics, pain situation, and pain knowledge) for all PVs. Qualitative data (PVs’ experiences in leading the PAP, their perceived benefits, barriers encountered, and recommendations for improving the PAP) were collected at week 12 (upon completion of the PAP). Data were analyzed using the Statistical Package for Social Sciences and content analysis for qualitative data. Results: A total of 46 PVs were recruited (34 females, 74%), with a mean ± SD age of 61.0 ± 5.1 years. Thirty-one of them reported having chronic pain. Before the training, their self-rated pain knowledge was 40.0 ± 20.5 (maximum 100 points) while their actual pain knowledge score was 86.1 ± 10.6 (maximum 100 points). The PVs reported an improvement in their knowledge and skills after leading PAPs. No PVs reported having received any negative comments about their role in leading the PAP but mentioned that they had received feedback on how to improve the program. Conclusions: This study provides further evidence that peer-led pain management programs are feasible and can lead to positive experiences for the PVs. Peer support models are coming into wide use because they show promise in helping patients to manage chronic conditions. Peer volunteers will become important resources in elderly care. The barriers that were identified may lead to improvements in the design and planning of future PAPs.
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Roberts, Nicola J., Carol A. Kelly, Kate A. Lippiett, Emma Ray e Lindsay Welch. "Experiences of nurses caring for respiratory patients during the first wave of the COVID-19 pandemic: an online survey study". BMJ Open Respiratory Research 8, n.º 1 (julho de 2021): e000987. http://dx.doi.org/10.1136/bmjresp-2021-000987.
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BackgroundNurses have been at the forefront of the pandemic response, involved in extensive coordination of services, screening, vaccination and front-line work in respiratory, emergency and intensive care environments. The nature of this work is often intense and stress-provoking with an inevitable psychological impact on nurses and all healthcare workers. This study focused on nurses working in respiratory areas with the aim of identifying and characterising the self-reported issues that exacerbated or alleviated their concerns during the first wave of the COVID-19 pandemic.MethodsAn online survey was developed consisting of 90 questions using a mixture of open-ended and closed questions. Participant demographic data were also collected (age, gender, ethnicity, number of years qualified, details of long-term health conditions, geographical location, nursing background/role and home life). The online survey was disseminated via social media and professional respiratory societies (British Thoracic Society, Primary Care Respiratory Society, Association of Respiratory Nurse Specialists) over a 3-week period in May 2020 and the survey closed on 1 June 2020.ResultsThe study highlights the experiences of nurses caring for respiratory patients during the first wave of the pandemic in early 2020. Concerns were expressed over the working environment, the supply and availability of adequate protective personal equipment, the quality of care individuals were able to deliver, and the impact on mental health to nurses and their families. A high number provided free-text comments around their worries and concerns about the impact on their household; these included bringing the virus home, the effect on family members worrying about them, mental health and the impact of changing working patterns, and managing with children. Although both formal and informal support were available, there were inconsistencies in provision, highlighting the importance of nursing leadership and management in ensuring equity of access to services.ConclusionsSupport for staff is essential both throughout the pandemic and afterwards, and it is important that preparation of individuals regarding building resilience is recognised. It is also clear that psychological support and services for nurses and the wider healthcare team need to be available and quickly convened in the event of similar major incidents, either global or local.
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Davies, O., e S. James. "52 A Community Cure for Frequent Reattenders: Developing An Interface Geriatrics Service". Age and Ageing 49, Supplement_1 (fevereiro de 2020): i14—i17. http://dx.doi.org/10.1093/ageing/afz186.06.
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Abstract Topic Setting up an interface geriatrics service in a seaside area with a large elderly population. Many elderly patients are readmitted due to the challenge of managing their chronic health conditions in the community. These patients are frail, with frequently exacerbated chronic conditions causing regular readmissions. We noted that treatment was rarely changed during these admissions and patients were not uniformly managed. Aims Aims for this project were to improve care for older people, reduce readmissions and produce clear patient care plans. Interventions Our first PDSA cycle involved implementing geriatrician presence at community MDTs (involving social services, GPs, intermediate care teams, and various others). This generated home visits to several patients, with a mix of acute and chronic issues. We offered Advance Care planning where appropriate to these patients. We noted several patients were repeatedly discussed at MDT. This brought into focus frequent attenders who were usually well-known to the community. In the next cycle we introduced ‘frequent attender’ plans for these patients, ensuring a unified approach to their management. Subsequent cycles involved geriatrician presence at the ‘frequent attenders’ steering group, and further links with community teams. Our primary intervention has been Advance care & frequent attender plans offering tailored management for complex patients. These are completed by a geriatrician discussing patients wishes for treatment and future care. Improvements Readmission rates show up to 90% reduction in admissions/ED attendances for patients following care plan implementation. Feedback from families and patients is positive – the service is ‘pragmatic and supportive’, delivering ‘empathetic care’. Discussion Implementing an interface geriatrics service highlights the importance of caring for frail patients in their preferred place of care, reducing unnecessary/inappropriate hospitalisations. Geriatrician presence at community MDTs has improved care by offering prompt access to medical advice and review of complex patients. It highlights patients presenting frequently to services, allowing us to work with patients and families to improve management. A frequent attender list generated by the hospital helps target patients for whom intervention will give significant benefit. We plan to extend this further by working with nursing homes that have high conveyancing rates. The service is being extended to more areas within our region, and we are working with GPs and care homes to further offer advance care planning to vulnerable and frail patients.
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Gonella, Silvia, Sara Campagna e Valerio Dimonte. "A Situation-Specific Theory of End-of-Life Communication in Nursing Homes". International Journal of Environmental Research and Public Health 20, n.º 1 (3 de janeiro de 2023): 869. http://dx.doi.org/10.3390/ijerph20010869.
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High-quality end-of-life communication between healthcare professionals (HCPs), patients and/or their family caregivers (FCs) improves quality of life and reduces non-beneficial care at the end of life. Nursing homes (NHs) are among the contexts at the forefront of these conversations. Having a solid theoretical basis for the role of end-of-life communication in NHs in transitioning to palliative-oriented care can offer indications for research, practice, education, and policy related to geropalliative care. This study aimed to develop a situation-specific theory of end-of-life communication in NHs by refining an existing theory. A four-step integrative approach was employed that included: (1) checking the assumptions for theorization; (2) exploring the phenomenon through multiple sources; (3) theorizing; and (4) reporting. All elements of the existing end-of-life communication theory in NHs were confirmed: end-of-life communication improved the understanding of FCs about their relatives’ health conditions, shared decision-making, and reflections on the desired preferences of residents/FCs for care at the end of life. Furthermore, the family environment affected the burden of FCs in the decision-making process. Finally, time and resource constraints, regulations, visitation restrictions due to the COVID-19 pandemic, and social and cultural values influenced the quality and timing of communication. The study findings confirmed the impact of the political, historical, social, and cultural context on end-of-life communication, thus providing the basis for a situation-specific theory.
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Armstrong, Peyton, Yong-Fang Kuo, Jordan Westra e Mukaila Raji. "TRENDS IN OSTEOPOROSIS DRUG USE AMONG MEDICARE BENEFICIARIES WITH & WITHOUT ALZHEIMER’S DISEASE/RELATED DEMENTIAS". Innovation in Aging 6, Supplement_1 (1 de novembro de 2022): 768. http://dx.doi.org/10.1093/geroni/igac059.2783.
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Abstract Background Osteoporotic fractures are a leading cause of disability and premature death in the elderly. Patients with Alzheimer’s and related dementia (ADRD) have high rates of osteoporosis (OP) and substantial risk of osteoporotic fractures. Yet research is sparse on trends and predictors of OP medication use in ADRD. Methods Medicare beneficiaries with OP aged ≥67 years with Medicare parts A/B/D without HMO from 2016–2018. Outcome was receipt of OP medications in 2018. A multivariable logistic regression assessed association between ADRD and OP drug prescribing, adjusted for age, sex, race, region, Medicare entitlement, dual Medicaid eligibility, chronic conditions, number of provider visits/hospitalizations, and nursing home (NH) resident status. Age/ADRD and NH residency/ADRD interactions were tested. Results Sample consisted of 47,871 people with OP and ADRD and 201,840 with OP without ADRD. OP drug use was 38.6% in ADRD patients vs. 52.7% in non-ADRD. After adjustment for demographics, chronic conditions, previous hospitalizations/physician visits, the OR for OP drug in ADRD vs. Non-ADRD was 0.85 (95% CI: 0.83–0.87). NH residents had lower odds for OP medication (OR: 0.61, 95% CI: 0.58–0.64). There were significant interactions between ADRD/age and between ADRD/NH residency. The OR for OP drug use associated with ADRD was 0.88 (95% CI: 0.86–0.90) among community-dwelling elders and 0.66 (95% CI: 0.64–0.69) among NH residents. Conclusions: ADRD patients received OP drugs at lower rates than non-ADRD counterparts. More research is needed on prescribing or deprescribing OP drugs in context of ADRD severity, patient preferences, remaining life expectancy and time-to-benefit from OP drugs.
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Okonkwo, Obinna, Simon Gibbon, Lucy McCarthy e Nicholas Taylor. "The Use of Skype Video Telecommunication (VTC) for Social Visits in a Medium Secure Hospital: A Service Evaluation". BJPsych Open 8, S1 (junho de 2022): S142. http://dx.doi.org/10.1192/bjo.2022.410.
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AimsThe COVID-19 pandemic brought unprecedented disruptions in the ways we lived and interacted with one another. Research studies done in the immediate aftermath suggested that the COVID-19 pandemic and associated lockdown restrictions may have increased feelings of isolation and loneliness, which together with disruptions in services may have precipitated psychological distress and mental health deterioration, particularly among persons with pre-existing mental health conditions. Following the introduction of first national lockdown in late March 2020, all visits to the hospital by family and friends were ceased. VTC became one of the rapid interventions implemented across several NHS Hospitals to promote continued patient contact with carers. In October 2021, we set out to undertake an evaluation project to determine the level of patient satisfaction with the use of Skype for social visits, to understand patient and staff perspectives on its pros and cons, and to understand patient preference post-COVID-19 pandemic.MethodsAll ward-based staff who had ever facilitated Skype social visits and all patients who had had at least one social visit facilitated by Skype were approached to participate in the project. Data were collected using anonymous questionnaires with both quantitative and qualitative items.ResultsA total of twenty-nine patients and thirty-nine nursing staff participated in the study.Sixty-two per cent of patient-participants reported being satisfied with the Skype social visits and over half (52%) rated the Skype social visits as ‘the same’ as face-to-face visits. All participants reported patient-satisfaction with the process and speed of setting up a Skype visit, the benefits of visual contact and the reduction of travel costs. A few patient-participants noted that they relished the opportunity of seeing their home environment. Issues regarding increased demands on staffing resources, privacy, IT skills, and hardware and software glitches were identified.Overall, Skype social visits have been a positive experience for the patients and have not resulted in any significant risk concerns. Most patients (90%) indicated that they would like Skype social visits to continue post-COVID-19 pandemic.ConclusionThe average length of stay (LOS) of patients is often longer in forensic compared to general adult mental health units and about 4.5 years at the study site. This evaluation found that the introduction of Skype for the purposes of social visits was considered a useful development by both patients and staff. The study findings were fed back to all stakeholders and certain changes have been implemented as a result.
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Vinoo, Deepa. "Dementia Care: Addressing Pain and Maximizing Comfort". Innovation in Aging 5, Supplement_1 (1 de dezembro de 2021): 288–89. http://dx.doi.org/10.1093/geroni/igab046.1120.
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Abstract Pain is common in older people who have Dementia, and is associated with a number of chronic and acute conditions. There is evidence that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated. Pain has a powerful effect on mood, sleep quality, functional ability, and overall quality of life. Rejecting care due to pain is very common among patients with Dementia. An association between pain and increased agitation has been noted, Significant reduction of agitation and psychotropic usage have been demonstrated by pain treatment in patients with moderate to severe dementia. This project was conducted in six memory care units with 150 residents at 815 bedded long-term geriatric care facility. All residents in memory care units from May 2018 to December 2019 were individually assessed for pain management, rejection of care, usage of psychotropics, falls and physical altercations. Trained interdisciplinary staff to evaluate pain by using PAIN AD. Educated interdisciplinary team on pharmacological and non-pharmacological pain management, and Pain management has improved from 40% to 90%, Rejection of care reduced from 80% to 30%. Usage of antipsychotics reduced by 12%. Falls reduced from 12% to 2%. Physical altercations reduced to zero. Staff call out due to work related injury significantly reduced. Staff verbalized improved job satisfaction and increased morale.
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Lofthouse-Jones, Chloe, Phil King, Helen Pocock, Mary Ramsay, Patryk Jadzinski, Ed England, Sarah Taylor, Julian Cavalier e Carole Fogg. "Reducing ambulance conveyance for older people with and without dementia: evidence of the role of social care from a regional, year-long service evaluation using retrospective routine data". British Paramedic Journal 6, n.º 3 (1 de dezembro de 2021): 58–69. http://dx.doi.org/10.29045/14784726.2021.12.6.3.58.
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Introduction: Older people, especially those with dementia, have a high risk of deterioration following admission to hospital. More than 60% of older people attended by South Central Ambulance Service (SCAS) clinicians are conveyed to hospital, although many conveyances may not have been due to life-threatening conditions. We aimed to understand patterns of conveyance and alternative referral pathways used following ambulance attendance to an older person.Methods: Service evaluation, using routinely collected, anonymised electronic records.Participants: Electronic records of people aged ≥75 years for whom an ambulance was dispatched between April 2016 and March 2017 within the geographical boundaries of SCAS NHS Foundation Trust, who were alive on arrival of the ambulance. Conveyance rates are described according to patient and emergency-call characteristics. Logistic regression was used to produce adjusted odds ratios for conveyance. Alternative referral pathways used are described.Results: Of 110,781 patients attended, 64% were conveyed to hospital. Factors associated with reduced odds of conveyance included out-of-hours calls (adjusted odds ratio (aOR) 0.82 [0.79‐0.85]), living alone with a care package or with family plus care package (aOR 0.66 [0.62‐0.69]; aOR 0.58 [0.54‐0.62] respectively) and a record of dementia (0.91 [0.87‐0.96]). Living in a nursing home was associated with an increased risk of conveyance (aOR 1.25 [1.15‐1.36]). Patients with dementia with more income were significantly less likely to be conveyed than those with less income. Alternative referral services were used in 22% of non-conveyed patients, most commonly GP, out-of-hours and falls services.Discussion: People aged ≥75 years have high rates of conveyance, which are influenced by factors such as out-of-hours calls, dementia and receipt of social care. Low use of alternative referral services may reflect limited availability or difficulty in access. A better understanding of how these factors influence ambulance clinician decision-making is integral to improvement of outcomes for older people.
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Redondo-Bravo, Lidia, Beatriz Fernandez-Martinez, Diana Gómez-Barroso, Alin Gherasim, Montserrat García-Gómez, Agustín Benito e Zaida Herrador. "Scabies in Spain? A comprehensive epidemiological picture". PLOS ONE 16, n.º 11 (1 de novembro de 2021): e0258780. http://dx.doi.org/10.1371/journal.pone.0258780.
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Introduction Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997–2019 as well as to describe the main environments of transmission using different data sources. Methods We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes. Results The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored. Discussion An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.
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Hickenbottom, Susan L., Kenneth M. Langa, Jeffrey S. Kutcher, Mohammed U. Kabeto, A. M. Fendrick e Steven J. Katz. "A National Study of the Quantity and Cost of Informal Caregiving for the Elderly with Stroke". Stroke 32, suppl_1 (janeiro de 2001): 326. http://dx.doi.org/10.1161/str.32.suppl_1.326-b.
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56 Background: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. While estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients. Objective: To determine a nationally representative estimate of the quantity and cost of informal caregiving for elderly stroke patients. Methods: We used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70 living in the community, to determine average weekly hours of informal caregiving. Multivariate and logistic regression analyses were performed to examine association of stroke and other covariates and assess the probability of receiving informal care. Average annual cost for informal caregiving was calculated. Results: Of the 7443 respondents, 656 (6%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, social support and sociodemographics, the proportion of patients receiving informal care increased with stroke severity, and there was a significant association of weekly hours of caregiving with stroke category (p<0.01). Using the mean 1998 wage for a home health aide ($8.20/hr.) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from $3500 to $7600, which would result in an annual cost of more than $5.7 billion for stroke-related informal caregiving in the US. Conclusions: The economic burden of informal caregiving following stroke has not been studied previously. Informal caregiving occurs frequently; associated costs are substantial and should be considered when estimating the cost of stroke treatment.
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Meisenberg, Barry R., Elizabeth Hahn, Madelaine Binner, David Weng, Barry R. Meisenberg, Elizabeth Hahn, Madelaine Binner e David Weng. "ReCAP: Insights Into the Potential Preventability of Oncology Readmissions". Journal of Oncology Practice 12, n.º 2 (fevereiro de 2016): 153–54. http://dx.doi.org/10.1200/jop.2015.006437.
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QUESTION ADDRESSED: Are oncology readmissions preventable? If so, what resources and changes in practice or culture would be required to reduce readmissions? CONCLUSION: Three independent reviewers analyzed 72 hospital readmissions and found that 22 (31%) of the 72 readmissions were preventable. The most common causes of preventability were overwhelming symptoms in patients who qualified for hospice but were not participating and insufficient communication between patients and the care team about symptom burden. The most common reason for nonpreventability were high symptom burden among patients not appropriate for hospice or for whom aggressive outpatient management was inadequate despite extensive efforts (Table). Readmissions from nursing facilities—where there is little oncology supervision—accounted for 35% of the total. METHODS: Standardized criteria to define preventability/nonpreventability were developed before data collection began. The records of sequential nonsurgical readmissions were reviewed independently by two experienced oncology reviewers. When the reviewers disagreed about assignment, a third reviewer broke the tie. Seventy-two readmissions from 69 patients were analyzed. The first two reviewers agreed that 18 (25%) were preventable and that 29 (40%) were not. A third reviewer found four of the split 25 cases to be preventable, so the consensus preventability rate was 22 (31%) of 72. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: A large minority of readmissions can be viewed as a failure of some aspect of the medical care system: symptom management, communication, psychosocial support, education or expectation management. The exact ratio of preventable to nonpreventable readmissions is less important than the finding that many are preventable with better outreach to frail or vulnerable patients and more rigorous or effective goals of care discussions. The findings are consistent with the small number of other studies of readmissions, all judged retrospectively. Such efforts are inherently subjective, but we attempted to minimize bias by creating standard definitions of preventability (Table) and by using independent assessments, avoiding an open consensus process that introduces additional types of bias. REAL-LIFE IMPLICATIONS: Some hospital readmissions may be preventable, depending on the conditions and social situation of the patients. Unfortunately, there are no ideal methods for determining preventability of hospital readmissions. Analyses of coded administrative data allow for large data sets, but such methods are silent about the appropriateness or potential preventability of the readmission. Coded data necessarily overlook patient-level issues such as fear, frailty, social isolation or symptom burden, and ignore a patient’s desire for aggressive cancer care. Indeed, some readmissions in oncology are a consequence of continued aggressive therapy that is requested by patients or families and is rendered due to the “shared decision making” process. Chart review, although limiting the sample size, allows more insights into the patient-level and social factors associated with readmissions as well as gaps in the care process, but not all. It cannot determine, for example, if a decision not to opt for hospice care was primarily motivated by patient attitudes, oncologist approach or some combination. Although these data include only 30-day readmissions, the same sort of issue likely pertain to all unplanned admissions and to emergency department visits as well. Oncology programs are encouraged to study their own patterns of unplanned admissions and readmission in order to learn about care gaps. Greater outreach to at–risk patients as in a medical home might prevent many unplanned admissions. Finally, we note that most studies of oncology readmissions have focused on physician assessment of causes with less attention on the patient perspective about reasons for unplanned admission. Such a study is ongoing and will complement these findings. [Table: see text]
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So, Joanne Siu Ping, e Kai Nin Joseph Chan. "The Effects of Stigma on the Caregivers of Elderly Patients With Psychiatric Issues in a Chinese Community". Innovation in Aging 5, Supplement_1 (1 de dezembro de 2021): 253. http://dx.doi.org/10.1093/geroni/igab046.979.
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Abstract World Health Organization in 2017 indicates the proportion of persons over the age of 60 years will exponentially grow from 12% in 2015 to 22% in 2050. Advanced age is a common risk factor for multiple conditions, including psychosis, depression, and other mental illnesses linked to cognitive and neurologic disorders. The majority of the studies identify ethnicity and socioeconomic status as primary determinants of mental health care access. Recent studies show that up to 12% of elderly Chinese have had a history of mental problems. However, over 50% of Chinese with mental disorders have failed to obtain professional help. Lack of access to health care for mental disorders has been linked to multiple underlying socioeconomic and cultural factors. These Chinese Americans lack an in-depth understanding of their psychosis, and psychiatric conditions are often a minority in nature. This study will systematically review the existing situations relating the factors to the stigma on caregivers. The result shows that the leading cause of psychiatric disorders, physical and emotional components of the elderly population, needs to be incorporated in the care plan in nursing homes and hospitals. In North America, the constant perception of discrimination and the inherent feeling of isolation and stigma among families with elderly members remains challenging. This review could contribute to the policy reform, which can help design effective control strategies to manage gaps of most mental disorders that continue to disproportionately affect different ethnic groups across the U. S. and Canada.
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Zoppini, Laura. "How the Family and Community Nurse Can Foster the Reduction of Improper Emergency Room Admissions and Promote Chronic Patient Care: Single-Center Observational Study - Asst GOM Niguarda". International Journal of Clinical Case Reports and Reviews 16, n.º 1 (10 de janeiro de 2024): 01–06. http://dx.doi.org/10.31579/2690-4861/357.
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Background The incidence of improper access, with the consequent overcrowding of emergency room facilities, indirectly represents an indicator of evaluation of the local area's ability to take care of patients. In fact, overcrowding in the emergency room is often mainly attributable to patients requiring non-urgent or deferrable services, who access the emergency room due to the lack of hospital-territory integration, and for whom differential care could be envisaged in the setting of local care, as in the case of elderly patients suffering from chronic pathologies. The Family and Community Nurse (FaCN) is the professional figure of reference who ensures nursing care at different levels of complexity in collaboration with all the professionals present in the community in which he works, pursuing the interdisciplinary, health and social integration of services and professionals and placing the person at the center. Purpose From January 1st, 2023, a reporting process has been launched by the emergency room nursing staff for the chronic patient discharged to home and taken into care by the family and community nurse service. A retrospective single-center observational study was carried out on patients discharged from the Emergency Room of the ASST Grande Ospedale Metropolitano Niguarda. The data presented relates to the period 01.01.2023 - 30.09.2023. The purpose of the study is twofold: 1. Describe ways to ensure continuity of care between hospital and territory/primary care, identifying their level of complexity with the TRIAGE scale. 2. Identify the resources activated and interventions performed by the Territorial Team of Family and Community Nurses. Method Included in the study were chronic, home-discharged patients with chronic conditions who were domiciled or residing in the territory of afferent to ASST GOM Niguarda, referred by the nursing staff of the same emergency department and taken over by Family and Community Nurses (FaCNs). Exclusion Criteria affected chronic patients domiciled or residing in the territory of afferent to ASST Niguarda who refused to be taken in charge or admitted to hospital wards, intermediate care facilities, Health Care Residences for the Elderly. The triage scale is a first-level multidimensional assessment tool that aims at identifying complex social-health needs for the local area. It consists of eight items: morbidity, nutrition, alvus and diuresis, mobility, personal hygiene, mental status and behavior with whom he/she lives, and direct care. Four levels of severity are identified: absent or mild, moderate, severe, and very severe, with a score ranging from 0 to 2. The sum of the scores applied to the different domains constitutes the total score, which allows the complexity of patients to be stratified into three levels. The triage form is filled out by the Emergency Room nurse in the event of discharge of the patient and if the patient has a score between 3 and 10; the activation of the FaCN is envisaged through an email report made by the Caring Nurse to the Territorial FaCN service (pre-discharge phase). The FaCN takes charge of the patient and guarantees a series of interventions and care services in relation to the level of complexity of the needs expressed by the patient (post-discharge phase). Outcomes Patients discharged with chronic pathologies reported in the period indicated were 250, with an average age of 81.75 years (standard deviation 9.67). Most reports are included in the intermediate risk class between scores of 3 and 7, and the most represented age class is that of patients over 80 years old. In patients reported to the FaCN service, professionals reached the patient or his caregiver out for an initial approach, within 24 hours of discharge from the emergency room. The outcome of the reports made shows that in 48.8% of cases the FaCNs took steps to establish a connection between the FaCNs' service and the most competent territorial references closest to the patient and took care of them towards more appropriate services (home palliative care, mental health, etc.), while in 51.6% of cases the FaCN took charge of the patient directly, providing the appropriate care (medications, venous sampling, recording of vital parameters, health education interventions, therapeutic and engagement adherence, also through teleassistance). At the moment no other deaths have been recorded and in no case has the patient visited the Emergency Room again. Conclusion The activation of the FaCN for chronic patients discharged from the Emergency Room has made it possible to facilitate patient care, overcome the fragmentation of services, and guarantee continuity of care, both in cases in which the patient has been directly taken care of and assisted by the FaCNs, and in cases in which the patient has been directed/orientated towards other local services. Over time, it will be possible to reduce the volume of hospital care activities for fragile patients and inappropriate access to the Emergency Room, by strengthening the continuity of care, precisely guaranteed by the strategic value of the Family and Community Nurse.
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Ayala Salinas, Rosa Aydee, Gandhy Ponce Gómez e Beatriz Carmona Mejia. "Necesidades de cuidados paliativos en el Paciente Crónico Degenerativo Complejo". Enfermería Global 22, n.º 1 (3 de janeiro de 2023): 167–92. http://dx.doi.org/10.6018/eglobal.513611.
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Introduction: Providing necessary healthcare to complex chronic degenerative patients, including palliative care, is a current important demand in order to increase the life expectancy of these populations.Objective: To describe the main needs regarding palliative care of persons living with complex chronic degenerative conditions in an institution of 3rd level of attention. The theoretical framework is Wagner's Chronic Care Model.Methodology: This is a descriptive, transversal, quantitative research. A total of 50 hospitalized patients without oncologic diagnosis from an institution of 3rd level of attention were assessed in order to identify their palliative care needs. The NECPAL CCOMS-ICO© 3.1 (2017) instrument was used. The Kuder-Richardson Reliability Test turned out to be 0.73.Results: Most participants showed some degree of cognitive deterioration regarding the areas of attention and language. Based on the Karnofsky index, 60% of the participants were physically disabled to carry out their daily activities. Fragility was evident in 82% of the participants, while 64%, 58%, and 62% showed delirium, pressure sores, and dysphagia respectively.Discussion and Conclusions: The present study contributes to the knowledge regarding the special care needs of persons living with complex chronic degenerative conditions. An objective is to reduce the long and costly hospital stays by implementing a home-extended palliative care plan which actively integrates the family members in the care process and decision making. Introducción. Brindar los cuidados necesarios a los pacientes crónicos, con la consiguiente inclusión de los Cuidados Paliativos, es una demanda actual debido al aumento de la esperanza de vida y la complejidad de los problemas de salud crónico degenerativos.Objetivo. La presente investigación tiene por objetivo describir las principales necesidades de atención paliativa en las personas con enfermedades crónicas degenerativas complejas en una unidad de tercer nivel de atención. Los referentes teóricos provienen del Modelo de Cuidado Crónico de Wagner (MCC).Metodología: Investigación cuantitativa descriptiva, transversal. Se valoró a un total de 50 pacientes hospitalizados en una unidad de tercer nivel de atención con diagnóstico no oncológico para identificar las necesidades de cuidados paliativo a través del instrumento NECPAL CCOMS-ICO© 3.1 (2017). La confiabilidad alcanzada tras recolección fue de .73 KR20.Resultados: La mayoría de los participantes tienen deterioro cognitivo en Atención y en Lenguaje. El declive funcional relacionado con el ‘índice de Karnofsky nos señala que el 60% están incapacitados físicamente para llevar a cabo sus actividades diarias. La presencia de fragilidad se manifiesta por el 82% de los participantes presenta infecciones, delirium el 64%, el 58% manifiesta Ulceras por presión y 62% problemas de disfagia.Discusión y Conclusiones: El presente estudio contribuye a valorar las necesidades de cuidados paliativos, disminuye internaciones hospitalarias largas y de alto costo económico y social para las familias y permite implementar un plan de cuidados paliativos extendidos al domicilio y tener previsto un plan de información sobre la toma de decisiones en la familia.
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Rivera-Hernandez, Maricruz, Amit Kumar, Lin-Na Chou, Tamra Keeney, Nasim Ferdows, Amol Karmarkar, Kyriakos S. Markides e Kenneth Ottenbacher. "Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries". PLOS ONE 17, n.º 1 (14 de janeiro de 2022): e0262079. http://dx.doi.org/10.1371/journal.pone.0262079.
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Objectives To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. Methods Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. Results Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91). Discussion Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.
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Furrow, Barry. "The Future of Behavioral Health: Can Private Equity and Telehealth Improve Access?" American Journal of Law & Medicine 49, n.º 2-3 (julho de 2023): 314–38. http://dx.doi.org/10.1017/amj.2023.34.
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AbstractTreatment of mental illness in the United States is woefully inadequate. One-third of adults report having a mental health condition or substance use disorder, but less than half receive treatment for their condition.Access is the problem. The U.S. is short on mental health professionals: more psychiatrists are needed and psychologists and social workers are overextended. Proposed solutions are to (1) increase reimbursement rates for psychiatrists and other mental health practitioners, and (2) use a wider range of providers, including nurses and family support specialists—all good ideas. My focus however is on two other forces that are moving into the behavioral health area, offering both financing and technologies to extend the reach of mental health services—private equity and telemental health.First, private equity firms see high demand in this market. Behavioral health is desperately needed but is highly fragmented and lacking in innovation. Private equity is attracted to outpatient programs that target specific conditions that have evidence-based clinical models—programs aimed at addiction, eating disorders, and autism; these areas require less capital. Federal and state reimbursement is available, some regulations have been relaxed to allow remote prescribing of medicine; and innovative telehealth tools can be used. The problem is that private equity has a poor track record in both nursing home care and behavioral care for teens. The private equity model and its financial incentives are at odds with good care.Second, telemental health tools, already in use because of the need during the pandemic, appear attractive. These tools require less capital to treat a higher volume of patients and promise much improved access to mental health treatment for populations that could not get such care because of travel distance, costs, and time limitations. The problem is that the telemental health tools have yet to be subjected to evidence-based testing.My goal in this article is to test whether these two developments – private equity and telemental health —can improve access for patients at an acceptable level of quality. I conclude that both have substantial problems and I offer a range of regulatory approaches to control patient abuses and poor quality.
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Vennedey, Vera, Kira Isabel Hower, Hendrik Hillen, Lena Ansmann, Ludwig Kuntz e Stephanie Stock. "Patients’ perspectives of facilitators and barriers to patient-centred care: insights from qualitative patient interviews". BMJ Open 10, n.º 5 (maio de 2020): e033449. http://dx.doi.org/10.1136/bmjopen-2019-033449.
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ObjectivesPrevious studies on patient-centred care (PCC) and its facilitators and barriers usually considered specific patient groups, healthcare settings and aspects of PCC or focused on expert perspectives. The objective of this study was to analyse patients’ perspectives of facilitators and barriers towards implementing PCC.DesignWe conducted semistructured individual interviews with chronically ill patients. The interviewees were encouraged to share positive and negative experiences of care and the related facilitators and barriers in all settings including preventive, acute and chronic health issues. Interview data were analysed based on the concept of content analysis.SettingInterviews took place at the University Hospital Cologne, nursing homes, at participants’ homes or by telephone.ParticipantsAny person with at least one chronic illness living in the region of Cologne was eligible for participation. 25 persons with an average age of 60 years participated in the interviews. The participants suffered from various chronic conditions including mental health problems, oncological, metabolic, neurological diseases, but also shared experiences related to acute health issues.ResultsParticipants described facilitators and barriers of PCC on the microlevel (eg, patient–provider interaction), mesolevel (eg, health and social care organisation, HSCO) and macrolevel (eg, laws, financing). In addition to previous concepts, interviewees illustrated the importance of being an active patient by taking individual responsibility for health. Interviewees considered functioning teams and healthy staff members a facilitator of PCC as this can compensate stressful situations or lack of staff to some degree. A lack of transparency in financing and reimbursement was identified as barrier to PCC.ConclusionIndividual providers and HSCOs can address many facilitators and barriers of PCC as perceived by patients. Large-scale changes such as reduction of administrative barriers, the expansion of care networks or higher mandatory nurse to patient ratios require political action and incentives.Trial registration numberDRKS00011925
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Rai, Aakriti, Shila Lamichhane, Tanuja Kumari Chaudhary e Beth A. Brooks. "Quality of Work life of Nurses in a Government Hospital, Chitwan". Med Phoenix 8, n.º 2 (31 de dezembro de 2023): 48–55. http://dx.doi.org/10.3126/medphoenix.v8i2.61818.
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Introduction: Work is an integral part of life where employees spend about one third of their entire life in workplace, thus working environment must be favorable. When the quality of work-life is stable, productivity is bound to increase. It seeks to benefit employees, their families, and the organization as well. The objective of the study is to identify the quality of work life of nurses working in Bharatpur hospital, Nepal.Materials and Methods: A descriptive cross sectional study design was used. The total number of 84 nurses from Bharatpur Hospital were purposively selected. Non-probability convenience sampling techniques was used to select a nurse working in Bharatpur Government hospital, Bharatpur, Chitwan having maximum of 6months job experience. Data were collected using standardized Brooks’ Quality of Nursing Work Life Survey tool. Data were analyzed using the statistical package of social science(SPSS) version 20.0. Inferential statistic was used to measure the association between quality of life of nurse and selected variables.Results: The study revealed that overall quality of work life were moderate (79.8%) of respondents. The findings on dimension wise quality of work life of nurses were 83.3%, 67.3% and 65.5% of respondents had moderate level of quality in work design, home life/ work life and work world dimension respectively, while 57.1% of respondents had high level of quality of work life of nurses in work context dimension. The Quality of Work Life of nurses was associated with level of education (χ2=11.027, p= 0.004).Conclusions: The majority of nurse had moderate level quality of work life. The authorities in the health care system should develop strategies for improving the nurses work conditions and their quality of work life so that, nurses will be able to perform quality care for their patients.
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Aakriti Rai, Shila Lamichhane, Mala Rijal, Brooks Beth A e Tanuja Kumari Chaudhary. "Quality of Work Life of Nurses in a Government Hospital, Nepal". Janaki Medical College Journal of Medical Science 11, n.º 3 (15 de dezembro de 2023): 44–54. http://dx.doi.org/10.3126/jmcjms.v11i3.60577.
Texto completo da fonteResumo:
Background and Objectives: Work is an integral part of life where employees spend about one third of their entire life in workplace, thus working environment must be favorable. When the quality of work-life is stable, productivity is bound to increase. It seeks to benefit employees, their families, and the organization as well. The objective of the study is to identify the quality of work life of nurses working in Bharatpur hospital, Nepal. Materials and Methods: A descriptive cross sectional study design was used. The total number of 84 nurses from Bharatpur Hospital were purposively selected. Non-probability convenience sampling techniques was used to select a nurse working in Bharatpur Government hospital, Bharatpur, Chitwan having maximum of 6 months job experience. Data were collected using standardized Brooks’ Quality of Nursing Work Life Survey tool. Data analyzed using the statistical package of social science (SPSS) version 20.0. Inferential statistic was used to measure the association between quality of life of nurse and selected variables. Results: The study revealed that overall Quality of Work life were moderate (79.8%) of respondents. The findings on dimension wise Quality of Work Life of nurses were 83.3%, 67.3% and 65.5% of respondents had moderate level of quality in work design, home life/ work life and work world dimension respectively, while 57.1% of respondents had high level of quality of work life of nurses in work context dimension. The Quality of Work Life of nurses was associated with level of education (X2 =11.027, p= 0.004). Conclusion: The majority of nurse had moderate level quality of work life. The authorities in the health care system should develop strategies for improving the nurses work conditions and their quality of work life so that, nurses will be able to perform quality care for their patients.