Perfil dos pacientes em cuidados paliativos na atenção domiciliar em um serviço do Sul do Brasil / Profile of patients under palliative care in home care in a service in Southern Brazil / Perfil de pacientes en cuidados paliativos en atención domiciliaria en un servicio del Sur de Brasil

Introdução: A Medicina de Família e Comunidade, como forma de cuidado mais próxima ao paciente, pode ofertar cuidados paliativos (CP) de modo integral e individualizado. Assim, torna-se relevante caracterizar a população atendida de modo a favorecer o desenvolvimento e implementação de estratégias para a ampliação da assistência de CP na Rede de Atenção à Saúde. Objetivo: Apresentar um panorama do perfil epidemiológico dos pacientes em CP domiciliares, no período de janeiro de 2018 a outubro de 2021, assistidos pelo Serviço de Atenção Domiciliar (SAD), vinculado ao Hospital Municipal de São José (HMSJ), na cidade de Joinville (SC). Métodos: Série de casos retrospectiva, incluindo os participantes do SAD que evoluíram a óbito no período da pesquisa. Os critérios de exclusão foram os participantes vivos no período da pesquisa; aqueles registrados, mas não atendidos pela equipe médica; os que receberam alta do programa; pacientes com prontuário incompleto; prontuários duplicados e menores de 18 anos. Os dados coletados incluíram número identificador do prontuário, idade, sexo, estado civil, diagnóstico, data de entrada no SAD, data de óbito, tempo de permanência no SAD, desfecho de óbito e via pela qual foi atestado o óbito, se recebeu analgesia com opioides e se fez uso de mais de um opioide, e se recebeu analgesia em bomba de infusão contínua (BIC) e/ou sedação paliativa. Os dados foram coletados pelos pesquisadores de prontuários médicos, codificados e conferidos duplamente. Foram realizadas então média e mediana das variáveis, bem como correlação dos dados e análise dos resultados. Resultados: Duzentos e oito pacientes foram incluídos; a média de idade foi 66,8 anos; as doenças neoplásicas foram as mais prevalentes (94,2%), destacando-se as neoplasias de trato gastrointestinal (21,1%), pulmonares (12,5%) e de mama (9,5%). A maior parte dos pacientes (37,9%) permaneceu sob os cuidados do SAD por mais de 30 dias e 75,9% da população analisada veio a óbito em ambiente domiciliar, e 45,67% desses indivíduos foram atestados via Serviço de Verificação de Óbitos e 30,2% via SAD. Quanto ao manejo da dor, 87,1% fizeram uso de opioides, mais frequentemente a morfina. Quanto à sedação paliativa, esta esteve presente em apenas 25,48%, prevalecendo o uso de midazolam. Conclusões: Neste estudo, encontrou-se maior prevalência de pacientes acometidos por doenças neoplásicas em fase final de vida, com necessidade de controle de dor adequado ­ contexto no qual o SAD possibilita o atendimento especializado ao paciente e seus familiares em um ambiente de maior conforto.

Introduction: Family Practice, being closer to the patient, can offer comprehensive and individualized Palliative Care (PC). Therefore, characterizing the population served becomes essential to support the development and implementation of strategies to expand PC services in the Health Care Network. Objective: Present an overview of the epidemiological profile of patients receiving home-based palliative care from January 2018 to October 2021, supported by Home Care Services (HCS) affiliated with Hospital Municipal São José (HMSJ) in the city of Joinville (SC). Methods: Retrospective case series with Participants in HCS who passed away during the study period were included. Exclusion criteria comprised living participants, those registered but not attended by the medical team, program discharges, incomplete medical records, duplicates, and individuals under 18 years of age. Collected data included record identifier, age, gender, marital status, diagnosis, entry and death dates, duration of HCS stay, death outcome and certification method, opioid analgesia use, use of multiple opioids, and use of continuous infusion pump (CIP) analgesia and/or palliative sedation. Researchers collected and double-checked the coded data, performed average and median calculations, correlated data, and analyzed results. Results: Two hundred and eight patients were included; average age was 66.8 years; neoplastic diseases were most prevalent (94.2%), particularly gastrointestinal (21.1%), pulmonary (12.5%), and breast cancers (9.5%). The majority of patients (37.9%) remained under HCS care for over 30 days, and 75.9% of the analyzed population passed away at home, with 45.67% certified by the Death Verification Service and 30.2% by HCS. Regarding pain management, 87.1% used opioids, most commonly morphine. Palliative sedation was present in only 25.48%, predominantly using midazolam. Conclusions: This study found a higher prevalence of patients with end-stage neoplastic diseases requiring adequate pain control, an area where HCS provides specialized care in a more comfortable environment.

Introducción: La Medicina Familiar y Comunitaria, como forma de atención más cercana al paciente, puede ofrecer Cuidados Paliativos (CP) de forma integral e individualizada. Por lo tanto, resulta relevante caracterizar la población atendida con el fin de favorecer el desarrollo e implementación de estrategias para ampliar la asistencia en CP en la red de Atención a la Salud. Objetivo: Presentar una visión general del perfil epidemiológico de los pacientes que recibieron cuidados paliativos domiciliarios, de enero de 2018 a octubre de 2021, atendidos por el Servicio de Atención de Salud a Domicilio (SAD), vinculado al Hospital Municipal São José (HMSJ), de la ciudad de Joinville (SC). Método: Serie de casos retrospectiva, incluyendo participantes del SAD que fallecieron durante el período de investigación. Los criterios de exclusión fueron participantes vivos durante el período de investigación; pacientes registrados pero no atendidos por el equipo médico; los que tuvieron alta del programa; con historial médico incompleto, historial médico duplicado y menores de 18 años. Los datos recogidos incluyeron número de identificación del historial médico, edad, sexo, estado civil, diagnóstico, fecha de ingreso al SAD, fecha de fallecimiento, tiempo de estancia en el SAD, desenlace de la muerte y vía por la que se certificó la muerte; si recibió analgesia con opioides y si usaron más de un opioide, y si recibieron analgesia con bomba de infusión continua (BIC) y/o sedación paliativa. Los datos fueron recopilados por investigadores de registros médicos, codificados y verificados dos veces. Luego se realizó la media y mediana de las variables, así como la correlación de datos y el análisis de los resultados. Resultados: Se incluyeron doscientos ocho pacientes; la edad promedio fue de 66,8 años; las enfermedades neoplásicas fueron las más prevalentes (94,2%), destacándose las neoplasias del tracto gastrointestinal (21,1%), pulmón (12,5%) y mama (9,5%). La mayoría de los pacientes (37,9%) permanecieron bajo atención del SAD más de 30 días y el 75,9% de la población analizada falleció en su domicilio, de los cuales el 45,67% fue certificado a través del Servicio de Urgencias de Verificación de Defunciones y el 30,2% a través del SAD. En cuanto al manejo del dolor, el 87,1% utilizaba opioides, con mayor frecuencia morfina. En cuanto a la sedación paliativa, estuvo presente solo en el 25,48%, prevaleciendo el uso de midazolam. Conclusiones: En este estudio se encontró una mayor prevalencia de pacientes afectados por enfermedades neoplásicas en la etapa final de la vida, que necesitan un control adecuado del dolor, un contexto en el que el SAD permite una atención especializada a los pacientes y sus familias en un ambiente más confortable.

Specialized nurses' role in ensuring patient safety within the context of telehealth in home care: A scoping review.

Objectives: Specialized nurses are uniquely positioned to implement innovative telehealth solutions to improve the quality and safety of home care, and this has become a focal point of contemporary healthcare research. This review aimed to identify the nature and scope of specialized nurses' roles in ensuring patient safety within the context of telehealth in home care. Methods: A scoping review of the international literature was carried out from January 1, 2013, to August 29, 2024. The review employed Levac et al.'s framework to delineate the research phenomenon and consolidate existing empirical research findings. Through a comparative analysis, the review integrated findings from selected studies, highlighting both similarities and differences related to this phenomenon, which led to the development of distinct categories. Results: The search yielded 1127 articles, from which 23 studies met the inclusion criteria for research synthesis and subsequent reporting of results. These studies spanned specialized nurses' roles in telehealth and various fields in which specialized nurses utilized telehealth to deliver high-quality and safe home care. The findings highlighted key outcomes linked to the improvement of patient safety in home care encompassing continuity of care, confidence in care, monitoring and early intervention, medication safety, engagement and adherence, and healthcare costs. Conclusions: The review revealed the crucial role played by specialized nurses in harnessing telehealth in healthcare to meet the highest care standards, creating an environment that prioritizes the well-being and patient safety in home care.

Mortality in long-term care residents: retrospective national cohort study.

OBJECTIVES: Mortality trends among people living in long-term care settings have been poorly understood. Linking data offers the potential to provide real-world, long-term national follow-up. Our aim was to describe patterns and associations with mortality among people moving-in to care homes in Scotland. METHODS: A retrospective cohort study was undertaken using routinely collected national social care data from the Scottish Care Home Census. These data were indexed and linked to national health data and mortality records for individuals moving- in to care homes in Scotland between 1 April 2013 and 31 March 2016. Location of death, underlying causes and time to death are reported. Survival analysis was undertaken using the Gompertz model for human mortality adjusted for key variables. RESULTS: Of 23 892 individuals moving-in to care homes, 20 250 (84.8%) died by 31 May 2020. Most deaths occurred in the care home setting (77.5%), with a fifth (20.5%) occurring in the hospital. 0.1% died the day they moved-in, 3.2% within a month, 24.2% within a year and 85% by 7 years. Dementia codes account for more than a third of all deaths (35.1%). Median survival time was shorter (701 vs 951 days; 23 vs 32 months) for those moving-in from the hospital, compared with the community. The adjusted HR for moving-in from the hospital was 1.19 (95% CI 1.15 to 1.22). CONCLUSIONS: Mortality is common in Scotland's care homes but varies in timing. Dementia is the most common cause. Those moving-in from the hospital are more likely to die sooner, and this evidence provides opportunities to improve support for all involved.

"I Don't Know What I'm Going to Meet Today": Home Care Workers' Decision-Making About Safety During the COVID-19 Pandemic.

The home care workforce provides supportive healthcare services to older adults. The COVID-19 pandemic heightened the need for knowledge that can better support this high-risk and understudied group of essential workers. The study aimed to understand decision-making about safety and well-being during the COVID-19 pandemic. The study design used a descriptive qualitative study approach, and 34 participants completed individual video or phone interviews. The results were organized into three themes specific to decision-making around safety and well-being for home care workers (HCWs) during the pandemic: 1) Responsibility, commitment, and dedication to their clients led HCWs to continue to provide essential services, 2) Safety concerns did not prevent HCWs from reporting to work, and 3) HCWs expressed more concern about clients than their own safety. Understanding the experiences of HCWs can offer important insights for developing strategies and policies to address the safety of these essential yet often overlooked healthcare professionals.

Factors related to the use of physical restraints and hand restraints among older adults receiving home care services.

OBJECTIVES: Physical restraints and hand restraints are used in medical settings to provide protection and control. However, few studies have investigated their use among community-dwelling older adults. The study explored variables associated with the use of physical restraints and hand restraints among older adults receiving home care services and the reasons behind their use. METHODS: This cross-sectional study recruited 128 older adults receiving home care services and with catheters. Data were collected regarding demographic characteristics; activities of daily living (ADLs); muscle strength; family function; the use of nasogastric tubes, urinary catheters, and tracheal tubes; and the type and duration of restraint use and the reasons behind such use. RESULTS: Among the participants, 76% experienced the use of physical restraints, and 34% experienced the use of hand restraints. The variables related to physical restraints were ADLs (adjusted odds ratio [AOR] = 0.95, p = .02) and the presence of a paid caregiver (AOR = 3.33, p = .02). The variables related to hand restraints were ADLs (AOR = 0.93, p = .03), use of a nasogastric tube (AOR = 13.46, p = .03) and the presence of a paid caregiver (AOR = 6.38, p = .02). The primary reasons behind restraint use were to prevent fall and extubation events. CONCLUSIONS: The use of physical restraints among older adults with catheters may be affected by their functioning in ADLs and the presence of paid caregivers to ensure their safety. Thus, implementing interventions that target functional capabilities and caregiving skills may help reduce the use of restraints.

Understanding Older Persons' Experiences of Care Encounters in the Home Environment: A Hermeneutic Study.

AIM: To explore and gain a deeper understanding of older persons' experiences of care encounters when their home becomes a workplace. BACKGROUND: Worldwide healthcare services are increasingly being provided in older persons' homes by registered nurses. This presents new challenges as the home environment of older persons now doubles as a workplace for healthcare professionals. However, there is limited research available on how older persons experience care encounters when their homes serve as workplaces and how this influences their overall well-being and quality of life. DESIGN: A qualitative hermeneutic study. METHODS: In-depth face-to-face interviews were conducted in Sweden from October 2023 to January 2024 with 10 purposefully selected older persons (aged 65+). Each participant received regular visits from a home care nurse in their home to address specific care needs, such as wound care, medication administration, blood sampling and general supervision. The interviews were audiotaped, transcribed verbatim and analysed using a hermeneutic interpretation. FINDINGS: The hermeneutic analysis emerged with one main theme: 'Experiencing care encounters at home as a lottery', with two underlying themes: 'Adapting to loss of control in the private sphere' and 'Striving for independence while navigating daily living'. CONCLUSIONS: Older persons try to control their lives despite the challenges associated with ageing and receiving care at home. They strive to maintain their independence and autonomy, which reflects their desire for self-determination. Supporting these efforts in an interdependent relationship can enhance their well-being and quality of life. REPORTING METHOD: Findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. PATIENT OR PUBLIC CONTRIBUTION: Data were collected by patient interviews. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This study emphasises the importance of supporting older persons in maintaining control over their lives while being cared for in their homes. In the care encounters with home care nurses, their well-being and quality of life can be improved by respecting their autonomy, involving them in decision-making and offering tailored support.

A Qualitative Descriptive Study Exploring the Systemic Challenges of Caring for Children With Medical Complexity at Home.

INTRODUCTION: The purpose of this study is to explore challenges within the home care system encountered by parental caregivers of children with medical complexity in Massachusetts. METHOD: A qualitative descriptive study was completed with 11 parental caregivers interviewed. RESULTS: Using conventional content analysis of transcripts, three themes emerged: (1) lack of discharge preparedness causes emotional distress, (2) care becomes increasingly complex creating new unanticipated challenges, and (3) psychological toll of parents assuming provider role. DISCUSSION: Navigating a variety of complex systemic challenges with minimal preparation or support contributes to an overall feeling of parental caregiver burnout. Additionally, mental health supports for parental caregivers are lacking, further exacerbating the negative impact of these challenges. Future work should focus on research, advocacy, and system reform that ensures parental caregivers receive necessary supports to care for children within a sustainable and supportive home care model. Nurses across the profession are in unique position to facilitate this change.

What contributes to a decline in cognitive performance among home care clients? Analysis of interRAI data from across Canada.

BACKGROUND: The current study examined potential risk factors for experiencing a decline on the interRAI Cognitive Performance Scale (CPS). METHODS: This was a retrospective cohort study using secondary data collected with the Resident Assessment Instrument for Home Care (RAI-HC) for all assessments completed in Canada between 2001 and 2020. Eligible home care clients included individuals 65+, with at least two assessments completed within 12 months, and who had a CPS score of zero at baseline (n = 146,187). A decline on the CPS was defined as any increase (i.e., worsening) on the CPS score between the two assessments. RESULTS: The mean age of the sample was 80.6 years (standard deviation = 7.7), 67.9% were female and 44.5% were widowed. At the time of the second assessment, 25.2% experienced a decline on their CPS score. In the final multivariate model, age, having a diagnosis of Alzheimer's dementia/other type of dementia, physical inactivity, and having a caregiver at risk of experiencing burden were the most significant predictors of experiencing the outcome. CONCLUSIONS: Roughly one-quarter of Canadian home care clients experienced a cognitive decline, over an average of seven months. Since there are some modifiable risk factors for this outcome, it is important to identify and flag these factors as early as possible. Early identification of modifiable risk factors allows clinicians to create care plans that can optimize the well-being of the client and their family.

Home Care Practices that Improve Performance of Activities of Daily Living of Patients Post-stroke:A Systematic Review.

Evidence is inconsistent on the effectiveness of home rehabilitation for patients post-stroke. This review aims to explore home care practices that improve the performance of activities of daily living of patients post-stroke. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), clinical trials and mixed-methods studies published from 2012 to 2022 were gathered from PubMed, ScienceDirect, EBSCO, and ProQuest in December 2022. The Mixed Method Appraisal Tool (MMAT) was used for quality appraisal. Narrative synthesis approach was utilized to present the findings. A total of 758 articles were screened, and 10 were included in the final analysis. Five out of ten programs were found superior compared with usual care. Factors that influence the effectiveness of the programs include the age of the participants, severity of disabilities, family participation, and presence of a multidisciplinary team. A multidisciplinary healthcare team approach toward the enhancement of knowledge, skills, and behaviors of patients and their families is common in effective home care. The role of nurses is emphasized not only as providers of direct patient care but also as coordinators of the healthcare team and patients and their families. This study provides insights for policymakers in developing healthcare system for post-stroke care. J. Med. Invest. 71 : 197-204, August, 2024.

Managing Vitality, Sustainable Performance and Fatigue in Nursing Home Staff: A Multi-Location Cross-Sectional Survey Study: Empirical Research Quantitative.

AIM: This study examines the moderating role of specific job resources in the association between job demands, vigour, sustainable performance and fatigue in nursing home staff. DESIGN: A multi-location cross-sectional survey study in line with the STROBE guidelines. METHODS: Online self-completion questionnaires were distributed in the Summer of 2022. A total of 667 healthcare employees from 24 nursing home locations in the Netherlands participated in this study. Data were analysed using hierarchical multiple regression analysis. RESULTS: Job resources were able to moderate the relation between job demands on the one hand, and vigour, sustainable performance and fatigue on the other. Regression analyses revealed that high cognitive job resources moderated (i.e., strengthened) the positive association between cognitive job demands and successively cognitive liveliness, physical strength and sustainable performance. Furthermore, high emotional job resources moderated (i.e., buffered) the positive relation between emotional job demands and emotional and cognitive fatigue, respectively. CONCLUSIONS: It can be concluded that job resources are crucial for nursing home staff to deal with their high job demands. Maintaining a healthy balance between job demands and sufficient, matching, job resources to promote vigour and sustainable performance, as well as to prevent fatigue of staff, seems to be important. IMPLICATIONS FOR THE PROFESSION: There is an urgent need to train nursing home staff to cope better with increasing job demands. Because job demands cannot be reduced in many situations, this study revealed that the idea of boosting job resources instead is appealing to both staff and managers. PATIENT OR PUBLIC CONTRIBUTION: Dutch healthcare staff from 24 nursing home locations were involved in this study by responding to the online survey.

Child maltreatment in young adults with residential youth care background: Prevalence and post-placement trends.

BACKGROUND: Young adults with residential youth care (RYC) background have often endured various forms of child maltreatment, impacting education, employment, health, mortality, and quality of life. There is limited research on the onset and duration of exposure to maltreatment before placement, as well as the prevalence of maltreatment occurring after children have been placed into out-of-home care. OBJECTIVE: This study aims to investigate: (1) The sex-specific prevalence and age chronology of self-reported exposure to child maltreatment, and (2) whether the rate of these maltreatment forms differ between the year before and after first out-of-home placement by the Child Welfare Service. PARTICIPANTS AND SETTING: This study is a part of VINGO, a Norwegian nation-wide 10-year follow-up examining the health and welfare of 157 (107 females) adults with RYC background. METHODS: The Maltreatment and Abuse Chronology of Exposure Scale was administered as an online questionnaire, and mean scores and percentages of maltreatment forms were compared. Differences between groups were examined using t-tests and Pearson's Chi-Squared test. RESULTS: Most participants, 154 of 157 (98 %), reported at least one form of child maltreatment. Females reported higher rates of sexual abuse than males (53 % vs. 22 %, p < .001). No other sex differences were found. A majority of participants (63 %) reported decreased maltreatment rates post-placement, while 37 % had stable or increasing rates. CONCLUSIONS: Young adults with RYC background report high child maltreatment rates. Although out-of-home care provides protection, further development and improvement of initiatives aimed at reducing the risk of revictimization is likely needed.

Prevalence and Predictors of Potentially Inappropriate Prescribing in Older People Receiving Home Health Care in Saudi Arabia According to the American Geriatrics Society Beers Criteria 2019.

BACKGROUND/OBJECTIVES: Potentially inappropriate prescribing (PIP) is a common health problem in older adults and is associated with negative health outcomes such as the occurrence of adverse drug events. Several studies have been conducted in different countries and settings to assess the prevalence of PIP, including in Home Care Services. However, data on the prevalence of PIP in home-care services in Saudi Arabia are limited. This study aimed to evaluate PIP use among older patients receiving home healthcare services in Saudi Arabia and to identify the predictors and commonly implicated medications.; Methods: A cross-sectional study was conducted over an 8-month period between January and August 2023. Data were collected from the medical records of patients older than 65 years who were currently receiving home health care services at King Faisal Hospital in Taif City, Saudi Arabia. PIPs were identified using the 2019 updated Beers Criteria.; Results: A total of 375 patients were included. Out of these, 285 PIPs were identified, of which 219 patients (58.4%) received at least one PIP. The most common therapeutic class associated with the PIPs was gastrointestinal medications (66.3%). Patient age and number of medications were significant predictors of PIP.; Conclusions: Our study found a high prevalence of PIP among elderly patients receiving home health care in Taif, Saudi Arabia. This study highlights the need for improved patient data automation and implementation of the Beers criteria to prevent PIPs in the future.

The association between interdental cleaning and periodontitis in an urban Thai adult cohort: a cross-sectional study.

BACKGROUND: Plaque biofilm is a major etiologic factor of periodontitis, and its effective removal prevents or ameliorates the disease. However, toothbrushing alone does not sufficiently clean the interdental area, and additional interdental cleaning is required to completely remove the plaque from this locale. This cross-sectional study aimed to assess the association of interdental cleaning on the prevalence of periodontitis in a large urban Thai adult cohort. METHODS: Interdental cleaning data were retrieved from a dental survey of 1,743 employees of the Electricity Generating Authority of Thailand (EGAT) in 2019. The Centers for Disease Control and Prevention/American Association of Periodontology (CDC/AAP) periodontal case definitions were applied. The participants were subdivided into two groups as those with or without periodontitis depending on their oral health status assessed by calibrated professional examiners. The proportion of subjects who performed interdental cleaning was assessed through a self-reported questionnaire by frequency (daily/ ≥ 1 per week/ none) and profile (correct/ incorrect) of interdental cleaning. Then, the association between interdental cleaning and periodontitis was calculated using logistic regression analysis controlling for the common risk factors of periodontitis such as age, sex, education, smoking, and diabetes. RESULTS: Participants who performed interdental cleaning on a daily basis and ≥ 1 per week were 27.5% (95% CI: 25.4, 29.6) and 29.1% (95% CI: 27.0, 31.3), respectively while the remainder did not practice. Of those who used interdental cleaning, about one-half focused on sites with food impaction. There was a significant 44% lower prevalence of periodontitis (adjusted odds ratio of 0.56 (95%CI: 0.40, 0.79) in the cohort with a frequent and correct group. CONCLUSIONS: Our data indicate an inverse association between interdental cleaning and periodontitis, particularly in those who routinely adhered to it. Regular interdental cleaning is likely to have a salutary effect on oral health. TRIAL REGISTRATION: The study was registered retrospectively in Thai Clinical Trials Registry, Registration number: TCTR20240817005, on 17 Aug 2024 ( https://www.thaiclinicaltrials.org ).

Prophylactic antibiotics and corticosteroid prescribing in palliative medicine: retrospective study.

OBJECTIVES: To investigate whether patients under the care of the community specialist palliative care team receiving steroids are at increased risk of infection.To identify other risk factors that predispose community palliative care patients to infection. METHODS: A retrospective chart review of all patients referred to a community specialist palliative care service. RESULTS: 177 adult patients were referred to the community specialist palliative care service. Corticosteroids were significantly associated with infection. 39% of patients who received an oral steroid had infection compared with 22% of those who did not receive steroids (OR 2.6 (95% CI 1.07 to 3), RR 1.78 (95% CI 1.08 to 2.9), p=0.02). Regular opioids were significantly associated with infection. 33% of patients receiving a regular opioid had an infection compared with 15% of those not receiving a regular opioid (OR 2.69 (95% CI 1.26 to 5.7), RR 2.06 (95% CI 1.2 to 3.8), p=0.008). Male gender, lung disease, diabetes and immunosuppressive therapies were associated with an increased rate of infection but were not statistically significant. CONCLUSIONS: Oral corticosteroids were associated with a significantly increased infection rate in a community palliative care population. These patients could potentially benefit from antibiotic prophylaxis while receiving corticosteroids.

[Epidemiology of tracheostomized children living at home in Argentina]. / Epidemiología de niños traqueostomizados que viven en sus hogares en Argentina.

INTRODUCTION: Although extensive research exists on the morbidity and mortality associated with tracheostomy in pediatrics, scarse work has been done to analyze the outcomes after hospital discharge of tracheostomized children. In our country there are no publications referring to the follow-up of this population. The general objective of this study was to describe and analyze the situation of tracheostomized children living at home in Argentina. MATERIALS AND METHODS: Descriptive, cross-sectional study through a survey with convenience sampling. Surveys sent between January and July 2023 were collected and analyzed. RESULTS: We obtained 193 surveys during the study period. One hundred eighteen children (61%) underwent tracheostomies before one year of age. The majority (n=183) have a Single Disability Certificate (94.8%). Regarding health coverage, 113 children have social insurance (58.5%), 42 have prepaid coverage (21.8%) and 38 depend on public insurance (19.7%). Almost all of the families (n=184) received some training to care for their children (95.3%). In their homes, 152 families (78.7%) had to resolve some adverse event related to the tracheostomy, and 128 families (66%) had to abandon some paid job. Although 118 children are not in school (61%), 170 (88%) receive rehabilitation therapy. DISCUSSION: Our research, the first of its kind, provides a crucial epidemiologic analysis of the situation of tracheostomized children living at home in Argentina. These findings are significant as they shed light on a previously unexplored area, emphasizing the need for further studies to confirm and expand these data.

Introducción: Si bien existe investigación sobre la morbimortalidad asociada a la traqueostomía en pediatría, pocos trabajos analizan los resultados luego del alta hospitalaria. En nuestro país no existen publicaciones referidas al seguimiento de esta población. El objetivo general de este trabajo fue describir y analizar la situación de niños traqueostomizados que viven en su hogar en Argentina. Materiales y métodos: Estudio descriptivo, transversal a través de una encuesta con muestreo por conveniencia. Se recolectaron y analizaron las encuestas remitidas entre enero y julio de 2023. Resultados: Se obtuvieron 193 encuestas durante el período de estudio. Fueron traqueostomizados antes del año de vida 118 niños (61%). La mayoría (n=183) posee Certificado Único de Discapacidad (94.8%). En relación a la cobertura de salud, 113 niños cuentan con Obra Social (58.5%), 42 con cobertura prepaga (21.8%) y 38 dependen del sector público (19.7%). Casi la totalidad de las familias (n=184) recibió capacitación para el cuidado de su hijo (95.3%). En sus hogares, 152 familias (78.7%) debieron resolver algún evento adverso relacionado con la traqueostomía y 128 familias (66%) abandonaron algún trabajo remunerado. Si bien 118 niños no se encuentran escolarizados (61%), 170 (88%) reciben terapia de rehabilitación. Discusión: Nuestra investigación, la primera de su tipo, proporciona un análisis epidemiológico crucial de la situación de los niños traqueostomizados que viven en sus hogares en Argentina. Hallazgos importantes, ya que arrojan luz sobre un área previamente inexplorada, enfatizando la necesidad de más estudios para confirmar y ampliar estos datos.

Associations between diabetes and risk of short-term and long-term nursing home stays among older people receiving home care services: A nationwide registry study.

BACKGROUND: Older people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS. METHODS: This nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010-2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using "non-insulin GLD only", "insulin and non-insulin GLD" and "insulin only". An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs. RESULTS: Both insulin-treated subgroups had a higher risk of a short-term NHS ("insulin only" users RR 1.06 (CI 1.03-1.09) and "insulin and non-insulin GLD" users RR 1.04 (CI 1.02-1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89-0.94)). The subgroup using "insulin and non-insulin GLD" had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81-0.91)). CONCLUSION: Despite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS's.

Medication Self-Management for Home Care Users Receiving Multidose Drug Dispensing: Qualitative Interview Study.

Background: Multidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. Objective: The aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. Methods: We conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants' homes, and the interview transcripts were analyzed thematically. Results: All participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. Conclusions: MDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy.

Attachment goes to court in Sweden: perception and application of attachment concepts in child removal court decisions.

Concerns have been raised regarding misconceptions about attachment theory in child protection settings, but the application of attachment concepts in judicial child protection decisions has not been systematically explored. This study therefore examined the perception and application of attachment concepts in Swedish judicial decision protocols concerning involuntary removals of children (aged 0-2 years) where emotional neglect was a notable concern (n=28). Attachment concepts were frequently misunderstood, and imprecisely articulated. Unsystematic observations of child behavior were used to infer attachment insecurity and, by extrapolation, caregiving deficiencies. Attachment concepts were primarily used to support child removal, and insecure attachment seemed to be viewed as meeting the legally required level of risk to warrant involuntary child out-of-home placement. Our results indicate that misconceptions about attachment theory may be prevalent in judicial decision protocols. We emphasize the need to elaborate on risks in legally relevant ways without incorrect appeals to attachment theory.

Nurse-related behavioural determinants associated with healthy eating support provided by Dutch community nurses: a cross-sectional study.

BACKGROUND: Community nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs' need for additional knowledge. METHODS: In this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs' characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients' dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations. RESULTS: More CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5-2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1-1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3-1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2-1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy. CONCLUSIONS: This study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs' competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia. REPORTING METHOD: The STROBE Statement was followed for reporting.

Exploring Health Care Professionals' Perspectives on the Use of a Medication and Care Support System and Recommendations for Designing a Similar Tool for Family Caregivers: Interview Study Among Health Care Professionals.

BACKGROUND: With the aging population on the rise, the demand for effective health care solutions to address adverse drug events is becoming increasingly urgent. Telemedicine has emerged as a promising solution for strengthening health care delivery in home care settings and mitigating drug errors. Due to the indispensable role of family caregivers in daily patient care, integrating digital health tools has the potential to streamline medication management processes and enhance the overall quality of patient care. OBJECTIVE: This study aims to explore health care professionals' perspectives on the use of a medication and care support system (MCSS) and collect recommendations for designing a similar tool for family caregivers. METHODS: Fifteen interviews with health care professionals in a home care center were conducted. Thematic analysis was used, and 5 key themes highlighting the importance of using the MCSS tool to improve medication management in home care were identified. RESULTS: All participants emphasized the necessity of direct communication between health care professionals and family caregivers and stated that family caregivers need comprehensive information about medication administration, patient conditions, and symptoms. Furthermore, the health care professionals recommended features and functions customized for family caregivers. CONCLUSIONS: This study underscored the importance of clear communication between health care professionals and family caregivers and the provision of comprehensive instructions to promote safe medication practices. By equipping family caregivers with essential information via a tool similar to the MCSS, a proactive approach to preventing errors and improving outcomes is advocated.