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Hammel GDSC, Simas LTL, Rodrigues LF, Zamberlan C, Lomba L, Backes DS. Mothers' perception of the care of newborn in the home environment. Rev Bras Enferm 2024; 77:e20230080. [PMID: 38655978 PMCID: PMC11034376 DOI: 10.1590/0034-7167-2023-0080] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/15/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES to identify mothers' perceptions about caring for newborns in the home environment, from the perspective of complexity thinking. METHODS qualitative, exploratory and descriptive research, carried out between November/2022 and February/2023. Data were collected through individual interviews with 21 mothers from southern Brazil who cared for newborns at home and analyzed using the thematic analysis technique. RESULTS the four thematic axes resulting from the data analysis: Living amidst order and disorder; embracing singularities; dealing with the certain and the uncertain; support network in the (re)organizing process demonstrate that the mother caring for a newborn in their home environment experiences a distinct and plural adaptive process, which must be welcomed and understood by health professionals who work within the family environment. FINAL CONSIDERATIONS the care of newborns in a home environment, in the perception of mothers, requires differentiated attention and a formal or informal support network that considers the unique specificities of each woman/mother in the personal, family and social spheres. Therefore, in addition to the social support network, it is important to rethink home intervention approaches.
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Affiliation(s)
| | | | | | | | - Lurdes Lomba
- Escola Superior de Enfermagem. Coimbra, Portugal
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Nakanishi M, Yamasaki S, Nakashima T, Miyamoto Y, Cooper C, Richards M, Stanyon D, Sakai M, Yoshii H, Nishida A. Association Between Dementia, Change in Home-Care Use, and Depressive Symptoms During the COVID-19 Pandemic: A Longitudinal Study Using Data from Three Cohort Studies. J Alzheimers Dis 2024; 99:403-415. [PMID: 38640160 DOI: 10.3233/jad-240097] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background The emotional impact of the coronavirus disease 2019 (COVID-19) pandemic on people with dementia has been quantified. However, little is known about the impact of change in home-care use owing to the pandemic. Objective To determine the longitudinal association between dementia, change in home-care use, and depressive symptoms during the pandemic. Methods We included data of 43,782 home-dwelling older adults from the English Longitudinal Study of Ageing (ELSA), Study of Health, Ageing and Retirement in Europe (SHARE), and National Health and Aging Trends Study (NHATS). This study considered the latest main wave survey prior to the pandemic as the baseline, and the COVID-19 survey as follow-up. In a series of coordinated analyses, multilevel binomial logistic regression model was used to examine the association between baseline dementia, change in home-care use at follow-up, and presence of depressive symptoms. Results Dementia, using the ELSA, SHARE, and NHATS datasets, was identified in 2.9%, 2.3%, and 6.5% of older adults, and home-care use reduced in 1.7%, 2.8%, and 1.1% of individuals with dementia, respectively. Dementia was significantly associated with the increased risk of depressive symptoms in all three cohorts. However, the interaction between dementia and period (follow-up) was non-significant in SHARE and NHATS. Across all three cohorts, home-care use during the pandemic, regardless of change in amount, was significantly associated with increased depressive symptoms, compared to the non-use of home care. Conclusions These results highlight the need for tailoring dementia care at home to promote independence and provide sustainable emotional support.
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Affiliation(s)
- Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai-shi, Miyagi, Japan
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Taeko Nakashima
- Department of Social Healthcare and Business, Faculty of Healthcare Management, Nihon Fukushi University, Mihama-cho, Aichi, Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health & Ageing at UCL, University College London, London, UK
| | - Daniel Stanyon
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Mai Sakai
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai-shi, Miyagi, Japan
| | - Hatsumi Yoshii
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai-shi, Miyagi, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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Knoefel F, Trudel C, Jaana M, Wilson C, Wallace RB, Ault L, Waldie P, Attef M, Thomas N, Goubran R, Sveistrup H, Tan P, Hsu A, Ridha S. Implementation of smart supportive dementia technology in a hospital transitional care setting using human-centred design. Healthc Manage Forum 2022; 35:318-323. [PMID: 35830226 PMCID: PMC9425717 DOI: 10.1177/08404704221103537] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Supportive smart home technology, for older adults living with dementia and their informal care partners, has shown some benefits in private homes. In this study, a supportive smart home system is being implemented in a hospital alternative level of care setting. This case report describes how a team of researchers and healthcare managers are navigating the complexities of a hospital setting, using human-centred design and implementation strategies, to facilitate the implementation and adoption of the technology.
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Affiliation(s)
- Frank Knoefel
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Carleton University, Ottawa, Ontario, Canada
- Bruyère Continuing Care, Ottawa, Ontario, Canada
- AGE-WELL National Innovation Hub SAM, Ottawa, Ontario, Canada
| | - Chantal Trudel
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Carleton University, Ottawa, Ontario, Canada
| | - Mirou Jaana
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Raymond B. Wallace
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Carleton University, Ottawa, Ontario, Canada
- AGE-WELL National Innovation Hub SAM, Ottawa, Ontario, Canada
| | - Laura Ault
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- AGE-WELL National Innovation Hub SAM, Ottawa, Ontario, Canada
| | | | | | - Neil Thomas
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Continuing Care, Ottawa, Ontario, Canada
- AGE-WELL National Innovation Hub SAM, Ottawa, Ontario, Canada
| | - Rafik Goubran
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Carleton University, Ottawa, Ontario, Canada
- AGE-WELL National Innovation Hub SAM, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- AGE-WELL National Innovation Hub SAM, Ottawa, Ontario, Canada
| | | | - Amy Hsu
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
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Affiliation(s)
- Rachel M Werner
- From the Leonard Davis Institute of Health Economics, University of Pennsylvania; and the Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Medical Center - both in Philadelphia (R.M.W.); and the Robert F. Wagner Graduate School of Public Service, New York University, New York (S.A.G.)
| | - Sherry A Glied
- From the Leonard Davis Institute of Health Economics, University of Pennsylvania; and the Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Medical Center - both in Philadelphia (R.M.W.); and the Robert F. Wagner Graduate School of Public Service, New York University, New York (S.A.G.)
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Weinfeld JM, Hart KM, Vargas JD. Home Blood Pressure Monitoring. Am Fam Physician 2021; 104:237-243. [PMID: 34523884] [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: 06/13/2023]
Abstract
Home blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure monitoring. Home blood pressure monitoring involves patients independently measuring their blood pressure with an electronic device, whereas ambulatory blood pressure monitoring involves patients wearing a portable monitor for 24 to 48 hours. Although ambulatory blood pressure monitoring is the diagnostic standard for measurement, home blood pressure monitoring is more practical and accessible to patients, and its use is recommended by the U.S. Preventive Services Task Force and the American College of Cardiology/American Heart Association. Home blood pressure monitoring generally results in lower blood pressure readings than in-office measurements, can confirm the diagnosis of hypertension after an elevated office blood pressure reading, and can identify patients with white coat hypertension or masked hypertension. Best practices for home blood pressure monitoring include using an appropriately fitting upper-arm cuff on a bare arm, emptying the bladder, avoiding caffeinated beverages for 30 minutes before taking the measurement, resting for five minutes before taking the measurement, keeping the feet on the floor uncrossed and the arm supported with the cuff at heart level, and not talking during the reading. An average of multiple readings, ideally two readings in the morning and again in the evening separated by at least one minute each, is recommended for one week. Home blood pressure readings can be used in hypertension quality measures.
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Affiliation(s)
| | - Kathryn M Hart
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jose D Vargas
- Georgetown University School of Medicine, Washington, DC, USA
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6
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Steingard RJ. From the Executive Editor's Desk. J Child Adolesc Psychopharmacol 2021; 31:455-456. [PMID: 34520236 DOI: 10.1089/cap.2021.29209.rjs] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Safe I. From female warriors in the rainforest to infectious disease specialists: COVID-19 in the Amazon. Lancet Respir Med 2021; 9:566-567. [PMID: 33684357 DOI: 10.1016/s2213-2600(21)00033-3] [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] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Izabella Safe
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil; Universidade do Estado do Amazonas, Manaus, Amazonas, 69065-001, Brazil.
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Cornwell T, Plencner B. House Calls: Providing Care Beyond the Office Walls. Fam Pract Manag 2021; 28:22A-22G. [PMID: 33973749] [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: 06/12/2023]
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Sethia R, Freeman T, Mead K, Selhorst A, Vala K, Skoracki L, Adelman M, VanKoevering K, Kang SY, Ozer E, Agrawal A, Old MO, Carrau RL, Rocco JW, Seim NB. Patient-Directed Home Drain Removal in Head and Neck Surgery. Laryngoscope 2021; 131:2471-2477. [PMID: 33847392 DOI: 10.1002/lary.29556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients. METHODS The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes. RESULTS One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved. CONCLUSIONS The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Taylor Freeman
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Katherine Mead
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amanda Selhorst
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kelly Vala
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Laura Skoracki
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Megan Adelman
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery; Fellow, Queen's Nursing Institute
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Huang FY, Ho CH, Liao JY, Hsiung CA, Yu SJ, Zhang KP, Chen PJ. Medical care needs for patients receiving home healthcare in Taiwan: Do gender and income matter? PLoS One 2021; 16:e0247622. [PMID: 33630929 PMCID: PMC7906386 DOI: 10.1371/journal.pone.0247622] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
Studies about medical care needs for home healthcare (HHC) previously focused on disease patterns but not gender and income differences. We used the Taiwan National Health Research Insurance Database from 1997 to 2013 to examine trends in medical care needs for patients who received HHC, and the gender and income gaps in medical care needs, which were represented by resource utilization groups (RUG). We aimed to clarify three questions: 1. Are women at a higher level of medical care needs for HHC than men, 2. Does income relate to medical care needs? 3. Is the interaction term (gender and income) related to the likelihood of medical care needs? Results showed that the highest level of medical care need in HHC was reducing whereas the basic levels of medical care need for HHC are climbing over time in Taiwan during 1998 and 2013. The percentages of women with income-dependent status in RUG1 to RUG4 are 26.43%, 26.24%, 30.68%, and 32.07%, respectively. Women were more likely to have higher medical care needs than men (RUG 3: odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10-1.25; RUG4: OR = 1.13, 95% CI = 1.06-1.22) in multivariates regression test. Compared to the patients with the high-income status, patients with the income-dependent status were more likely to receive RUG3 (OR = 2.34, 95% CI = 1.77-3.09) and RUG4 (OR = 1.98, 95% CI = 1.44-2.71). The results are consistent with the perspectives of fundamental causes of disease and feminization of poverty theory, implying gender and income inequalities in medical care needs. Policymakers should increase public spending for delivering home-based integrated care resources, especially for women with lower income, to reduce the double burden of female poverty at the higher levels of medical care needs for HHC.
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Affiliation(s)
- Fang-Yi Huang
- Department of Social and Policy Sciences, Yuan Ze University, Taoyuan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jung-Yu Liao
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | | | | | - Ping-Jen Chen
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Jones B, Comerford S, Curry K, Holubiec I. Navigating Turbulent Waters: Leading Home and Community Care Practice Change during the COVID-19 Pandemic. Nurs Leadersh (Tor Ont) 2020; 33:62-67. [PMID: 33616527 DOI: 10.12927/cjnl.2021.26419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/12/2023]
Abstract
This case study outlines the journey of a home-care organization to support practice change during the COVID-19 crisis. The leadership attributes and organizational structures and processes required for a nimble knowledge-to-action response are explored in relation to client screening, personal protective equipment and development of virtual care. A home and community practice lens was often not evident in the literature or guidance documents. This added complexity to the process of rapidly evaluating evidence and guidance across two provinces and issuing practice direction to a widely dispersed and mobile workforce. A cross-functional clinical response team has been invaluable in the organization's pandemic response.
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Affiliation(s)
- Barbara Jones
- Former Director, Professional Practice and Education, VON Canada, Ottawa, ON
| | - Shari Comerford
- Director, Nurse Practitioner, Professional Practice, VON Canada, Ottawa, ON
| | - Karen Curry
- Practice Education Consultant, VON Canada, Ottawa, ON
| | - Irene Holubiec
- Senior Director Practice, Quality and Risk, VON Canada, Ottawa, ON
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Vaitheswaran S, Lakshminarayanan M, Ramanujam V, Sargunan S, Venkatesan S. Experiences and Needs of Caregivers of Persons With Dementia in India During the COVID-19 Pandemic-A Qualitative Study. Am J Geriatr Psychiatry 2020; 28:1185-1194. [PMID: 32736918 PMCID: PMC7340037 DOI: 10.1016/j.jagp.2020.06.026] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [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: 06/01/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the experiences and needs of caregivers of persons with dementia during the COVID-19 pandemic and lockdown in a city in India. DESIGN Qualitative study using a telephonic semistructured interview. SETTING A specialist geriatric outpatient mental health service based in a nongovernmental organization in Chennai, India. PARTICIPANTS A purposive sampling of family members of persons with dementia registered in the database and seen within the previous 6 months. RESULTS Thirty-one caregivers participated. Thematic analysis of the data showed two sets of issues that the caregivers of persons with dementia faced in their experiences during the pandemic. The first set was unique to the caregivers that directly related to their caregiving role, while the second set did not relate directly to their caregiving role. These two sets also appeared to have a two-way interaction influencing each other. These issues generated needs, some of which required immediate support while others required longer-term support. The caregivers suggested several methods, such as use of video-consultations, telephone-based support and clinic-based in-person visits to meet their needs. They also wanted more services postpandemic. CONCLUSION Caregivers of persons with dementia had multiple needs during the pandemic. Supporting them during these times require a pragmatic multilayered approach. Systemic changes, policies and frameworks, increased awareness, use of technology, and better access to health are necessary.
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Affiliation(s)
- Sridhar Vaitheswaran
- Dementia Care in SCARF, Schizophrenia Research Foundation (SCARF), (SV, ML, VR, SS, SV) Chennai, India.
| | - Monisha Lakshminarayanan
- Dementia Care in SCARF, Schizophrenia Research Foundation (SCARF), (SV, ML, VR, SS, SV) Chennai, India
| | - Vaishnavi Ramanujam
- Dementia Care in SCARF, Schizophrenia Research Foundation (SCARF), (SV, ML, VR, SS, SV) Chennai, India
| | - Subashini Sargunan
- Dementia Care in SCARF, Schizophrenia Research Foundation (SCARF), (SV, ML, VR, SS, SV) Chennai, India
| | - Shreenila Venkatesan
- Dementia Care in SCARF, Schizophrenia Research Foundation (SCARF), (SV, ML, VR, SS, SV) Chennai, India
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Zhou J, Xu S, Cao Z, Tang J, Fang X, Qin L, Zhou F, He Y, Zhong X, Hu M, Wang Y, Lu F, Bao Y, Dai X, Wu Q. Validation of the Palliative Prognostic Index, Performance Status-Based Palliative Prognostic Index and Chinese Prognostic Scale in a home palliative care setting for patients with advanced cancer in China. BMC Palliat Care 2020; 19:167. [PMID: 33129305 PMCID: PMC7603699 DOI: 10.1186/s12904-020-00676-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The predictive value of the prognostic tool for patients with advanced cancer is uncertain in mainland China, especially in the home-based palliative care (HPC) setting. This study aimed to compare the accuracy of the Palliative Prognostic Index (PPI), the Performance Status-Based Palliative Prognostic Index (PS-PPI), and the Chinese Prognosis Scale (ChPS) for patients with advanced cancer in the HPC setting in mainland China. METHODS Patients with advanced cancer admitted to the hospice center of Yuebei People's Hospital between January 2014 and December 2018 were retrospectively calculated the scores according to the three prognostic tools. The Kaplan-Meier method was used to compare survival times among different risk groups. Receiver operating characteristic curve analysis was used to assess the predictive value. The accuracy of 21-, 42- and 90-day survival was compared among the three prognostic tools. RESULTS A total of 1863 patients were included. Survival time among the risk groups of all prognostic tools was significantly different from each other except for the PPI. The AUROC of the ChPS was significantly higher than that of the PPI and PS-PPI for 7-, 14, 21-, 42-, 90-, 120-, 150- and 180-day survival (P < 0.05). The AUROC of the PPI and PS-PPI were not significantly different from each other (P > 0.05). CONCLUSIONS The ChPS is more suitable than the PPI and PS-PPI for advanced cancer patients in the HPC setting. More researches are needed to verify the predictive value of the ChPS, PPI, and PS-PPI in the HPC setting in the future.
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Affiliation(s)
- Jun Zhou
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Sitao Xu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ziye Cao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Jing Tang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiang Fang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ling Qin
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Fangping Zhou
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yuzhen He
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xueren Zhong
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Mingcai Hu
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yan Wang
- Emergency rescue command center of Shaoguan city, Shaoguan, Guangdong China
| | - Fengjuan Lu
- Hospice center of Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi China
| | - Yongzheng Bao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiangheng Dai
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Qiang Wu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
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Abstract
OBJECTIVES This study sought to determine the impact of Healthy Families Healthy Futures (HFHF) enhanced with Steps to Success (STS). HFHF is a structured home visiting program for teen parents in Houston that focuses on improving parenting skills and preventing child abuse. HFHF enhanced with STS includes content and activities aimed to reduce repeat pregnancies within 24 months after the first child's birth. METHODS The study team recruited 248 young mothers for the study, primarily through local health clinics and schools, and then randomly assigned them to either a treatment group that was eligible to participate in HFHF enhanced with STS or to a control group. The control group was not offered any other program through the study. Outcomes were measured by a survey administered 12 months after program intake, in five domains aligned with the program's logic model: (1) exposure to information related to program content, (2) contraception knowledge, (3) contraception use, (4) enhanced family functioning, and (5) child health and development. To estimate program impacts, we used ordinary least squares regression, controlling for demographics and baseline measures of the outcome variables, if available. We use both frequentist approaches (calculations of statistical significance) and Bayesian posterior probabilities to interpret the findings. RESULTS HFHF enhanced with STS significantly (p < .05) impacted exposure to information on parenting and birth control, with effects of 20.8 and 15.4 percentage points, respectively. Using Bayesian posterior probabilities, there is an 85% chance that the program had a favorable effect on these outcomes. We also calculate a probability of 77% that the program had a favorable impact on long-acting reversible contraceptive (LARC) use, but a probability of 89% that the program reduced knowledge of birth control pills; these two results were not statistically significant (p = .17 and .10, respectively). CONCLUSIONS FOR PRACTICE These findings are primarily favorable and consistent with the program content and goals. Smaller than anticipated sample sizes due to recruitment challenges increased the chances for random error to affect the ability to detect statistically significant differences on many of our other outcomes; Bayesian posterior probabilities can therefore aid in interpreting the impact estimates. More research of this promising model is warranted.
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Affiliation(s)
- Susan Zief
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543, USA.
| | - John Deke
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543, USA
| | | | - Andrew Langan
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543, USA
| | - Subuhi Asheer
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543, USA
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Ćwirlej-Sozańska A, Wójcicka A, Kluska E, Stachoń A, Żmuda A. Assessment of the effects of a multi-component, individualized physiotherapy program in patients receiving hospice services in the home. BMC Palliat Care 2020; 19:101. [PMID: 32646517 PMCID: PMC7350635 DOI: 10.1186/s12904-020-00600-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/22/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The interest in physiotherapy programs for individuals in hospice is increasing. The aim of our study was to assess the impact of a multi-component, individualized physiotherapy program on the functional and emotional conditions and quality of life of patients receiving hospice services in the home. METHODS The study included 60 patients (mean 66.3 years) receiving hospice services in the home. A model of a physiotherapy program was designed, including breathing, strengthening, transfer, gait, balance, functional, and ergonomic exercises, as well as an adaptation of the patient's living environment to functional needs. The tests were performed before and after the intervention. The study used the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, the World Health Organization Quality of Life - Bref (WHOQOL-BREF), the Visual Analogue Scale (VAS) pain scale, the Tinetti POMA Scale, and the Geriatric Depression Scale (GDS). To enable comparison of our results worldwide, a set of International Classification of Functioning, Disability and Health (ICF) categories was used. RESULTS The average functional level of the ADL (mean 2.9) and the IADL (mean 11.9), as well as the WHOQOL-BREF (mean 46.4) of the patients before the intervention were low, whereas the intensity of pain (VAS mean 5.8), the risk of falling (Tinetti mean 8.2), and depression (GDS mean 16.7) were recorded as high. After the completion of the intervention program, a significant improvement was found in the ADL (mean 4.0), IADL (mean 13.9), WHOQOL-BREF (mean 52.6), VAS (mean 5.1), risk of falling (Tinetti mean 12.3), and GDS (mean 15.7) scores. CONCLUSIONS The physiotherapeutic intervention had a significant impact on improving the performance of ADL, as well as the emotional state and quality of life of patients receiving hospice services in the home. The results of our research provide evidence of the growing need for physiotherapy in individuals in hospice and for comprehensive assessment by means of ICF. Registered 02.12.2009 in the Research Registry ( https://www.researchregistry.com/why-register ) under the number research registry 5264.
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Affiliation(s)
| | - Agnieszka Wójcicka
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Edyta Kluska
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Anna Stachoń
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Anna Żmuda
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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18
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Kurata N, Minton L, Del Priore D, Merino D, Miller C, Lee MJ. An Interim Report on the Provision of Prenatal Care for Pregnant Mothers Experiencing Homelessness in Hawai'i. Hawaii J Health Soc Welf 2020; 79:118-121. [PMID: 32490398 PMCID: PMC7260861] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The State of Hawai'i ranks third in the nation for homelessness. Homelessness disproportionately affects the health care of pregnant mothers and their children. These homeless persons are at risk for malnutrition, physical and psychological trauma, injuries and chronic illnesses, and have difficulty accessing healthcare and social services. With the generous support of a Waiwai Ola grant from AlohaCare, a non-profit health plan in Hawai'i, the Maternal-Fetal Medicine physicians at the University Health Partners of Hawai'i created a pilot program with a midwife and medical assistant to provide prenatal health care and social services for homeless mothers on the island of O'ahu. This innovative project has given the midwife and medical assistant opportunities to perform needs assessments for homeless mothers and pilot new mobile health devices out in the field that can be optimized for delivering prenatal and postpartum health care for the most vulnerable populations of homeless mothers and their newborns.
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Affiliation(s)
- Nicole Kurata
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Le'a Minton
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Dante Del Priore
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Dynaka Merino
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Corrie Miller
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Men-Jean Lee
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
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Kim G, Kim WS, Kim TW, Lee YS, Lee H, Paik NJ. Home-based rehabilitation using smart wearable knee exercise device with electrical stimulation after anterior cruciate ligament reconstruction: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e20256. [PMID: 32443364 PMCID: PMC7254399 DOI: 10.1097/md.0000000000020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/26/2022] Open
Abstract
INTRODUCTION Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise. METHODS AND ANALYSIS This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome. DISCUSSION This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction. TRIAL REGISTRATION NUMBER This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.
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Affiliation(s)
- Gowun Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Hooman Lee
- EXOSYSTEMS Inc., Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
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20
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Abstract
Heart failure (HF), a global public health problem affecting 26 million people worldwide, significantly impacts quality of life. The prevalence of depression associated with HF is 3 times higher than that of the general population. Evidence, though, supports the use of transitional care as a method to enhance functional status and improve rates of depression in patients with HF. This article discusses the findings of a quality improvement project that evaluated health outcomes in underserved patients with HF who participated in a transitional care home visitation program. The visitation program exemplifies the role of leadership in facilitating transitions across the health care continuum. The 2-year retrospective review included 79 participants with HF. Comparisons of outcomes were made over 6 months. Although not statistically significant, clinically significant differences in health outcomes were observed in participants who received a home visit >14 days compared with ≤14 days after hospital discharge. A home visitation program for underserved patients with HF offers opportunities to enhance care across the continuum. Ongoing evaluation of the existing home visitation program is indicated over time with the goal of offering leaders data to enhance patient and family-centered transitional care coordination.
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Affiliation(s)
- Erica R Arnold
- University of Alabama at Birmingham Hospital (Dr Arnold); Center for Nursing Excellence, and Heart Failure Transitional Care Services for Adults (HRTSA) Clinic, University of Alabama at Birmingham Hospital (Dr White-Williams); The University of Alabama at Birmingham School of Nursing (Drs White-Williams and Miltner); Community Medicine & Population Health, College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa (Dr Hites); The University of Alabama at Birmingham School of Public Health (Dr Su); and Clinical and Global Partnerships, Jane H. Brock-Florence Nightingale Endowed Professor in Nursing, The University of Alabama at Birmingham School of Nursing (Dr Shirey)
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Kitzman H, Olds DL, Knudtson MD, Cole R, Anson E, Smith JA, Fishbein D, DiClemente R, Wingood G, Caliendo AM, Hopfer C, Miller T, Conti G. Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial. Pediatrics 2019; 144:e20183876. [PMID: 31748254 PMCID: PMC6889968 DOI: 10.1542/peds.2018-3876] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. METHODS We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership). RESULTS Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors. CONCLUSIONS The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.
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Affiliation(s)
- Harriet Kitzman
- School of Nursing, University of Rochester, Rochester, New York
| | | | | | - Robert Cole
- School of Nursing, University of Rochester, Rochester, New York
| | - Elizabeth Anson
- School of Nursing, University of Rochester, Rochester, New York
| | - Joyce A Smith
- School of Nursing, University of Rochester, Rochester, New York
| | - Diana Fishbein
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, State College, Pennsylvania
| | - Ralph DiClemente
- College of Global Public Health, New York University, New York, New York
| | - Gina Wingood
- Mailman School of Public Health, Columbia University, New York, New York
| | - Angela M Caliendo
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christian Hopfer
- Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ted Miller
- Pacific Institute for Research and Evaluation and School of Public Health, Curtin University, Beltsville, Maryland; and
| | - Gabriella Conti
- Departments of Economics and Social Science, University College London, London, United Kingdom
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22
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Santos Suárez J, Del Valle Arnáez G. [Home palliative care. Which is the future?]. J Healthc Qual Res 2019; 34:338-339. [PMID: 31740373 DOI: 10.1016/j.jhqr.2019.07.002] [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] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/30/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Affiliation(s)
- J Santos Suárez
- Equipo de Apoyo de Cuidados Paliativos, Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Asturias, España.
| | - G Del Valle Arnáez
- Equipo de Apoyo de Cuidados Paliativos, Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Asturias, España
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23
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Huang J, Pacheco Barzallo D, Rubinelli S, Münzel N, Brach M, Gemperli A. What influences the use of professional home care for individuals with spinal cord injury? A cross-sectional study on family caregivers. Spinal Cord 2019; 57:924-932. [PMID: 31127196 PMCID: PMC6892416 DOI: 10.1038/s41393-019-0296-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/14/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE The objective of this study is to identify what characteristics of the family caregivers influenced the use of professional home care for persons with SCI in Switzerland. SETTING Community setting, nationwide in Switzerland. METHODS Questionnaires were filled out by the adult family caregivers of persons with SCI. Influence of characteristics of the caregivers was analyzed with regression models, adjusting for the characteristics of the person with SCI. Logistic regression was used for whether professional home care was used. Poisson regression was applied for the absolute and relative amount of professional home care. RESULTS In total, 717 family caregivers participated in the study (31% response rate). Among the participants, 33% hired professional home care for 10 h per week on average. The level of dependency of the persons with SCI had a significant influence on the utilization of care. The availability and proximity of the primary family caregiver, namely being spouse and cohabiting, reduced the amount of services used, whereas caregivers who worked full time employed more services. Higher levels of education and income increased the use of professional home care. Compared with their reference groups, caregivers with older age and those with a migratory background used comparable or larger absolute amount of professional services, which, however, represented a smaller proportion of total hours of care. CONCLUSIONS Adequate support requires consideration of the characteristics of both the caregiver and of the person with SCI. The needs of family caregivers should also be assessed systematically in the needs assessment.
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Affiliation(s)
- Jianan Huang
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Diana Pacheco Barzallo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | | | - Mirjam Brach
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
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Komarzynski S, Huang Q, Lévi FA, Palesh OG, Ulusakarya A, Bouchahda M, Haydar M, Wreglesworth NI, Morère JF, Adam R, Innominato PF. The day after: correlates of patient-reported outcomes with actigraphy-assessed sleep in cancer patients at home (inCASA project). Sleep 2019; 42:zsz146. [PMID: 31323086 PMCID: PMC7587155 DOI: 10.1093/sleep/zsz146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/08/2018] [Revised: 04/26/2019] [Indexed: 12/23/2022] Open
Abstract
Subjective sleep assessment in cancer patients poorly correlates with actigraphy parameters that usually encompass multiple nights. We aimed to determine the objective actigraphy measures that best correlated with subjective sleep ratings on a night-by-night basis in cancer patients. Thirty-one cancer patients daily self-rated sleep disturbances using the single dedicated item of the MD Anderson Symptom Inventory (0-10 scale) with 18 other items, and continuously wore a wrist actigraph for 30 days. Objective sleep parameters were computed from the actigraphy nighttime series, and correlated with subjective sleep disturbances reported on the following day, using repeated measures correlations. Multilevel Poisson regression analysis was performed to identify the objective and subjective parameters that affected subjective sleep rating. Poor subjective sleep score was correlated with poor sleep efficiency (rrm = -0.13, p = 0.002) and large number of wake episodes (rrm = 0.12, p = 0.005) on the rated night. Multilevel analysis demonstrated that the expected sleep disturbance score was affected by the joint contribution of the wake episodes (exp(β) = 1.01, 95% confidence interval = 1.00 to 1.02, p = 0.016), fatigue (exp(β) = 1.35, 95% confidence interval = 1.15 to 1.55, p < 0.001) and drowsiness (exp(β) = 1.70, 95% confidence interval = 1.19 to 2.62, p = 0.018), self-rated the following evening, and sleep disturbance experienced one night before (exp(β) = 1.77, 95% confidence interval = 1.41 to 2.22, p < 0.001). The night-by-night approach within a multidimensional home tele-monitoring framework mainly identified the objective number of wake episodes computed from actigraphy records as the main determinant of the severity of sleep complaint in cancer patients on chemotherapy. This quantitative information remotely obtained in real time from cancer patients provides a novel framework for streamlining and evaluating interventions toward sleep improvement in cancer patients.
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Affiliation(s)
- Sandra Komarzynski
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
| | - Qi Huang
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Cancer Chronotherapy Team, Department of Statistics, University of Warwick, Coventry, UK
| | - Francis A Lévi
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Oxana G Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA
| | - Ayhan Ulusakarya
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Mohamed Bouchahda
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
- Mousseau Clinics, Ramsay Générale de Santé, Evry, France
- Clinique St Jean, Melun, France
| | - Mazen Haydar
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Nicholas I Wreglesworth
- North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Jean-François Morère
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
- Faculty of Medicine, Paris South University, Le Kremlin-Bicêtre, France
| | - René Adam
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Hepatobiliary Centre, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Pasquale F Innominato
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
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Affiliation(s)
- Ana Arroyo de la Rosa
- Grupo de Medicina Rural de SemFYC, Equipo de Atención Primaria, Centro de Salud de La Zarza, Servicio Extremeño de Salud, La Zarza, Badajoz, España
| | - Xavier Bayona Huguet
- Grupo de trabajo de gestión y gestión clínica de la CAMFiC, Equipo de Atención Primaria Bellvitge, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, España.
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Chen Q, Amano T, Park S, Kim B. Home and Community-based Services and Life Satisfaction among Homebound and Poor Older Adults. J Gerontol Soc Work 2019; 62:708-727. [PMID: 31293224 DOI: 10.1080/01634372.2019.1639094] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 06/09/2023]
Abstract
Little evidence exists regarding the role of Home and Community-Based Services (HCBS) utilization on life satisfaction among older people who are both homebound and low-income. Guided by the personal-environment (P-E) fit perspective, this study aims to: (1) describe characteristics of older people with homebound and low-income status; (2) investigate how the combination of homebound and low-income status is associated with life satisfaction; and (3) examine whether HCBS utilization moderates the association between homebound and low-income status and life satisfaction. Data were drawn from the 2012 Health and Retirement Study, and the sample included respondents who were 51+ years who completed a questionnaire for HCBS utilization (n= 1,662). Results describe sociodemographic, health-related, and environmental characteristics of older adults. Combined homebound and low-income status was a significant predictor of lower life satisfaction (β = -0.15, p< .05), but better life satisfaction when they used HCBS (β = 0.33, p <.10). These findings suggest that promoting HCBS utilization is a promising strategy to enhance well-being among those homebound and poor. Further studies are needed to test the effectiveness of HCBS with longitudinal data and to investigate the details of effective HCBS utilization such as frequency of use and types of services.
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Affiliation(s)
- Qingru Chen
- Medical Social Work Department, Huadong Hospital affiliated to Fudan University , Shanghai , China
| | - Takashi Amano
- Brown School, Washington University in St. Louis , St. Louis , MO , USA
| | - Sojung Park
- Brown School, Washington University in St. Louis , St. Louis , MO , USA
| | - Borin Kim
- College of Health and Human Services, University of New Hampshire , Durham , NH , USA
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Pais B, Buluschek P, Nef T, Schütz N, Saner H, Gatica D, Santschi V. [New healthcare technologies to support home care of older people]. Rev Med Suisse 2019; 15:1407-1411. [PMID: 31411832] [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: 06/10/2023]
Abstract
The ageing of the Swiss population is increasing the healthcare needs and costs. Both frailty and chronic diseases affecting older people reduce their ability to live independently. However, the vast majority of older people want to continue living at home, while having a quality of life and receiving the best healthcare services. In this context, new connected healthcare technologies can be a relevant solution to facilitate home care of older people. In this article, we present the issues related to these technologies and, more particularly, to what extent they could contribute to home care of older people and be a benefit for patients and family caregivers, but also for physicians and other healthcare professionals. Finally, the fears and risks associated with these technologies, and the importance of scientifically assessing their usefulness are discussed.
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Affiliation(s)
- Bruno Pais
- Institut et Haute Ecole de la Santé La Source, HES-SO Haute école spécialisée de Suisse occidentale, Avenue Vinet 30, 1004 Lausanne
| | | | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Université de Berne, 3012 Berne
| | - Narayan Schütz
- ARTORG Center for Biomedical Engineering Research, Université de Berne, 3012 Berne
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research, Université de Berne, 3012 Berne
- Hôpital de l'Ile, 3010 Berne
| | | | - Valérie Santschi
- Institut et Haute Ecole de la Santé La Source, HES-SO Haute école spécialisée de Suisse occidentale, Avenue Vinet 30, 1004 Lausanne
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Affiliation(s)
- Lauran Hardin
- Senior director of education and curriculum for the Camden Coalition's National Center for Complex Health and Social Needs
| | - Diana J Mason
- Senior policy service professor at George Washington University School of Nursing's Center for Health Policy and Media
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Affiliation(s)
- Lukas Radbruch
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
| | - Bernd Oliver Maier
- Klinik für Palliativmedizin und interdisziplinäre Onkologie, St. Josefs-Hospital Wiesbaden, Wiesbaden, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, München, Deutschland
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Maetens A, Deliens L, Van den Block L, Beernaert K, Cohen J. Are We Evolving Toward Greater and Earlier Use of Palliative Home Care Support? A Trend Analysis Using Population-Level Data From 2010 to 2015. J Pain Symptom Manage 2019; 58:19-28.e10. [PMID: 31004775 DOI: 10.1016/j.jpainsymman.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/31/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT The need for increased use and earlier initiation of palliative home care has been advocated by several international organizations. OBJECTIVES To investigate time trends in the use and timing of initiating palliative home care support (PHCS). METHODS We conducted an observational study using routinely collected population-level databases linked with health claims data for the entire population living at home that died of diseases indicative of palliative care needs in Belgium between 2010 and 2015 (n = 230,704). Trends and trends by cause of death and age were measured through changes over time in prevalence of use of PHCS. Rates were standardized for age, sex, and cause of death distribution in 2010. The median number of days before death when PHCS was initiated was calculated for each year. RESULTS Uptake of PHCS increased from 31.7% to 34.9% between 2010 and 2015. Trends were similar in size for all groups, except for people who died of dementia (smallest increase with 1.9 percent point). The timing of initiating PHCS advanced from 41 to 46 days before death, with the smallest increase observed among people who died of dementia (+2.5 days). The proportion of people receiving PHCS only in the last week of life changed from 15.3% to 13.9%. CONCLUSION This population-level study found a slight trend toward more and earlier initiation of PHCS between 2010 and 2015. However, uptake of PHCS remained below estimated needs in the population and the proportion of people receiving PHCS in their very late life remained stable over time.
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Affiliation(s)
- Arno Maetens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels & Ghent, Belgium.
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels & Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels & Ghent, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels & Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels & Ghent, Belgium
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Benson T, Sladen J, Done J, Bowman C. Monitoring work well-being, job confidence and care provided by care home staff using a self-report survey. BMJ Open Qual 2019; 8:e000621. [PMID: 31259287 PMCID: PMC6567942 DOI: 10.1136/bmjoq-2018-000621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/15/2019] [Accepted: 05/19/2019] [Indexed: 11/03/2022] Open
Abstract
Background and method In care homes, staff well-being, job confidence and opinion of the care provided to residents are central to morale and care quality. In this study, care home staff in the East Midlands region of England completed self-reported outcome and experience surveys in two rounds. Mean scores for each home are shown using a scale from 0 (all chose lowest option) to 100 (all chose highest option). High scores are good. Results In round 1, 332 staff in 15 homes submitted responses; in round 2, 207 staff in 9 homes. Mean scores in round 1 and round 2 were similar, although those of some homes scores differed significantly, cancelling each other out. Overall, Work Wellbeing mean score was 83 (care home range 48-97), with worthwhileness (92) the highest ranked item and anxiety at work (78) the lowest. Job Confidence mean score was 84 (range 59-94), with able to manage the work (86) highest and involvement in decisions that affect staff (79) lowest. Care Provided mean score was 86 (range 59-97), with treat people kindly (91) highest and well organised (80) lowest. Homes rated as outstanding by the Care Quality Commission had higher scores on average than those rated good, which were higher than those rated as needing improvement. Conclusions This study has demonstrated the practicality of measuring staff views of their Work Wellbeing, Job Confidence and Care Provided in care homes. Rather than wait for adverse quality outcomes to be detected, this approach offers a way to track staff morale and declared capability over time.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Thatcham, UK
- Institute of Health Informatics, UCL, London, UK
| | | | | | - Clive Bowman
- City University School of Health Sciences, London, UK
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Wyte-Lake T, Der-Martirosian C, Claver M, Davis D, Dobalian A. Provider Delivery of Emergency Preparedness Education in Home-Based Primary Care. Disaster Med Public Health Prep 2019; 13:547-554. [PMID: 30378517 PMCID: PMC6494722 DOI: 10.1017/dmp.2018.114] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACTIntroductionHome health agencies have been tasked to improve their patients' disaster preparedness. Few studies have evaluated the robustness of tools to support preparedness in home health. Through evaluation of the Home-Based Primary Care (HBPC) Patient Assessment Tool, we conducted a survey to identify strengths and challenges in supporting the preparedness of patients served by home health programs such as the Veterans Health Administration's HBPC program. METHODS: Practitioners from 10 HBPC programs fielded the Patient Assessment Tool with all patients during a 3-week period. Logistic regression and bivariate analyses were used to identify patient characteristics associated with the delivery of preparedness education. RESULTS: A total of 754 Patient Assessment Tools were returned. The educational item most likely to be covered was how to activate 911 services (87%). The item least likely to be discussed was information on emergency shelter registration and emergency specialty transportation (44%). When compared to the low risk group, HBPC patients in the high/medium risk group were more likely to receive preparedness education materials for 6 of the 9 educational preparedness items (P values less than 0.05).DiscussionPractitioners are relaying preparedness education to their most vulnerable patients, suggesting that home health agencies can provide disaster preparedness in the home. Nonetheless, there is room for improvement. (Disaster Med Public Health Preparedness. 2019;13:547-554).
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Affiliation(s)
- Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), 16111 Plummer St. MS-152, North Hills, CA 91343, P: (818) 891-7711 ext. 36100 F: (818) 895-5838
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA)
| | - Maria Claver
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Gerontology Program, California State University, Long Beach, CA
| | - Darlene Davis
- Geriatrics and Extended Care, Home and Community Based Care, U.S. Department of Veterans Affairs (VA)
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN
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Goehner A, Kricheldorff C, Bitzer EM. Trained volunteers to support chronically ill, multimorbid elderly between hospital and domesticity - a systematic review of one-on-one-intervention types, effects, and underlying training concepts. BMC Geriatr 2019; 19:126. [PMID: 31046693 PMCID: PMC6498473 DOI: 10.1186/s12877-019-1130-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/05/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND New approaches are needed to address the challenges of demographic change, staff shortages, and societal change in the care of the elderly. While volunteering has barely been established as a pillar of the welfare state in several countries, legislators and nonprofit or community-based organizations in some countries favor the increased integration of volunteers, as they can rely on many dedicated people. When caring for the multimorbid elderly, the transition from hospital to domesticity involves certain risks. Currently, no systematic knowledge exists on whether and how elderly benefit from volunteer support after a hospital stay. Objectives of this systematic review were to (1) identify evaluated approaches with trained volunteers supporting chronically ill, multimorbid elderly one-on-one at the interface between hospital and domesticity; (2) investigate the patient-related effectiveness of the approaches; (3) present the characteristics of the supporting volunteers; and (4) present the underlying teaching and training concepts for the volunteers. METHODS A systematic search of the following online databases was conducted in April 2017: the Cochrane Library, Medline (PubMed), CINAHL, and PsycINFO (Ebscohost). We included (cluster/quasi-) randomized controlled trials, controlled clinical trials and single-group pre-post design. An institutional search was conducted on eight national institutions from research and practice in Germany. Screening was conducted by one researcher, risk of bias was assessed. Study authors were contacted for study and training details. RESULTS We identified a total of twelve studies, eight of which evaluated treatment following hospital stay: psychosocial-coordinative support (n = 2), physical-cognitive activation (n = 4), and assistance with medication intake (n = 2). We saw short-term effects with small and medium effect sizes. Most volunteers were women aged between 45 and 61 years. Their training lasted 12-26 h and took place prior to first patient contact. During the intervention, volunteers could rely on permanent supporting structures. CONCLUSIONS Few studies exist that have evaluated one-on-one-volunteer support following hospitalization, and the effects are inconsistent. As such, further, well-designed studies are needed. The suitability and transferability of the interventions in country-specific settings should be examined in feasibility studies. Furthermore, an international discussion on the appropriate theoretical backgrounds of volunteer training is needed.
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Affiliation(s)
- Anne Goehner
- Center for Geriatric Medicine and Gerontology Freiburg, Medical Center, Faculty of Medicine, University of Freiburg, Lehener Str. 88, 79106 Freiburg, Germany
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
| | - Cornelia Kricheldorff
- Catholic University of Applied Sciences Freiburg, Karlstr. 63, 79104 Freiburg, Germany
| | - Eva Maria Bitzer
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
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Seamer P, Brake S, Moore P, Mohammed MA, Wyatt S. Did government spending cuts to social care for older people lead to an increase in emergency hospital admissions? An ecological study, England 2005-2016. BMJ Open 2019; 9:e024577. [PMID: 31028036 PMCID: PMC6501965 DOI: 10.1136/bmjopen-2018-024577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Government spending on social care in England reduced substantially in real terms following the economic crisis in 2008, meanwhile emergency admissions to hospitals have increased. We aimed to assess the extent to which reductions in social care spend on older people have led to increases in emergency hospital admissions. DESIGN We used negative binomial regression for panel data to assess the relationship between emergency hospital admissions and government spend on social care for older people. We adjusted for population size and for levels of deprivation and health. SETTING Hospitals and adult social care services in England between April 2005 and March 2016. PARTICIPANTS People aged 65 years and over resident in 132 local councils. OUTCOME MEASURES Primary outcome variable-emergency hospital admissions of adults aged 65 years and over. Secondary outcome measure-emergency hospital admissions for ambulatory care sensitive conditions (ACSCs) of adults aged 65 years and over. RESULTS We found no significant relationship between the changes in the rate of government spend (£'000 s) on social care for older people within councils and our primary outcome variable, emergency hospital admissions (Incidence rate ratio (IRR) 1.009, 95% CI 0.965 to 1.056) or our secondary outcome measure, admissions for ACSCs (IRR 0.975, 95% CI 0.917 to 1.038). CONCLUSIONS We found no evidence to support the view that reductions in government spend on social care since 2008 have led to increases in emergency hospital admissions in older people. Policy makers may wish to review schemes, such as the Better Care Fund, which are predicated on a relationship between social care provision and emergency hospital admissions of older people.
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Affiliation(s)
- Paul Seamer
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Simon Brake
- Warwick Medical School, University of Warwick, Coventry, UK
- Head Office, NHS Walsall Clinical Commissioning Group, Walsall, UK
| | - Patrick Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mohammed A Mohammed
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Steven Wyatt
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
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Wood NK. Home-Based Interventions in a Case of First Latch at 27 Days. Nurs Womens Health 2019; 23:135-140. [PMID: 30794770 DOI: 10.1016/j.nwh.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/12/2018] [Accepted: 01/01/2019] [Indexed: 06/09/2023]
Abstract
In this article, I describe the effects of home interventions on latching difficulty that persisted for 27 days for a mother-neonate dyad. The neonate manifested latching difficulty immediately after cesarean birth, and it became worse when nipple shields, bottles, and pacifiers were introduced. Manual expression and an electric pump were implemented when the neonate started losing weight, resulting in reduced frequency of breastfeeding directly at the breast. Additionally, the neonate continued to have latching difficulty after frenotomy. The use of home-based interventions supported ongoing educational opportunities for optimal latch, and I recommend that this type of health education be consistent among health professionals.
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Ware P, Dorai M, Ross HJ, Cafazzo JA, Laporte A, Boodoo C, Seto E. Patient Adherence to a Mobile Phone-Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study. JMIR Mhealth Uhealth 2019; 7:e13259. [PMID: 30806625 PMCID: PMC6412156 DOI: 10.2196/13259] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings. OBJECTIVE The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone-based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program. METHODS A mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics. RESULTS Overall average adherence was 73.6% (SD 25.0) with average adherence rates declining over time at a rate of 1.4% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients' ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients' perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). CONCLUSIONS The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.9911.
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Affiliation(s)
- Patrick Ware
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Mala Dorai
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Canadian Centre for Health Economics, Toronto, ON, Canada
| | - Chris Boodoo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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Du W, Gnjidic D, Pearson SA, Hilmer SN, McLachlan AJ, Blyth F, Viney R, Joshy G, Day C, Banks E. Patterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: a prospective cohort investigation among adults aged 45 years and over in Australia. BMJ Open 2019; 9:e027305. [PMID: 30772867 PMCID: PMC6398774 DOI: 10.1136/bmjopen-2018-027305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. DESIGN Prospective cohort analysis. SETTINGS, PARTICIPANTS, MEASUREMENTS Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009-June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations. PRIMARY OUTCOME HMR receipt during the 5-year study period. RESULTS Over 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5-9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5-9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health; this association was attenuated substantially following additional adjustment for polypharmacy. CONCLUSIONS HMR was common in individuals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting.
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Affiliation(s)
- Wei Du
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School and Centre for Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, University of Sydney, North Shore, Sydney, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School and Centre for Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Sydney Medical School University of Sydney, Camperdown, Camperdown, Australia
| | - Rosalie Viney
- Centre for Health Economics Research Eval., University of Technology, Sydney, New South Wales, Australia
| | - Grace Joshy
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Cathy Day
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
| | - Emily Banks
- Research School of Population Health, Australian National University, Canberra, Sydney, Australia
- The Sax Institute, Sydney, New South Wales, Australia
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Abstract
The aging population is steadily rising, resulting in an increased need for in-home healthcare. This study examined the impact of several carative factors demonstrated by home health nurses. Multiple regression was used to examine the impact of the carative factors, measured by the Caring Nurse Patient Interaction Scale (CNPI-70). A total of 77 home health nurses from five home health agencies in Northeastern Pennsylvania participated in the study. The findings indicate that the principles of care theory are widely applied in home health settings. The author recommends that care theory be a focus of educational health programs and future research.
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Gilmour H. Unmet home care needs in Canada. Health Rep 2018; 29:3-11. [PMID: 30485384] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Unmet home care needs have been linked to poor health, increased use of other health services, admission to nursing homes and reduced emotional well-being. DATA AND METHODS Using data from the 2015/2016 Canadian Community Health Survey, this article describes home care use and unmet home care needs by type (i.e., home health care [HHC] and support services) in community-dwelling adults. Among the population with home care needs, the degree to which needs were met, partially met or unmet is presented, as well as information about the barriers to obtaining home care services and the places services were sought. Multivariate analysis was used to examine factors associated with unmet home care needs by type, while controlling for predisposing, enabling and needs-related factors. RESULTS In 2015/2016, just over one-third (35.4%) of people with home care needs, an estimated 433,000 people, did not have those needs met. This was more prevalent among those with support needs than those with HHC needs. Availability of services was most often cited as a barrier to obtaining home care services, particularly for those with an unmet need for HHC services. Age group, household type, long-term care insurance and health status factors were associated with perceiving an unmet home care need, with few differences by type of unmet need. DISCUSSION The degree to which needs were met and the perceived barriers to obtaining home care services varied by type of unmet home care need. The results indicate proportionally higher unmet needs for home care services among adults aged 35 to 49. This suggests a possible service gap.
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Affiliation(s)
- Heather Gilmour
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
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Norman GJ, Wade AJ, Morris AM, Slaboda JC. Home and community-based services coordination for homebound older adults in home-based primary care. BMC Geriatr 2018; 18:241. [PMID: 30305053 PMCID: PMC6180527 DOI: 10.1186/s12877-018-0931-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Medically complex vulnerable older adults often face social challenges that affect compliance with their medical care plans, and thus require home and community-based services (HCBS). This study describes how non-medical social needs of homebound older adults are assessed and addressed within home-based primary care (HBPC) practices, and to identify barriers to coordinating HCBS for patients. METHODS An online survey of members of the American Academy of Home Care Medicine (AAHCM) was conducted between March through November 2016 in the United States. A 56-item survey was developed to assess HBPC practice characteristics and how practices identify social needs and coordinate and evaluate HCBS. Data from 101 of the 150 surveys received were included in the analyses. Forty-four percent of respondents were physicians, 24% were nurse practitioners, and 32% were administrators or other HBPC team members. RESULTS Nearly all practices (98%) assessed patient social needs, with 78% conducting an assessment during the intake visit, and 88% providing ongoing periodic assessments. Seventy-four percent indicated 'most' or 'all' of their patients needed HCBS in the past 12 months. The most common needs were personal care (84%) and medication adherence (40%), and caregiver support (38%). Of the 86% of practices reporting they coordinate HCBS, 91% followed-up with patients, 84% assisted with applications, and 83% made service referrals. Fifty-seven percent reported that coordination was 'difficult.' The most common barriers to coordinating HCBS included cost to patient (65%), and eligibility requirements (63%). Four of the five most frequently reported barriers were associated with practices reporting it was 'difficult' or 'very difficult' to coordinate HCBS (OR from 2.49 to 3.94, p-values < .05). CONCLUSIONS Despite the barriers to addressing non-medical social needs, most HBPC practices provided some level of coordination of HCBS for their high-need, high-cost homebound patients. More efforts are needed to implement and scale care model partnerships between medical and non-medical service providers within HBPC practices.
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Affiliation(s)
- Gregory J. Norman
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
| | - Amy J. Wade
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
| | - Andrea M. Morris
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
| | - Jill C. Slaboda
- West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA 92037 USA
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Wolpaw JR, Bedlack RS, Reda DJ, Ringer RJ, Banks PG, Vaughan TM, Heckman SM, McCane LM, Carmack CS, Winden S, McFarland DJ, Sellers EW, Shi H, Paine T, Higgins DS, Lo AC, Patwa HS, Hill KJ, Huang GD, Ruff RL. Independent home use of a brain-computer interface by people with amyotrophic lateral sclerosis. Neurology 2018; 91:e258-e267. [PMID: 29950436 PMCID: PMC6059033 DOI: 10.1212/wnl.0000000000005812] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/13/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To assess the reliability and usefulness of an EEG-based brain-computer interface (BCI) for patients with advanced amyotrophic lateral sclerosis (ALS) who used it independently at home for up to 18 months. METHODS Of 42 patients consented, 39 (93%) met the study criteria, and 37 (88%) were assessed for use of the Wadsworth BCI. Nine (21%) could not use the BCI. Of the other 28, 27 (men, age 28-79 years) (64%) had the BCI placed in their homes, and they and their caregivers were trained to use it. Use data were collected by Internet. Periodic visits evaluated BCI benefit and burden and quality of life. RESULTS Over subsequent months, 12 (29% of the original 42) left the study because of death or rapid disease progression and 6 (14%) left because of decreased interest. Fourteen (33%) completed training and used the BCI independently, mainly for communication. Technical problems were rare. Patient and caregiver ratings indicated that BCI benefit exceeded burden. Quality of life remained stable. Of those not lost to the disease, half completed the study; all but 1 patient kept the BCI for further use. CONCLUSION The Wadsworth BCI home system can function reliably and usefully when operated by patients in their homes. BCIs that support communication are at present most suitable for people who are severely disabled but are otherwise in stable health. Improvements in BCI convenience and performance, including some now underway, should increase the number of people who find them useful and the extent to which they are used.
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Affiliation(s)
- Jonathan R Wolpaw
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH.
| | - Richard S Bedlack
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Domenic J Reda
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Robert J Ringer
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Patricia G Banks
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Theresa M Vaughan
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Susan M Heckman
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Lynn M McCane
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Charles S Carmack
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Stefan Winden
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Dennis J McFarland
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Eric W Sellers
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Hairong Shi
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Tamara Paine
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Donald S Higgins
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Albert C Lo
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Huned S Patwa
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Katherine J Hill
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Grant D Huang
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
| | - Robert L Ruff
- From the Department of Neurology (J.R.W., D.S.H.), Albany Stratton Veterans Affairs Medical Center; Wadsworth Center (J.R.W., T.M.V., S.M.H., L.M.M., C.S.C., S.W., D.J.M., E.W.S.), National Center for Adaptive Neurotechnologies, New York State Department of Health, Albany; Durham Veterans Affairs Medical Center (R.S.B.) and Department of Neurology (R.S.B.), Duke University School of Medicine, NC; Veterans Affairs Cooperative Studies Program Coordinating Center (D.J.R., H.S., T.P.), Hines VA Medical Center, IL; Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.J.R.) and University of New Mexico College of Pharmacy; Department of Neurology (P.G.B.), Louis Stokes Cleveland Veterans Affairs Medical Center, OH; Providence Veterans Affairs Medical Center (A.C.L.) and Department of Neurology, Brown University, RI; Veterans Affairs Connecticut Healthcare System (H.S.P.) and Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Communication Science and Disorders (K.J.H.), University of Pittsburgh, PA; Cooperative Studies Program Central Office (D.G.H.), Department of Veterans Affairs Office of Research & Development, Washington, DC; and Louis Stokes Cleveland Veterans Affairs Medical Center (R.L.R.) and Department of Neurology, Case Western Reserve University School of Medicine, OH
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Cain SM, Cornfeld RJ, Waibel KH, Jorgensen-Wagers KL, Keen RS, Brown JN, Hearn HA, Jack AL, Black I, Ortiz-Rosado E. Military Medicine Implements In-home Virtual Health in Europe. US Army Med Dep J 2018:59-64. [PMID: 30623400] [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: 06/09/2023]
Abstract
OBJECTIVE This report outlines a multispecialty implementation effort which included 12 specialty practices and 28 clinicians within Regional Health Command Europe (RHCE) and Landstuhl Regional Medical Center (LRMC) to pilot an in-home virtual health (VH) program using existing resources. METHODS AND MATERIALS Synchronous VH encounters were performed using an Acano desktop conferencing client (Cisco Systems, Inc, San Jose, CA) and a USB web camera at the provider (distant) site and the patient's own computer or device in the home. A web real-time conferencing (Web RTC) server provided the connections. RESULTS Between October 2016 and May 2018, 310 synchronous VH appointments to patients' homes in 23 geographic locations in 9 countries on 3 different continents were completed; 28 skill type I and II specialty providers at LRMC, SHAPE Belgium Army Health Clinic (AHC), and Vilseck AHC, Germany Primary Care Clinic participated. The providers represented 9 distinct specialties and primary care. Appointment types were as follows: 85 (39%) follow-up type appointments; 70 (32%) group type appointments; 65 (30%) initial specialty care appointments. The 3 most active clinics were Pediatric Gastroenterology with 88 (28%), the Nutrition Clinic with 82 (26%), and the Traumatic Brain Injury Clinic with 63 (20%) encounters. Full audio and video connectivity rate was 97%, excluding reconnects after dropped calls which occasionally occurred. Patient satisfaction scores were high 16/17 (94%) with 5% of patients surveyed. CONCLUSION Low complexity synchronous VH appointments were successfully accomplished across a broad spectrum of health care services and appointment types. Landstuhl RMC specialists received consults from sites across a vast geographic area including Europe, the Middle East, and Africa. An in-home VH option gives providers a special tool to extend services far beyond traditional boundaries. This pilot project helped RHCE and LRMC providers gain valuable experience extending care to the home and will provide foundational knowledge for future VH efforts targeting groups and outcomes.
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Affiliation(s)
- Steven M Cain
- European Regional Virtual Health, Regional Health Command Europe
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Lopez-de-Andres A, de Miguel-Diez J, Hernandez-Barrera V, Jiménez-Trujillo I, Martinez-Huedo MA, Del Barrio JL, Jimenez-Garcia R. Effect of the economic crisis on the use of health and home care services among elderly Spanish diabetes patients. Diabetes Res Clin Pract 2018; 140:27-35. [PMID: 29601915 DOI: 10.1016/j.diabres.2018.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/29/2017] [Revised: 01/03/2018] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
Abstract
AIMS To describe the utilization of health and home care services among older people (≥65 years) with diabetes during the economic crisis; to identify the factors associated with changes in the utilization of these services; and to study the time trends (2009-2014). METHODS We used the European Health Interview Surveys for Spain (EEHSS) for 2009/10 and 2014. The dependent variables included self-reported hospitalizations; general practitioner (GP) visits; 'other healthcare services' (OHS) used; and home care services (HCS) used. RESULTS We identified 6026 and 6020 diabetic patients (EEHSS2009 and EEHSS2014, respectively). A significant decrease in the number of GP visits (OR 0.94; 95% CI 0.91-0.98) and the use of HCS (OR 0.95; 95% CI 0.91-0.99) was found; however, we found an increase in the use of OHS (OR 1.06; 95% CI 1.02-1.10). Multivariate models showed that factors associated with an increased use included chronic conditions, worse self-rated health, pain and mental disorders. Physical activity was a strong predictor of lower hospitalizations and HCS use. Female gender was associated with significantly lower hospitalizations and a higher use of OHC and HCS. CONCLUSION We found a decrease in the number of GP visits and the use of HCS among elderly diabetic adults; however, we also observed an increase in the use of OHS, which may partly explain this decrease in the figures. Significant differences in the use of health services were found according to gender. The effect of the economic crisis, if any, seems to have had a small magnitude.
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Affiliation(s)
- Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain.
| | - Javier de Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Comunidad de Madrid, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Maria-Angeles Martinez-Huedo
- Preventive Medicine and Public Health, Unidad de Docencia, Hospital Universitario La Paz, Madrid, Comunidad de Madrid, Spain
| | - José Luis Del Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
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Davis K, Willink A, Stockwell I, Whiton K, Burgdorf J, Woodcock C. Designing a Medicare Help at Home Benefit: Lessons from Maryland’s Community First Choice Program. Issue Brief (Commonw Fund) 2018; 2018:1-9. [PMID: 29993205] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Karen Davis
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health
| | - Amber Willink
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health
| | - Ian Stockwell
- Policy and Research Unit, Hilltop Institute, University of Maryland, Baltimore, MD
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Ellington L, Cloyes KG, Xu J, Bellury L, Berry PH, Reblin M, Clayton MF. Supporting home hospice family caregivers: Insights from different perspectives. Palliat Support Care 2018; 16:209-219. [PMID: 28464961 PMCID: PMC5670030 DOI: 10.1017/s1478951517000219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Our intention was to describe and compare the perspectives of national hospice thought leaders, hospice nurses, and former family caregivers on factors that promote or threaten family caregiver perceptions of support. METHOD Nationally recognized hospice thought leaders (n = 11), hospice nurses (n = 13), and former family caregivers (n = 14) participated. Interviews and focus groups were audiotaped and transcribed. Data were coded inductively, and codes were hierarchically grouped by topic. Emergent categories were summarized descriptively and compared across groups. RESULTS Four categories linked responses from the three participant groups (95%, 366/384 codes): (1) essentials of skilled communication (30.6%), (2) importance of building authentic relationships (28%), (3) value of expert teaching (22.4%), and (4) critical role of teamwork (18.3%). The thought leaders emphasized communication (44.6%), caregivers stressed expert teaching (51%), and nurses highlighted teamwork (35.8%). Nurses discussed teamwork significantly more than caregivers (z = 2.2786), thought leaders discussed communication more than caregivers (z = 2.8551), and caregivers discussed expert teaching more than thought leaders (z = 2.1693) and nurses (z = 2.4718; all values of p < 0.05). SIGNIFICANCE OF RESULTS Our findings suggest differences in priorities for caregiver support across family caregivers, hospice nurses, and thought leaders. Hospice teams may benefit from further education and training to help cross the schism of family-centered hospice care as a clinical ideal to one where hospice team members can fully support and empower family caregivers as a hospice team member.
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Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Jiayun Xu
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lanell Bellury
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - Patricia H. Berry
- Hartford Center of Gerontological Excellence, Oregon Health & Science University, Portland, Oregon, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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Toivo T, Dimitrow M, Puustinen J, Savela E, Pelkonen K, Kiuru V, Suominen T, Kinnunen S, Uunimäki M, Kivelä SL, Leikola S, Airaksinen M. Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness. BMC Geriatr 2018; 18:74. [PMID: 29548304 PMCID: PMC5857129 DOI: 10.1186/s12877-018-0737-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/29/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. METHODS Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. DISCUSSION The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources. TRIAL REGISTRATION The study is registered in the Clinical Trials.gov ( NCT02545257 ). Registration date September 9 2015.
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Affiliation(s)
- Terhi Toivo
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
| | - Maarit Dimitrow
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
| | - Juha Puustinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
- Satakunta Hospital District, Satakunta Central Hospital, Unit of Neurology, Sairaalantie 3, 28500 Pori, Finland
| | - Eeva Savela
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100 Lohja, Finland
| | | | - Valtteri Kiuru
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Tuula Suominen
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Sirkka Kinnunen
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Mira Uunimäki
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
- Institute of Clinical Medicine, Department of Family Medicine, University of Turku, 20014 Turku, Finland
| | - Saija Leikola
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100 Lohja, Finland
| | - Marja Airaksinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
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Tanuseputro P, Beach S, Chalifoux M, Wodchis WP, Hsu AT, Seow H, Manuel DG. Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study. PLoS One 2018; 13:e0191322. [PMID: 29447291 PMCID: PMC5813907 DOI: 10.1371/journal.pone.0191322] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While most individuals wish to die at home, the reality is that most will die in hospital. AIM To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital. DESIGN Observational retrospective cohort study, examining location of death and health care in the last year of life. SETTING/PARTICIPANTS Population-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754). RESULTS More than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors-including patient illness, home care services, and days of being at home-receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51-0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39-0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47-0.51). CONCLUSION Location of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.
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Affiliation(s)
- Peter Tanuseputro
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
| | - Sarah Beach
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Mathieu Chalifoux
- Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
| | - Walter P. Wodchis
- Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada
| | - Amy T. Hsu
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
| | - Hsien Seow
- Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Douglas G. Manuel
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
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Philip RR, Philip S, Tripathy JP, Manima A, Venables E. Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers. BMC Palliat Care 2018; 17:26. [PMID: 29444688 PMCID: PMC5813368 DOI: 10.1186/s12904-018-0278-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/25/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The well lauded community-based palliative care programme of Kerala, India provides medical and social support, through home-based care, for patients with terminal illness and diseases requiring long-term support. There is, however, limited information on patient characteristics, caregivers and programme performance. This study was carried out to describe: i) the patients enrolled in the programme from 1996 to 2016 and their diagnosis, and ii) the care-giver characteristics and palliative care support from nurses and doctors in a cohort of patients registered during 2013-2015. METHODS A descriptive study was conducted in the oldest community-based palliative clinic in Kerala. Data were collected from annual patient registers from 1996 to 2016 and patient case records during the period 2013-2015. RESULTS While 91% of the patients registered in the clinic in 1996 had cancer, its relative proportion came down to 32% in 2016 with the inclusion of dementia-related illness (19%) cardiovascular accidents (17%) and severe mental illness (5%).Among patients registered during 2013-15, the median number of home visits from nurses and doctors in 12 months were five and one respectively. In the same cohort, twelve months' post-enrolment, 56% of patients died, 30% were in continuing in active care and 7% opted out. Those who opted out of care were likely to be aged < 60 years, received one or less visit annually from a doctor or have a serious mental illness. 96% of patients had a care-giver at home, 85% of these care-givers being female. CONCLUSIONS The changing dynamics over a 20-year period of this palliative care programme in Kerala, India, highlights the need for similar programmes to remain flexible and adapt their services in response to a growing global burden of Non Communicable Diseases. While a high death rate is expected in this population, the high proportion of patients choosing to stay in the programme suggests that home-based care is valued within this particular group. A diverse range of clinical and psycho-social support skills are required to assist families and their caregivers when caring for a cohort such as this one.
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Affiliation(s)
- Rekha Rachel Philip
- Department of Community Medicine, Government T.D Medical College, Alappuzha, Kerala, India.
| | - Sairu Philip
- Department of Community Medicine, Government T.D Medical College, Alappuzha, Kerala, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - Abdulla Manima
- Malappuram Initiative in Palliative Care, Malappuram, Kerala, India
| | - Emilie Venables
- Medical Department, Médecins Sans Frontières, Brussels, Belgium
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Førsund LH, Grov EK, Helvik AS, Juvet LK, Skovdahl K, Eriksen S. The experience of lived space in persons with dementia: a systematic meta-synthesis. BMC Geriatr 2018; 18:33. [PMID: 29390970 PMCID: PMC5795848 DOI: 10.1186/s12877-018-0728-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying how persons with dementia experience lived space is important for enabling supportive living environments and creating communities that compensate for the fading capabilities of these persons. Several single studies have explored this topic; however, few studies have attempted to explicitly review and synthesize this research literature. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding persons with dementia's experience of space. METHODS A systematic, computerized search of AgeLine, CINAHL Complete, Embase, Medline and PsycINFO was conducted using a search strategy that combined MeSH terms and text words for different types of dementia with different descriptions of experience. Studies with 1) a sample of persons with dementia, 2) qualitative interviews as a research method and 3) a description of experiences of lived space were included. The search resulted in 1386 articles, of which 136 were identified as eligible and were read and assessed using the CASP criteria. The analysis was inspired by qualitative content analyses. RESULTS This interpretative qualitative meta-synthesis included 45 articles encompassing interviews with 672 persons with dementia. The analysis showed that living in one's own home and living in long-term care established different settings and posed diverse challenges for the experience of lived space in persons with dementia. The material revealed four main categories that described the experience of lived space: (1) belonging; (2) meaningfulness; (3) safety and security; and (4) autonomy. It showed how persons with dementia experienced a reduction in their lived space due to the progression of dementia. A comprehensive understanding of the categories led to the latent theme: "Living with dementia is like living in a space where the walls keep closing in". CONCLUSION This meta-synthesis reveals a process whereby lived space gradually becomes smaller for persons with dementia. This underscores the importance of being aware of the experiences of persons with dementia and the spatial dimensions of their life-world. To sustain person-centred care and support the preservation of continuity and identity, one must acknowledge not only the physical and social environment but also space as an existential experience for persons with dementia.
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Affiliation(s)
- Linn Hege Førsund
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene Kristine Juvet
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
- The National Institute of Public Health, Oslo, Norway
| | - Kirsti Skovdahl
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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Pierotti D. Patient Experience Surveys Are Personal. Home Healthc Now 2018; 36:61-62. [PMID: 29298204 DOI: 10.1097/nhh.0000000000000642] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Danielle Pierotti
- Danielle Pierotti, PhD, RN, CENP, is the Vice President, Quality and Research, Visiting Nurse Associations of America/Elevating Home, Arlington, Virginia
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