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Gobbini E, Toffart AC, Boisserie Lacroix L, Pinsolle J, Schoutteten L, Federspiel I, Pierret T, Pérol M, Feyeux A. Immune checkpoint inhibitors and hospitalization at home in France. Bull Cancer 2021; 109:89-97. [PMID: 34785029 DOI: 10.1016/j.bulcan.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The administration of immune checkpoints inhibitors (ICIs) within hospitalization at home (HaH) organizations is an interesting alternative to conventional care. Three surveys were carried out to describe the different organizational models of French HaHs and criteria used by physicians in patient selection. METHODS Three surveys were conducted between April 1 and August 31, 2020. The first one was addressed to all French HaHs, and the two others to public HaHs and oncologists treating patients with solid cancer in the Auvergne-Rhone-Alpes region. RESULTS Overall, 54 French HaHs and 23 oncologists participated to the study. The health professionals involved in the patients' care were very heterogeneous, although in 92% of cases, the treatment prescription was made by the oncologist. HaH physicians were more involved in clinical assessment the day before treatment (19% vs. 0%), treatment validation (56% vs. 15%), and treatment prescription (19% vs. 0%), while nurses were better equipped (emergency kit available in 81% versus 50% of cases) when HaHs did carry out ICIs compared to when they did not. Most oncologists agreed that age, neuropsychiatric disorders, home environment, as well as treatment duration and good tolerance should be considered in patient selection. ECOG PS status and treatment response were less consensually considered. CONCLUSION These results highlight the variability in French HaH organizations and patient selection criteria for employing ICIs at home. This study resulted in recommendations for administrating ICIs in HaH settings, which will likely be instrumental in further promoting this activity across France.
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Affiliation(s)
- Elisa Gobbini
- CHU Grenoble-Alpes, Unité d'oncologie thoracique, 38700 La Tronche, France; Centre de recherche sur le cancer de Lyon, 69008 Lyon, France.
| | | | | | - Julian Pinsolle
- Centre Hospitalier Métropole Savoie, Unité de pneumologie, 73000 Chambéry, France
| | - Laure Schoutteten
- CHU Grenoble-Alpes, Unité d'oncologie médicale, 38700 La Tronche, France
| | - Isabelle Federspiel
- Centre Hospitalier Universitaire de Grenoble-Alpes, Unité centralisée des préparations médicamenteuses cytotoxiques, Pharmacie hospitalière, La Tronche, France
| | - Thomas Pierret
- CHU Grenoble-Alpes, Unité d'oncologie thoracique, 38700 La Tronche, France
| | - Maurice Pérol
- Centre Léon Bérard, Unité d'oncologie Thoracique, 69008, Lyon, France
| | - Amélie Feyeux
- Centre Hospitalier de Bourg-en-Bresse, Hospitalisation À Domicile, France
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2
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Hole C, Munn LT, Swick M. The Virtual Hospital: An Innovative Solution for Disaster Response. J Nurs Adm 2021; 51:500-506. [PMID: 34550104 DOI: 10.1097/nna.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Like any disaster, the COVID-19 pandemic has presented significant challenges to healthcare systems, especially the threat of insufficient bed capacity and resources. Hospitals have been required to plan for and implement innovative approaches to expand hospital inpatient and intensive care capacity. This article presents how one of the largest healthcare systems in the United States leveraged existing technology infrastructure to create a virtual hospital that extended care beyond the walls of the "brick and mortar" hospital.
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Affiliation(s)
- Colleen Hole
- Author Affiliations: Chief Nurse Executive, Atrium Health Ambulatory Care, and Vice President, Clinical Integration in Population Health (Ms Hole), Director of Interprofessional Research and Assistant Professor (Dr Munn), Department of Emergency Medicine, and Enterprise Chief Nurse (Dr Swick), Atrium Health, Charlotte, North Carolina
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3
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Shi G, Chen C. Home-based versus outpatient pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26099. [PMID: 34032747 PMCID: PMC8154446 DOI: 10.1097/md.0000000000026099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although home-based pulmonary rehabilitation programs have been shown in some studies to be an alternative and effective model, there is a lack of consensus in the medical literature due to different study designs and lack of standardization among procedures. Therefore, the purpose of this study was to compare the efficacy of a home-based versus outpatient pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). METHODS Five electronic databases including Embase, PubMed, Scopus, Science Direct, and Cochrane Library will be searched in May 2021 by 2 independent reviewers. The reference lists of the included studies will be also checked for additional studies that are not identified with the database search. There is no restriction on the dates of publication or language in the search. The randomized controlled trials focusing on comparing home-based and outpatient pulmonary rehabilitation for COPD patients will be included in our meta-analysis. The following outcomes should have been measured: functional exercise capacity, disease-specific health-related quality of life, and cost-effectiveness measures. Risk ratio with a 95% confidence interval or standardized mean difference with 95% CI is assessed for dichotomous outcomes or continuous outcomes, respectively. RESULTS It was hypothesized that these 2 methods would provide similar therapeutic benefits. REGISTRATION NUMBER 10.17605/OSF.IO/5CV48.
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Affiliation(s)
| | - Chuanjun Chen
- Department of Oncology, Xinchang County People's Hospital, Zhejiang 312500, China
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4
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Chiang JK, Kao YH. Quality of end-of-life care of home-based care with or without palliative services for patients with advanced illnesses. Medicine (Baltimore) 2021; 100:e25841. [PMID: 33950997 PMCID: PMC8104190 DOI: 10.1097/md.0000000000025841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/19/2021] [Indexed: 01/04/2023] Open
Abstract
Palliative care has improved quality of end-of-life (EOL) care for patients with cancer, and these benefits may be extended to patients with other serious illnesses. EOL care quality for patients with home-based care is a critical problem for health care providers. We compare EOL quality care between patients with advanced illnesses receiving home-based care with and without palliative services.The medical records of deceased patients who received home-based care at a community teaching hospital in south Taiwan from January to December 2019 were collected retrospectively. We analyzed EOL care quality indicators during the last month of life.A total of 164 patients were included for analysis. Fifty-two (31.7%) received palliative services (HP group), and 112 (68.3%) did not receive palliative services (non-HP group). Regarding the quality indicators of EOL care, we discovered that a lower percentage of the HP group died in a hospital than did that of the non-HP group (34.6% vs 62.5%, P = .001) through univariate analysis. We found that the HP group had lower scores on the aggressiveness of EOL care than did the non-HP group (0.5 ± 0.9 vs 1.0 ± 1.0, P<.001). Furthermore, palliative services were a significant and negative factor of dying in a hospital after adjustment (OR = 0.13, 95%CI = 0.05-0.36, P < .001).For patients with advanced illnesses receiving home-based care, palliative services are associated with lower scores on the aggressiveness of EOL care and a reduced probability of dying in a hospital.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
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5
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Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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6
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Mittaine‐Marzac B, Zogo A, Crusson J, Cheneau V, Pinel M, Brandely‐Piat M, Amrani F, Havard L, Balladur E, Louissaint T, Nivet L, Ankri J, Aegerter P, De Stampa M. COVID-19 outbreak: An experience to reappraise the role of hospital at home in the anti-cancer drug injection. Cancer Med 2021; 10:2242-2249. [PMID: 33665971 PMCID: PMC7982610 DOI: 10.1002/cam4.3682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The COVID-19 outbreak has posed considerable challenges to the health care system worldwide, especially for cancer treatment. We described the activity and the care organisation of the Hospitalisation At Home (HAH) structure during the pandemic for treating patients with anti-cancer injections. METHODS We report the established organisation, the eligibility criteria, the patient characteristics, the treatment schemes and the stakeholders' role during two 5-week periods in 2020, before and during the French population's lockdown. RESULTS The increase of activity during the lockdown (+32% of treated patients, +156% of new patients and +28% of delivered preparations) concerned solid tumour, mainly breast cancer, even if haematological malignancies remained the most frequent. Thirty different drugs were delivered, including three new drugs administered in HAH versus 19 during the routine period (p < 0.01). For those clinical departments accustomed to using HAH, the usual organisation was kept, but with adjustments. Five clinical departments increased the number of patients treated at home and widened the panel of drugs prescribed. Three oncology departments and one radiotherapy department for the first time solicited HAH for anti-cancer injections, mainly for immunotherapy. We adjusted the HAH organisation with additional human resources and allowed to prescribe drugs with an infusion time of <30 min only for the new prescribers. CONCLUSION HAH allowed for the continuation of anti-cancer injections without postponement during the pandemic, and for a decrease in unnecessary patient travel to hospital with its concomitant COVID-19 transmission risk. Often left out of guidelines, the place of HAH in treating cancer patients should be reappraised, even more so during a pandemic.
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Affiliation(s)
- Bénédicte Mittaine‐Marzac
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
| | - Arsene Zogo
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | | | - Valerie Cheneau
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Marie‐Claire Pinel
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | | | - Fatma Amrani
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Laurent Havard
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Elisabeth Balladur
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Taina Louissaint
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Laurence Nivet
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Joel Ankri
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
| | - Philippe Aegerter
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
| | - Matthieu De Stampa
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
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7
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van Herwerden MC, van Steenkiste J, El Moussaoui R, den Hollander JG, Helfrich G, J A M Verberk I. [Home telemonitoring and oxygen therapy in COVID-19 patients: safety, patient satisfaction, and cost-effectiveness]. Ned Tijdschr Geneeskd 2021; 165:D5740. [PMID: 33720552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the implementation of home telemonitoring and oxygen therapy in COVID-19 patients. Primary outcomes were safety, patient satisfaction, reduction of hospital stay, and cost-effectiveness. DESIGN Retrospective cohort study. METHOD All COVID-19 patients who were discharged with home telemonitoring and oxygen therapy between June 1st and November 1st 2020 were included. Eligible patients had a maximum oxygen requirement of 2 liters per minute during the 24 hours prior to discharge with a minimal peripheral oxygen saturation of 94%. A mobile application for telemonitoring was used, which patients or relatives had to be able to use independently. Patient demographics, clinical parameters, data on telemonitoring and readmissions were extracted from the electronic patient records. A survey for patient satisfaction and a cost-effectiveness analysis were performed. RESULTS Out of 619 admissions, 49 patients were discharged with home telemonitoring and oxygen therapy. Median duration of home oxygen therapy was 11 days with a potential reduction in hospitalization of 616 days. Six patients were readmitted and were significantly more febrile on discharge (67% versus 14%, p=0.01) and had lower oxygenation (95%, (IQR 93-96) versus 96%, (IQR 95-97), p=0.02) with similar levels of oxygen administration. Patient satisfaction was high with a mean score of 5 to 6 on a scale measuring satisfaction from 1 to 7. Estimated total cost reduction was € 146.736. CONCLUSION This study shows that home telemonitoring and oxygen administration can be safely applied in COVID-19 patients resulting in a high patient satisfaction and reduction in hospital stay and costs.
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Affiliation(s)
| | | | | | | | - Gea Helfrich
- Maasstad Ziekenhuis, afd. Longziekten, Rotterdam
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8
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Franzosa E, Gorbenko K, Brody AA, Leff B, Ritchie CS, Kinosian B, Ornstein KA, Federman AD. "At Home, with Care": Lessons from New York City Home-based Primary Care Practices Managing COVID-19. J Am Geriatr Soc 2021; 69:300-306. [PMID: 33179761 PMCID: PMC8285037 DOI: 10.1111/jgs.16952] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES COVID-19 required rapid innovation throughout the healthcare system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was to determine strategies used by New York City (NYC)-area HBPC practices to provide patient care during the first wave of the COVID-19 pandemic with the goal of informing planning and preparation for home-based practices nationwide. DESIGN Cross-sectional qualitative design using semi-structured interviews. SETTING HBPC practices in the NYC metro area during spring 2020. PARTICIPANTS HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators, and social workers/social work coordinators (n = 13) at 6 NYC-area practices. MEASUREMENTS Semi-structured interviews explored HBPC practices' COVID-19 care delivery challenges, adaptations, and advice for providers. Interviewers probed patient care, end-of-life care, telehealth, community-based services and staffing. Interviews were recorded and transcribed. Data were analyzed through a combined inductive and deductive thematic approach. RESULTS Participants described care delivery and operational adaptations similar to those universally adopted across healthcare settings during COVID-19, such as patient outreach and telehealth. HBPC-specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in-person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long-standing patients. CONCLUSION NYC-area HBPC providers adapted care delivery and operations rapidly during the height of the COVID-19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork, and partnerships with outside providers. As the pandemic continues to surge around the United States, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ksenia Gorbenko
- Department of Population Health Science and Policy, Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abraham A Brody
- Hartford Institute of Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatrics, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Kinosian
- Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Geriatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex D Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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McNamara R, Donnelly K, Boyle N, Menzies D, Hollywood R, Little E, Tiernan E, Donohoe K, Delaney A, Duffy F, Feeney E, O'Hanlon S. Community frailty response service: the ED at your front door. Emerg Med J 2020; 37:714-716. [PMID: 32972913 PMCID: PMC7517235 DOI: 10.1136/emermed-2020-210005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022]
Abstract
We describe the expansion and adaptation of a frailty response team to assess older people in their usual place of residence. The team had commenced a weekend service to a limited area in February 2020. As a consequence of demand related to the COVID-19 pandemic, we expanded it and adapted the model of care to provide a 7-day service to our entire catchment area. Five hundred and ninety two patient reviews have been completed in the first 105 days of operation with 43 patients transferred to hospital for further investigation or management following assessment.
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Affiliation(s)
- Rosa McNamara
- Emergency Department, Saint Vincent's University Hospital, Dublin, Ireland
| | - Kerri Donnelly
- Occupational Therapy, Saint Vincent's University Hospital, Dublin, Ireland
| | - Nichola Boyle
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin - National University of Ireland, Dublin, Ireland
| | - David Menzies
- Emergency Department, Saint Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin - National University of Ireland, Dublin, Ireland
| | | | - Elizabeth Little
- Emergency Department, Saint Vincent's University Hospital, Dublin, Ireland
| | - Eoin Tiernan
- Palliative Medicine, Saint Vincent's University Hospital, Dublin, Ireland
| | - Karen Donohoe
- Department of Medicine, Saint Vincent's University Hospital, Dublin, Ireland
| | - Aidan Delaney
- Occupational Therapy, Saint Vincent's University Hospital, Dublin, Ireland
| | - Fionnuala Duffy
- Occupational Therapy, Saint Vincent's University Hospital, Dublin, Ireland
| | - Eoin Feeney
- School of Medicine, University College Dublin - National University of Ireland, Dublin, Ireland
- Infectious Diseases, Saint Vincent's University Hospital, Dublin, Ireland
| | - Shane O'Hanlon
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin - National University of Ireland, Dublin, Ireland
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Abstract
There is a variety of portable ventilators on the market, each with its' own features. A clinician needs to understand the unique characteristics of the ventilators available in his or her region, as well as the nuances of primary and secondary settings for these portable home ventilators in order to create a comfortable breath that allows for adequate gas exchange for the patient. Understanding the interplay of the portable home ventilator and the ventilator circuit is also a key component of transitioning a patient to a portable home ventilator. This review details characteristics of some of the more commonly used machines in the United States, as well as the settings to be considered in supporting a child with chronic respiratory failure outside of the hospital. As more patients are being discharged from the hospital with mechanical home ventilation, new ventilators are being developed that expand upon features of current machines.
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Affiliation(s)
- Julie L Fierro
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States.
| | - Howard B Panitch
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States.
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Abstract
The ability to maintain functional status is an essential aspect of self-care for older adults. Instrumental activities of daily living (IADLs) decline within hours of hospitalization and are often overlooked, underassessed, and underreported. The aim of this integrative review was to examine and compare methods used to assess IADLs to determine the best measure for use across the care continuum, especially during transitions of care. A literature search without date restrictions was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Embase databases. Twelve studies of moderate quality were included in this review. More than half (58%) of the studies utilized the Lawton and Brody Scale to measure IADL among home-based and hospitalized patients. Implementation of this scale as standard practice and sharing the results with healthcare providers would encourage continuity of care with the goal of supporting older adults aging in place and preventing rehospitalization. In turn, this communication process may improve the transition from the inpatient to home setting, where, since 1999, the Outcome and Assessment Information Set has been mandated.
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Affiliation(s)
- Irina Koyfman
- Irina Koyfman, MSN, RN, NP-C, is a Doctor of Nursing Practice Student, Johns Hopkins School of Nursing, Baltimore, Maryland. Deborah Finnell, DNS, CARN-AP, FAAN, is a Professor, Johns Hopkins School of Nursing, Baltimore, Maryland
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12
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Gérard AC. [Heart failure, improve the return home]. Soins Gérontologie 2019; 24:39-42. [PMID: 30765087 DOI: 10.1016/j.sger.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Heart failure, a serious and progressive disease, mainly affects the elderly. The Vendée coastline attracts high numbers of retired people to the region. Faced with this observation, Vendée departmental hospital deemed it necessary to put in place a monitoring unit providing adapted care in order to reduce the rate of mortality and rehospitalisation. The implementation of the Return Home programme has had a positive impact on the optimised care management of patients.
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Affiliation(s)
- Anne-Claire Gérard
- Service de cardiologie, Centre hospitalier départemental Vendée, Les Oudairies, 85925 La Roche-sur-Yon cedex 9, France.
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13
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Ranaldi H, Deighan C, Taylor L. Exploring patient-reported outcomes of home-based cardiac rehabilitation in relation to Scottish, UK and European guidelines: an audit using qualitative methods. BMJ Open 2018; 8:e024499. [PMID: 30559161 PMCID: PMC6303573 DOI: 10.1136/bmjopen-2018-024499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The Heart Manual (HM) is the UK's leading facilitated home-based cardiac rehabilitation (CR) programme for individuals recovering from myocardial infarction and revascularisation. This audit explored patient-reported outcomes of home-based CR in relation to current Scottish, UK and European guidelines. SETTING Patients across the UK returned their questionnaire after completing the HM programme to the HM Department (NHS Lothian). PARTICIPANTS Qualitative data from 457 questionnaires returned between 2011 and 2018 were included for thematic analysis. Seven themes were identified from the guidelines. This guided initial deductive coding and provided the basis for inductive subthemes to emerge. RESULTS Themes included: (1) health behaviour change and modifiable risk reduction, (2) psychosocial support, (3) education, (4) social support, (5) medical risk management, (6) vocational rehabilitation and (7) long-term strategies and maintenance. Both (1) and (2) were reported as having the greatest impact on patients' daily lives. Subthemes for (1) included: guidance, engagement, awareness, consequences, attitude, no change and motivation. Psychosocial support comprised: stress management, pacing, relaxation, increased self-efficacy, validation, mental health and self-perception. This was followed by (3) and (4). Patients less frequently referred to (5), (6) and (7). Additional themes highlighted the impact of the HM programme and that patients attributed the greatest impact to a combination of all the above themes. CONCLUSIONS This audit highlighted the HM as comprehensive and inclusive of key elements proposed by Scottish, UK and EU guidelines. Patients reported this had a profound impact on their daily lives and proved advantageous for CR.
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Affiliation(s)
| | | | - Louise Taylor
- The Heart Manual Department, NHS Lothian, Edinburgh, UK
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14
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Franzin-Garrec M, Huin C, Pernot B, Prudhomme V. [Not Available]. Soins 2018; 63:42-45. [PMID: 30366703 DOI: 10.1016/j.soin.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The certification visit by the French National Health Authority requires a high level of commitment and collaboration on the part of the teams of the healthcare facility concerned. Professionals from a hospital at home unit having obtained its Level A certification describe the process and explain how the approach helped to give meaning to collective action when caring for patients in their home.
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Affiliation(s)
| | - Carole Huin
- Fondation Santé Service, 15, quai de Dion-Bouton, 92816 Puteaux, France
| | - Bénédicte Pernot
- Fondation Santé Service, 15, quai de Dion-Bouton, 92816 Puteaux, France
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15
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Kelley T. There's No (Treatment) Place Like Home. Manag Care 2018; 27:28-29. [PMID: 30142061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
David Levine, MD, of Boston's Brigham and Women's hospital, is spearheading a program in which hospital level care is delivered to patients' homes. It's a research project for now. Eligible candidates who decide to participate are randomly assigned either to an inpatient-care control group or to Levine's "Home Hospital."
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Tanneberger S, Pannuti F, Mirri R, Panetta A, Mariano P, Romano D, Giordani S, Martoni A, Farabegoli G. Hospital-at-Home for Advanced Cancer Patients within the Framework of the Bologna Eubiosia Project: An Evaluation. Tumori 2018; 84:376-82. [PMID: 9678621 DOI: 10.1177/030089169808400313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background An evaluation of the Bologna Hospital-at-Home (BHH) was undertaken to examine the following aspects: 1) median daily costs of the BHH; 2) delivery of medical services; 3) patient satisfaction with the care received and frequency of requests for transfer to the alternative setting. Delivery of services and patient's satisfaction in the BHH were compared with data collected for a traditional hospital (Ospedale Sant'Orsola Malpighi, Bologna - OSM). Methods Our analysis was performed as a cost analysis considering two periods of time in 1992 and 1993/94. Included were direct and indirect costs; no intangible costs were found. The patient's perspective was selected for the analysis. The observational study examining delivery of service and quality of life of patients admitted to the two care settings, BHH and OSM, considered patient's clinical history and an interview conducted by the evaluation team 6 weeks after admission to either facility. Data included patient's characteristics, quantity of diagnostic and therapeutic measures, circumstances of life, satisfaction with the care received, and intention for transfer to the alternative setting of nursing. The statistical significance of our assumption of comparable care intensity and better patient quality of life in the BHH was tested by the Pearson Chi-square test. Results A survey was carried out of 236 patients treated in the BHH or the OSM. The setting of assistance did not influence the provision of services. The time of “talking to the doctor” was notably higher for BHH than for OSM patients. The analysis of satisfaction showed that 98% of the surveyed BHH patients believed it matched the actual needs. The quality of life was considered to be reduced/bad in 67% of the OSM patients but in only 51% of BHH patients. An opinion was also requested with regard to transfer to the alternative setting of nursing: 47% of OSM patients judged BHH care would be better than traditional hospital. The median daily costs in BHH reached 118,789 Lire (range, 108,569-129,027 Lire, depending on performance status). Conclusions Although the economic advantage of hospital-at-home care certainly is important, we would like to stress that better quality and dignity of life should be the main point supporting the idea of hospital-at-home care.
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Affiliation(s)
- S Tanneberger
- Associazione Nazionale Tumori, Divisione Oncologia Medica, Bologna, Italy
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Boisserie-Lacroix L, Marquestaut O, de Stampa M. [Palliative care at home: patient care pathways and clinical characteristics]. Sante Publique 2018; 29:851-859. [PMID: 29473399 DOI: 10.3917/spub.176.0851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The great majority of French people express their desire to receive palliative care at home. The objective of this study was to describe the clinical care pathways and characteristics of patient receiving hospital at home palliative care. METHODS This study compared the care pathways and clinical characteristics of patients receiving palliative care at home in the Ile-de-France region in 2014. Retrospective data were extracted from the French medical information systems programme. RESULTS 817 patients receiving palliative care at home were included in the study. They were older, more often referred to hospital at home by a primary care physician, had shorter lengths of stay and more often died at home compared to patients without palliative care. Palliative care patients mainly presented cancer and received frequent technical nursing care. The oldest patients (≥ 75 years old) more often presented neurodegenerative diseases, were less often transferred to hospital, and more often died at home compared to younger patients. A higher proportion of home deaths was observed in nursing home residents and patients who died at home required less technical nursing care. CONCLUSION This study provides important information concerning admission to hospital at home, the frequent changes of places of care and the complexity of maintaining palliative care at home until the patient's death.
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Gérard AC. [Improving the management of heart failure in the Vendée]. Rev Infirm 2018; 67:35-37. [PMID: 29609791 DOI: 10.1016/j.revinf.2018.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Heart failure is a serious condition which affects mainly elderly people. In the Vendée region, where many people choose to retire, hospital teams have noticed an increase in hospitalisations for heart failure. To optimise the management of these patients, a follow-up service was set up in July 2016 comprising a PRADO programme specifically supporting the return home of patients with heart failure.
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Affiliation(s)
- Anne-Claire Gérard
- Service de cardiologie Centre hospitalier départemental Vendée Les Oudairies, 85925 La Roche-sur-Yon Cedex 9, France.
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20
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Buret L, Duchesnes C, Giet D. [Clinical integration programs for complex situations: Functional support and normative challenge]. Presse Med 2017; 46:1113-1114. [PMID: 28919270 DOI: 10.1016/j.lpm.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 06/14/2017] [Accepted: 08/02/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Laetitia Buret
- Université de Liège, faculté de médecine, département de médecine générale, avenue Hippocrate, 13, bâtiment B23, 4000 Liège, Belgique.
| | - Christiane Duchesnes
- Université de Liège, faculté de médecine, département de médecine générale, avenue Hippocrate, 13, bâtiment B23, 4000 Liège, Belgique
| | - Didier Giet
- Université de Liège, faculté de médecine, département de médecine générale, avenue Hippocrate, 13, bâtiment B23, 4000 Liège, Belgique
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Lindley RI, Anderson CS, Billot L, Forster A, Hackett ML, Harvey LA, Jan S, Li Q, Liu H, Langhorne P, Maulik PK, Murthy GVS, Walker MF, Pandian JD, Alim M, Felix C, Syrigapu A, Tugnawat DK, Verma SJ, Shamanna BR, Hankey G, Thrift A, Bernhardt J, Mehndiratta MM, Jeyaseelan L, Donnelly P, Byrne D, Steley S, Santhosh V, Chilappagari S, Mysore J, Roy J, Padma MV, John L, Aaron S, Borah NC, Vijaya P, Kaul S, Khurana D, Sylaja PN, Halprashanth DS, Madhusudhan BK, Nambiar V, Sureshbabu S, Khanna MC, Narang GS, Chakraborty D, Chakraborty SS, Biswas B, Kaura S, Koundal H, Singh P, Andrias A, Thambu DS, Ramya I, George J, Prabhakar AT, Kirubakaran P, Anbalagan P, Ghose M, Bordoloi K, Gohain P, Reddy NM, Reddy KV, Rao TNM, Alladi S, Jalapu VRR, Manchireddy K, Rajan A, Mehta S, Katoch C, Das B, Jangir A, Kaur T, Sreedharan S, Sivasambath S, Dinesh S, Shibi BS, Thangaraj A, Karunanithi A, Sulaiman SMS, Dehingia K, Das K, Nandini C, Thomas NJ, Dhanya TS, Thomas N, Krishna R, Aneesh V, Krishna R, Khullar S, Thouman S, Sebastian I. Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. Lancet 2017; 390:588-599. [PMID: 28666682 DOI: 10.1016/s0140-6736(17)31447-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/17/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. METHODS The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training-including information provision, joint goal setting, carer training, and task-specific training-that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3-6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). FINDINGS Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78-1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 [14%]patients in the intervention group vs 82 [13%] in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 [13%] intervention patients vs 110 events in 79 [13%] control patients; p=0·80). INTERPRETATION Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care. FUNDING The National Health and Medical Research Council of Australia.
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Abstract
BACKGROUND People with stroke conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed that offer people in hospital an early discharge with rehabilitation at home (early supported discharge: ESD). OBJECTIVES To establish if, in comparison with conventional care, services that offer people in hospital with stroke a policy of early discharge with rehabilitation provided in the community (ESD) can: 1) accelerate return home, 2) provide equivalent or better patient and carer outcomes, 3) be acceptable satisfactory to patients and carers, and 4) have justifiable resource implications use. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (January 2017), Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1) in the Cochrane Library (searched January 2017), MEDLINE in Ovid (searched January 2017), Embase in Ovid (searched January 2017), CINAHL in EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to December 2016), and Web of Science (to January 2017). In an effort to identify further published, unpublished, and ongoing trials we searched six trial registries (March 2017). We also performed citation tracking of included studies, checked reference lists of relevant articles, and contacted trialists. SELECTION CRITERIA Randomised controlled trials (RCTs) recruiting stroke patients in hospital to receive either conventional care or any service intervention that has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. DATA COLLECTION AND ANALYSIS The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow-up. Two review authors scrutinised trials, categorised them on their eligibility and extracted data. Where possible we sought standardised data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not. We assessed risk of bias for the included trials and used GRADE to assess the quality of the body of evidence. MAIN RESULTS We included 17 trials, recruiting 2422 participants, for which outcome data are currently available. Participants tended to be a selected elderly group of stroke survivors with moderate disability. The ESD group showed reductions in the length of hospital stay equivalent to approximately six days (mean difference (MD) -5.5; 95% confidence interval (CI) -3 to -8 days; P < 0.0001; moderate-grade evidence). The primary outcome was available for 16 trials (2359 participants). Overall, the odds ratios (OR) for the outcome of death or dependency at the end of scheduled follow-up (median 6 months; range 3 to 12) was OR 0.80 (95% CI 0.67 to 0.95, P = 0.01, moderate-grade evidence) which equates to five fewer adverse outcomes per 100 patients receiving ESD. The results for death (16 trials; 2116 participants) and death or requiring institutional care (12 trials; 1664 participants) were OR 1.04 (95% CI 0.77 to 1.40, P = 0.81, moderate-grade evidence) and OR 0.75 (95% CI 0.59 to 0.96, P = 0.02, moderate-grade evidence), respectively. Small improvements were also seen in participants' extended activities of daily living scores (standardised mean difference (SMD) 0.14, 95% CI 0.03 to 0.25, P = 0.01, low-grade evidence) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02, low-grade evidence). We saw no clear differences in participants' activities of daily living scores, patients subjective health status or mood, or the subjective health status, mood or satisfaction with services of carers. We found low-quality evidence that the risk of readmission to hospital was similar in the ESD and conventional care group (OR 1.09, 95% CI 0.79 to 1.51, P = 0.59, low-grade evidence). The evidence for the apparent benefits were weaker at one- and five-year follow-up. Estimated costs from six individual trials ranged from 23% lower to 15% greater for the ESD group in comparison to usual care.In a series of pre-planned analyses, the greatest reductions in death or dependency were seen in the trials evaluating a co-ordinated ESD team with a suggestion of poorer results in those services without a co-ordinated team (subgroup interaction at P = 0.06). Stroke patients with mild to moderate disability at baseline showed greater reductions in death or dependency than those with more severe stroke (subgroup interaction at P = 0.04). AUTHORS' CONCLUSIONS Appropriately resourced ESD services with co-ordinated multidisciplinary team input provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. Results are inconclusive for services without co-ordinated multidisciplinary team input. We observed no adverse impact on the mood or subjective health status of patients or carers, nor on readmission to hospital.
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Affiliation(s)
- Peter Langhorne
- ICAMS, University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Satu Baylan
- Queen Elizabeth University HospitalInstitute of Health and Wellbeing, College of Medical, Veterinary and Life SciencesGlasgowUKG51 4TF
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23
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Nicolas V. [Specialised Alzheimer's teams at home]. Rev Infirm 2017; 66:22. [PMID: 28048986 DOI: 10.1016/j.revinf.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Specialised Alzheimer's teams aim to optimise the autonomy and quality of life of patients and their carers in their home.
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Affiliation(s)
- Véronique Nicolas
- Équipe spécialisée Alzheimer, Drac Sud Romanche, ADPA, immeuble la Maisnie, Bât A, 13 Place du Château, 38220 Vizille, France.
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24
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Albert A. [Role of the advanced practice nurse in gerontology]. Rev Infirm 2017; 66:27-28. [PMID: 28048989 DOI: 10.1016/j.revinf.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An advanced practice nurse in gerontology, working in an in-home nursing care department, describes her missions with the teams, the patient and the carers.
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Affiliation(s)
- Aude Albert
- SSIAD, ADMR 3 Étangs, 52 boulevard Dethez, 13800 Istres, France.
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25
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Leung I, Casalino E, Pateron D, Grateau G, Garandeau E, de Stampa M. [Participation of general practitioners in the management of their “hospital at home” patients]. Sante Publique 2016; 28:499-504. [PMID: 28155754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectives: Hospital at home (HAH) care is becoming increasingly popular in France and requires the involvement of general practitioners (GPs) in the care of their patients. The objective of this study was to identify the incentives and barriers to the involvement of general practitioners in HAH. Materials and methods: A qualitative study was carried out using semi-structured interviews during a focus group with 12 GPs. All interviews were recorded and then transcribed verbatim and data analysis used the grounded theory method. Results: General practitioners appeared to be familiar with the indications and places of care for HAH, but they highlighted the difficulties associated with the HAH request circuit. GPs identified difficulties determining their exact role in HAH, which were improved by their clinical expertise in home visits. Doctors stressed the complexity of home care, but they were assisted by the coordinating physician and they requested specific training. Conclusion: We identified incentives and barriers to the participation of GPs in HAH. The request circuit needs to be simplified, home visits need to be strengthened and support must be provided to GPs in their management of complex care.
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Affiliation(s)
- Paul Rousseau
- Geriatrics and Extended Care, VA Medical Center, Phoenix, USA
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Schieron M. [In process]. Pflege Z 2016; 69:516-518. [PMID: 29414205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Renz M. [In process]. Pflege Z 2016; 69:512-515. [PMID: 29414204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Stoltz P, Lindholm M, Udén G, Willman A. The Meaning of Being Supportive for Family Caregivers as Narrated by Registered Nurses Working in Palliative Homecare. Nurs Sci Q 2016; 19:163-73. [PMID: 16624988 DOI: 10.1177/0894318406286598] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to illuminate the meaning of being supportive to family caregivers who care for a relative at home as narrated by registered nurses. The context used to allow for the meaning of being supportive to be illuminated was palliative home care. The study uses a phenomenological-hermeneutical method inspired by the philosophy of Ricoeur. Data consisted of narrative interviews, which were analyzed in three recurring phases: naive reading, structural analyses and interpreted whole. Twenty nurses from the hospitals in Sweden participated in the study. Two core themes were found: forming a relationship and keeping caregiving at home.
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Affiliation(s)
- Peter Stoltz
- School of Health and Society, Malmö University, Malmö, Sweden
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Talon-Chrétien MC, Jakovenko F, Franzin-Garrec M, Révy M, Nerich B, Roucoules B. [The coordination of caregivers in the patient's home]. Soins 2016; 61:28-32. [PMID: 27393984 DOI: 10.1016/j.soin.2016.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Home care is provided by different partners who may be self-employed in private practice, part of an association or employed by the hospital. For optimal patient management, all these caregivers, whatever their role, must collaborate while respecting the work of each individual. This collective consciousness requires the reorganisation of our care system to improve efficiency. Communication between everyone is essential.
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Affiliation(s)
| | - Florence Jakovenko
- Association des infirmiers libéraux du bassin alésien (Ailba), Maison de la santé, Espace Pré Saint-Jean, bât. B, 34 B avenue Jean-Baptiste Dumas, 30100 Alès, France
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Abstract
In the summer of 2004, Florida experienced 4 major hurricanes in a matter of weeks. These hurricanes left many Floridians without power and passable roads, interrupted communications, and destroyed some homes. During this time, Tampa General Hospital had 1 patient living at home with an implanted ventricular assist device. The patient had been discharged home only 2 weeks before hurricane Frances hit hard. Although the patient was able to stay at home and experienced no major problems with the device, there were several situations that taught us many lessons about caring for patients with ventricular assist devices during environmental catastrophic events.
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Nativel C, El Khebir C, Senasson D. [Hospital-at-home at the end of life, challenges and limits]. Soins 2015; 60:41-42. [PMID: 26567074 DOI: 10.1016/j.soin.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The requests for hospital-at-home palliative care are made by health professionals as well as by patients and their families. Nurse coordinators assess them in order to identify the limits and assure high-quality care. Team meetings enable professionals to decide on a joint approach and provide support to the caregivers where necessary.
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Summerfelt WT, Sulo S, Robinson A, Chess D, Catanzano K. Scalable hospital at home with virtual physician visits: pilot study. Am J Manag Care 2015; 21:675-684. [PMID: 26633092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the safety, feasibility, and efficacy of a substitutive Hospital at Home (HaH) model where physician care was provided via 2-way biometrically enhanced tele-video for a 34-day care episode. STUDY DESIGN Prospective, nonrandomized, quasi-experiment. METHODS Using medical record and patient survey data, we compared patients cared for in HaH (n = 50) versus the traditional acute care hospital (n = 52). RESULTS Patients in HaH had substantial contact with the HaH physician, as well as in-person visits with nurse practitioners and other care providers. HaH patients were more satisfied with their care in multiple domains and met illness-specific quality standards at similar rates to hospital comparison patients. Functional outcomes were notable for a trend toward improvements in activities of daily living among HaH patients. Compared with hospital patients at 90 days after discharge, HaH patients were less likely to experience a hospital readmission (adjusted odds ratio, 0.39; 95% CI, 0.21-0.72). CONCLUSIONS This pilot study suggests that a scalable substitutive model of HaH using biometrically enhanced 2-way tele-video, virtual physician visits, and caring for patients over a 34-day episode is safe, feasible, highly satisfactory, and may be associated with substantial reductions in hospital readmissions.
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Affiliation(s)
- Wm Thomas Summerfelt
- Advocate Health Care, 3075 Highland Pkwy, Ste 600, Downers Grove, IL 60515. E-mail:
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Castillo J. Why peritoneal dialysis works for me. Nephrol News Issues 2015; 29:24. [PMID: 26454911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
OBJECTIVES To provide an overview of the four major palliative care delivery models: ambulatory clinics, home-based programs, inpatient palliative care units, and inpatient consultation services. The advantages and disadvantages of each model and the generalist and specialist roles in palliative care will be discussed. DATA SOURCES Literature review. CONCLUSION The discipline of palliative care continues to experience growth in the number of programs and in types of delivery models. Ambulatory- and home-based models are the newest on the scene. IMPLICATIONS FOR NURSING PRACTICE Nurses caring for oncology patients with life-limiting disease should be informed about these models for optimal impact on patient care outcomes. Oncology nurses should demonstrate generalist skills in the care of the seriously ill and access specialist palliative care providers as warranted by the patient's condition.
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Justin M. [Hospital at home care for children with leukaemia]. Soins Pediatr Pueric 2015; 36:36-38. [PMID: 26183100 DOI: 10.1016/j.spp.2015.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The care pathway of a child with leukaemia is long and often difficult. The different professionals work together to ensure optimal care management. Hospital at home forms part of this pathway in partnership with the inhospital departments, the general practitioner and the day hospital. This link between the different professionals is assured by the hospital at home child health nurse coordinator.
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Affiliation(s)
- Manuela Justin
- Hospitalisation à domicile pédiatrique, AP-HP, Unité de soins nord-ouest, Hôpital Louis-Mourier, 178 rue des Renouillers, 92700 Colombes, France.
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Caudron E. [Supporting patients at the end of life at home based on the hospital at home model]. Rev Infirm 2014:34-35. [PMID: 26050405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hospital at home structures aim to assure the transition between hospital and home, including by supporting a life project through to its last moments. Good coordination between the different players and constant consideration of the patient and their family are necessary in order to ensure that the quality of care at home is equivalent to what provided in hospital.
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Mamoudy C, Jaulin M, Cerf D. [Coordination for a successful return home]. Rev Infirm 2014:19-20. [PMID: 26043540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The organisation of the return home of a dependent person is an important stage in their care. Good coordination between the different healthcare and social professionals enable their needs to be assessed in order for adapted solutions to be offered. In this global approach, the teams take into account not only the patient in their living environment but also their family carer.
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Aston G. The Most Wired Innovator award. Hosp Health Netw 2014; 88:48-51. [PMID: 25265845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hazenberg A, Kerstjens HAM, Prins SCL, Vermeulen KM, Wijkstra PJ. Initiation of home mechanical ventilation at home: a randomised controlled trial of efficacy, feasibility and costs. Respir Med 2014; 108:1387-95. [PMID: 25081652 DOI: 10.1016/j.rmed.2014.07.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Home mechanical ventilation (HMV) in the Netherlands is normally initiated in hospital, but this is expensive and often a burden for the patient. In this randomised controlled study we investigated whether initiation of HMV at home in patients with chronic respiratory failure is non-inferior to an in hospital based setting. METHODS Seventy-seven patients were included, of which 38 patients started HMV at home. All patients were diagnosed with chronic respiratory failure due to a neuromuscular or thoracic cage disease. Primary outcome was the arterial carbon dioxide (PaCO2) while quality of life and costs were secondary outcomes. Telemonitoring was used in the home group to provide therapeutic information, for example; transcutaneous carbon dioxide, oxygen saturation and ventilator information, to the caregivers. Follow-up was six months. RESULTS PaCO2, improved by 0.72 (SE ± 0.16) kPa in the hospital group and by 0.91 (±0.20) in the home group, both improvements being significant and the latter clearly not inferior. There were also significant improvements in quality of life in both groups, again not being inferior with home treatment. CONCLUSION This study is the first to show that initiation of HMV at home in a selective group of patients with chronic respiratory failure is as effective for gas exchange and quality of life as hospital initiation. In addition we found that it is safe, technically feasible and that more than € 3000 per patient can be saved compared to our standard care.
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Affiliation(s)
- A Hazenberg
- University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands.
| | - H A M Kerstjens
- University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands
| | - S C L Prins
- TNO - The Netherlands Organization for Applied Scientific Research, The Netherlands
| | - K M Vermeulen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - P J Wijkstra
- University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands
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De Stampa M, Marquestaut O, Mac E, Loffredo ML, Andrieu M. [Coordination in hospital-based home care]. Soins Gerontol 2014:33-34. [PMID: 24908846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hospital at home involves multidisciplinary teams who provide care 24/7 in the homes of increasingly elderly patients. They present complex medical, mental and social needs with secondary functional incapacities.
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Gardner E. High tech = high touch: Innovative technology is making inroads into senior care, but a few roadblocks remain. Health Data Manag 2014; 22:18-22. [PMID: 24915688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Liamina NP, Kotel'nikova EV, Biziaeva EA, Karpova ÉS. [Approaches potentiating cardioprotective effect of ambulatory physical training in patients with ischemic heart disease and multivessel coronary artery involvement after coronary stenting]. Kardiologiia 2014; 54:19-25. [PMID: 25675716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cardiorehabilitation of patients with multivessel coronary lesions is an obligatory component of ambulatory stage of care. With the aim of potentiating cardioprotective and antiischemic impact of rehabilitative preventive measures in 36 patients with ischemic heart disease (IHD) and multivessel coronary artery involvement who had undergone percutaneous coronary intervention we studied cardioprotective and antiischemic effect of long-term (24 weeks) administration of 70 mg/day trimetazidine in combination with moderate intensity physical training with the use of distance surveillance by a physician. The chosen therapeutic approach in patients with residual ischemia after incomplete anatomical revascularization provided early persistent formation of cardioprotective and antiischemic effect proven by increase of tolerance to physical exercise, improvement of diastolic function, and positive dynamics of both ECG parameters and biochemical markers of myocardial ischemia.
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Kancz D, Hürlimann B. [Enteral feeding: sent home with a feeding tube]. Krankenpfl Soins Infirm 2014; 107:22-23. [PMID: 24640845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Milburn L. Technology: End bed blocking without delay. Health Serv J 2013; 123:21. [PMID: 24383296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Health and social care organizations in Southwark and Lambeth are joining forces for an ambitious programme in which nurses work with other professionals to deliver hospital-level care to patients in their homes. Early indications are that the integrated approach is reducing admissions and improving care.
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López-Liria R, Ferre-Salmerón R, Arrebola-López C, Granados-Valverde R, Gobernado-Cabero MÁ, Padilla-Góngora D. [Home-based rehabilitation in the functional recovery of patients with cerebrovascular disease]. Rev Neurol 2013; 56:601-607. [PMID: 23744246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The study of the effectiveness of rehabilitation treatment applied to patients with sequelae following a cerebrovascular disease (CVD) plays a decisive role nowadays in planning their management in public healthcare and to improve existing guidelines regarding assessment and treatment. AIM To describe the characteristics presented by patients who have suffered a CVD and were treated in mobile rehabilitation-physiotherapy units (MRPU) and how such treatment affects their functional recovery. PATIENTS AND METHODS Descriptive, prospective study conducted on 124 patients referred to the MRPUs in the province of Almeria between 2008 and 2011. The variables analysed (both pre- and post-treatment) included personal history and characteristics, Barthel index, Modified Ashworth Spasticity Scale, pain (shoulder) and the Canadian Neurological Scale. RESULTS The final sample consisted of 106 participants (mean age: 73.72 years). The disabling process was ischaemic in 77.4% and hypertension was the most prevalent risk factor (81%). The mean initial Barthel index was 31.04 and the mean final index was 57.62 (t = -11.75; p < 0.001). The Canadian Neurological Scale showed a favourable progression in the level of consciousness, orientation and language (p < 0.001). Altogether 56.2% of the patients were discharged as a result of the improvement of their condition, and did not require any further outpatient rehabilitation. CONCLUSIONS The results obtained reflect an important functional improvement in patients treated in the MRPUs. Home-based rehabilitation is considered a necessary tool for persons with greater clinical vulnerability and no access to outpatient care, which provides them with the benefits of effective treatment.
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Abstract
BACKGROUND Specialist paediatric home-based nursing services have been proposed as a cost-effective means of reducing distress resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay. This review is an update of our original review, which was published in 2006. OBJECTIVES To evaluate specialist home-based nursing services for children with acute and chronic illnesses. SEARCH METHODS We searched the following databases in February 2012: the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012 Issue 2, Ovid MEDLINE, EMBASE, PsycINFO, CINAHL and Sociological Abstracts. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) of children from birth to age 18 years with acute or chronic illnesses allocated to specialist home-based nursing services compared with conventional health care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs. DATA COLLECTION AND ANALYSIS Two review authors extracted data from the studies independently and resolved any discrepancies by recourse to a third author. Meta-analysis was not appropriate because of the clinical diversity of the studies and the lack of common outcome measures. MAIN RESULTS We screened 4226 titles to yield seven RCTs with a total of 840 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported a reduction in the hospital stay with no difference in the hospital readmission rates. Three studies reported a reduction in parental anxiety and improvement in child behaviours was reported in three studies. Overall increased parental satisfaction was reported in three studies. Also, better parental coping and family functioning was reported in one study. By contrast, one study each reported no impact on parental burden of care or on functional status of children. Home care was reported as more costly for service providers with substantial cost savings for the family in two studies, while one study revealed no significant cost benefits for the family. AUTHORS' CONCLUSIONS Current research does not provide supporting evidence for a reduction in access to hospital services or a reduction in hospital readmission rate for children with acute and chronic illnesses using specialist home-based nursing services; however, the only summary finding across a few studies was that there is a significant decrease in length of hospitalisation. The preliminary results show no adverse impact on physical health outcomes and a number of papers reported improved satisfaction with home-based care. Further trials are required, measuring health, satisfaction, service utilisation and long-term costs.
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Affiliation(s)
- Chitra S Parab
- Illawarra Shoalhaven Diagnostic & Assessment Service, Illawarra Shoalhaven Local Health District, North Wollongong, Australia.
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