Scoping review: Social support impacts hospital readmission rates.

AIMS AND OBJECTIVES: To review and synthesise the current literature on social support and hospital readmission rates. BACKGROUND: Hospital readmission rates have not declined significantly since 2010 despite efforts to identify and implement strategies to reduce readmissions. After discharge, patients often report the need for help at home with personal care, medical care and/or transportation. Social factors can positively or negatively affect the transition from hospital to home and the extended recovery period experienced by patients. METHODS: Published primary studies in peer-reviewed journals, written in English, assessing the adult medical/surgical population and discussing social support and hospital readmission rates were included. A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was completed for this scoping review. RESULTS: The search resulted in 2919 articles. After removing duplicates and reviewing content for the inclusion and exclusion criteria, 23 articles were selected for review. Social support is provided by those within one's social circle. There are several types of social support and depending on the needs to the patient, the type of social required and provided is different. CONCLUSIONS: The most common form of social support needed at home for people recovering after a hospitalisation was instrumental support, tangible care in the form of assistance with daily personal and medical care, and transportation. Patients who lacked adequate social support after discharge were at an increased risk of hospital readmission. RELEVANCE TO CLINICAL PRACTICE: Identifying factors, such as social support, that may impact hospital readmission rates is important for quality hospital to home care transitions. Assessing patients' needs and available social support to meet those needs may be an essential part of the discharge planning process to decrease the risk of hospital readmission.

Development and Pilot of the Caregiver Strategies Inventory.

Children with autism spectrum disorder often demonstrate unusual behavioral responses to sensory stimuli (i.e., sensory features). To manage everyday activities, caregivers may implement strategies to address these features during family routines. However, investigation of specific strategies used by caregivers is limited by the lack of empirically developed measures. In this study, we describe the development and pilot results of the Caregiver Strategies Inventory (CSI), a supplement to the Sensory Experiences Questionnaire Version 3.0 (SEQ 3.0; Baranek, 2009) that measures caregivers' strategies in response to their children's sensory features. Three conceptually derived and empirically grounded strategy types were tested: cognitive-behavioral, sensory-perceptual, and avoidance. Results indicated that the CSI demonstrated good internal consistency and that strategy use was related to child age and cognition. Moreover, parent feedback after completing the CSI supported its utility and social validity. The CSI may be used alongside the SEQ 3.0 to facilitate a family-centered approach to assessment and intervention planning.

Observational characterization of sensory interests, repetitions, and seeking behaviors.

Sensory interests, repetitions, and seeking behaviors (SIRS) are common among children with autism spectrum disorder (ASD) and other developmental disabilities (DD) and involve unusual actions that intensify or reinforce a sensory experience. Researchers and practitioners typically use parent-report measures or informal clinical observations to understand the presence and nature of SIRS. In this study, we used a scoring supplement to the Sensory Processing Assessment for Young Children, an observational measure, to characterize SIRS across three groups of children-those with ASD (n=40), DD (n=37), and typical development (n=39). Group differences were identified in frequency and intensity of overall SIRS, complexity of SIRS, and incidence of particular types of SIRS (i.e., posturing, sighting, proprioceptive seeking, spinning). Facial affect was also explored and found to be primarily neutral during engagement in SIRS across groups. Implications for practice and future research are discussed.

Instrumental support: A conceptual analysis.

The aim of this paper was to use the Walker and Avant method of concept analysis to evaluate the concept of instrumental support in the context of hospital to home care transitions. Findings from this concept analysis suggest three defining attributes of instrumental support: informal support providers, tangible support, and unmet personal needs. Antecedents identified: a strong and supportive social network, an independently functioning adult, an illness resulting in hospitalization, a change in functional status, and the patient being discharged home from the hospital. Consequences of not having adequate instrumental support: unsuccessful recovery at home, increased risk for hospital readmission, decline in physical functioning, health complications, and increased risk of mortality. Empirical referents: patient's report of successful recovery, returning to an independent level of functioning, and the lack of hospital readmission or health complication. A model and a contrary case study were developed to provide examples of clinical cases related to instrumental support. Recommendations related to clinical practice include evaluating the availability/adequacy of instrumental support before hospital discharge and including the identified instrumental support person in the discharge planning process. There are proven benefits of having people within one's social network providing instrumental support during the home recovery period.

Post-Hospital Availability of Instrumental Support May Influence Patients' Readiness for Discharge.

PURPOSE OF STUDY: Evaluate the relationship between unplanned acute care utilization after discharge from an index hospital admission and registered nurse and patient perceptions of available instrumental support the patient would have after discharge. PRIMARY PRACTICE SETTING: Three hospitals in a large regional hospital system in the southeastern United States. METHODOLOGY AND SAMPLE: Retrospective, secondary quantitative analysis of 13,361 patient records (mean age 58.4 years; 51% female) from index hospitalizations evaluating patient and nurse responses to 2 questions that specifically address instrumental support on both the patient and nurse versions of the Readiness for Hospital Discharge Survey (RHDS) and subsequent unexpected care received (emergency department [ED] visit, observation stay, hospital readmission) in the acute care setting within 60 days of discharge. Logistic regression was used to evaluate the relationship between RHDS scores and unplanned care received. RESULTS: Patients who required hospital-based acute care within 60 days after discharge had lower average RN-RHDS scores than those who did not require hospital-based acute care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Including a nursing assessment of potential postdischarge expected instrumental support may be helpful in identifying patients who are at a higher risk of experiencing postdischarge acute care utilization. Monitoring ED visits and observation stays in addition to readmissions will facilitate capturing significantly more points of care received after discharge and provide additional information regarding postdischarge care utilization.

Experiences of African Americans Living With Sickle Cell Disease.

INTRODUCTION: About 100,000 individuals in the United States live with sickle cell disease (SCD). Palliative care (PC) can improve symptom management for these individuals. The purpose of the study was to explore (a) the experiences of people living with SCD, and (b) their knowledge and perceptions of PC. METHOD: Using a qualitative, descriptive design, adults with SCD were recruited from a foundation in the southeastern United States. Data included social and SCD-related demographics and audio-recorded, semi-structured focus groups. Analysis took a thematic analysis approach. RESULTS: Participants: There were 16 African Americans who participated in the study, 75% of whom were females, and aged 22 to 71 years. Five themes were identified: unique and unpredictable impact of SCD on daily life, the changing experience of SCD over time, stigmatization/marginalization in health care interactions, perceptions of support in managing SCD symptoms/crises, and PC: "What is it?" DISCUSSION: Participants lacked PC knowledge. PC should be offered to individuals with SCD as part of comprehensive SCD management.

Parent reports of sensory experiences of preschool children with and without autism: a qualitative study.

This study describes sensory experiences of children with and without autism. Parents of 66 preschoolers (29 typically developing; 37 with autism) described situations in which their child had "good" and "bad" sensory experiences and their perception of how these situations felt to the child. The most common unpleasant experiences for both groups related to sound; the most common pleasant experiences involved touch and movement. Children with autism were reported to have more extreme or unusual experiences and negative food-related experiences than typically developing peers. Parental explanations for children's responses focused on the qualities of the child, stimulus, or context. Parents of children with autism were more likely to recognize elements in their children's experiences as being sensory and to attribute those responses to aspects of autism. Parents' positive response to the interview itself was an unexpected result with clinical relevance.

Pharmacology of ocular allergy.

PURPOSE OF REVIEW: To evaluate the pharmacology of current drug development directed towards ocular allergy. Increased worldwide prevalence of ocular allergy has stimulated expansion of management strategies towards physiologic and immunologic drug targets. RECENT FINDINGS: Present drug targets are located in the conjunctival mucosal surface at the initial site of allergen exposure. Pharmacologic intervention attends to early and late phase reactions. Targets generating a response include mast cells, IgE, released preformed mediator histamine, and newly formed mediators, such as prostaglandins, leukotrienes and cytokines. Methods to simulate allergy and measure efficacy of drugs are the conjunctival allergen challenge and the conjunctival provocation test. Pharmacologic outcome is measured via cytologic biomarkers and clinical signs/symptoms of redness, itching, lid swelling and chemosis. Endpoint instruments such as the Ocular Allergy Index and Eye Allergy Patient Impact Questionnaire have emerged from the field of pharmacoeconomics. SUMMARY: Important pharmacologic properties of targets have been revealed. First, histamine is more specifically antagonized by second generation antihistamines. Second, newly formed mediators and downstream responders (prostaglandins, leukotrienes, interleukins, intercellular adhesion molecule 1, tumor necrosis factor, vascular cell adhesion molecule, eosinophils and neutrophils) are more selectively antagonized by dual/multiple-action agents.

Child and family characteristics influencing intervention choices in autism spectrum disorders.

A myriad of treatment options are available for children with autism, yet little is understood regarding characteristics of parents (e.g., education) and children (e.g., severity of autism symptoms) that influence types and amounts of therapy utilization. Interviews from 70 families were analyzed to determine potential influences on utilization (e.g., start of first services, use of traditional services). Descriptive findings regarding therapy types were similar to national studies. However, only three of the variables predicted utilization of specific therapies: severity of sensory processing problems was associated with earlier initiation of services in general, and higher maternal and paternal education was associated with the use of dietary and/or vitamin therapy as well as with more types of services. No other variables had predictive value; thus, the amount and type of therapies received may be more related to diagnostic practices and/or to the affordances/constraints of service delivery and reimbursement systems at particular ages.