Mothers' perception of the care of newborn in the home environment.

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.

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.

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.

Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis.

BACKGROUND: Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting. OBJECTIVE: The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services. METHOD: This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale." FINDINGS: In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale. CONCLUSION: The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.

Evolución de la producción científica sobre Servicios de Atención de Salud a Domicilio: análisis bibliométrico MEDLINE versus EMBASE / Evolution of the scientific production on Home Care Services: bibliometric analysis MEDLINE versus EMBASE

Objetivo: Analizar la evolución de la producción científica sobre Servicios de Atención de Salud a Domicilio indizada en las bases de datos bibliográficas MEDLINE y Embase.Método:Estudio descriptivo transversal. Los datos se obtuvieron de las bases de datos MEDLIEN y Embase, interrogando mediante los descriptores “Home Care Services” y “Home Care” según la base a interrogar. El periodo estudiado fue desde el inicio de la indización en esta base de datos hasta el 31 de diciembre de 2021.Resultados:Se comprobó un modelo de regresión con muy buen ajuste al lineal creciente, siendo el coeficiente de determinación R2 = 0,91 (p < 0,001). Las tendencias observadas fueron para MEDLINE R2 = 0,94 y para Embase R2 = 0,85. La obsolescencia ofreció en MEDLINE un semiperiodo de Burton-Kebler (B-K) igual a 19 años y en Embase de 12 años. El Índice de Price fue en MEDLINE del 13,71% y en Embase del 23,68%. Se observó asociación significativa directa en la relación Embase versus MEDLINE (1 versus 0,83; p < 0,001).Conclusiones:La producción científica presentó un adecuado incremento lineal sin alcanzar el modelo exponencial. Si bien, los resultados sobre obsolescencia fueron superiores a lo esperado. La relación de la producción científica entre las dos bases demostró asociación directa significativa. (AU)

Objective: To analyze the evolution of the scientific production on Home Health Care Services indexed in the MEDLINE and Embase bibliographic databases.Method:Cross-sectional descriptive study. The data was obtained from the MEDLIEN and Embase databases, interrogating using the descriptors “Home Care Services” and “Home Care” according to the database interrogated. The period studied was from the start of indexing in this database until December 31, 2021.Results:A regression model with a very good fit to the increasing linear was verified, with the coefficient of determination R2 = 0.91 (p < 0.001). The trends observed were for MEDLINE R2 = 0.94 and for Embase R2 = 0.85. Obsolescence offered a Burton-Kebler (B-K) half-period equal to 19 years in MEDLINE and 12 years in Embase. The Price Index was 13.71% in MEDLINE and 23.68% in Embase. A direct significant association was observed in the Embase versus MEDLINE relationship (1 versus 0.83, p < 0.001).Conclusions:The scientific production presented an adequate linear increase without reaching the exponential model. Although, the results on obsolescence were higher than expected. The relationship of scientific production between the two bases showed a significant direct association. (AU)

Implementation of smart supportive dementia technology in a hospital transitional care setting using human-centred design.

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.

Home Health Care Utilization in Children With Medicaid.

BACKGROUND: Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. METHODS: We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality's Chronic Condition Indicators and Feudtner's Complex Chronic Conditions. RESULTS: Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care. CONCLUSIONS: Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.

Nutrición parenteral domiciliaria en España, 2019: informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA / Home and Ambulatory Artificial Nutrition (NADYA) Group report: home parenteral nutrition in Spain, 2019

Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe.com) del año 2019. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE desde el 1 de enero al 31 de diciembre de 2019. Resultados: se registraron 283 pacientes (51,9 %, mujeres), 31 niños y 252 adultos procedentes de 47 hospitales españoles, lo que representa una tasa de prevalencia de 6,01 pacientes/millón de habitantes/año 2019. El diagnóstico más frecuente en los adultos fue “oncológico paliativo” y “otros” (21,0 %). En los niños fue la enfermedad de Hirschsprung junto a la enterocolitis necrotizante, las alteraciones de la motilidad intestinal y la pseudoobstrucción intestinal crónica, con 4 casos cada uno (12,9 %). El primer motivo de indicación fue el síndrome del intestino corto tanto en los niños (51,6 %) como en los adultos (37,3 %). El tipo de catéter más utilizado fue el tunelizado tanto en los niños (75,9 %) como en los adultos (40,8 %). Finalizaron 68 episodios, todos en adultos: la causa más frecuente fue el fallecimiento (54,4 %). Pasaron a la vía oral el 38,2 %. Conclusiones: el número de centros y profesionales colaboradores con el registro NADYA va incrementándose. Se mantienen estables las principales indicaciones y los motivos de finalización de la NPD. (AU)

Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was “palliative oncological” and “others” (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable. (AU)

[Home and Ambulatory Artificial Nutrition (NADYA) Group report: home parenteral nutrition in Spain, 2019]. / Nutrición parenteral domiciliaria en España, 2019: informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

INTRODUCTION: Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was "palliative oncological" and "others" (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable.

INTRODUCCIÓN: Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe.com) del año 2019. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE desde el 1 de enero al 31 de diciembre de 2019. Resultados: se registraron 283 pacientes (51,9 %, mujeres), 31 niños y 252 adultos procedentes de 47 hospitales españoles, lo que representa una tasa de prevalencia de 6,01 pacientes/millón de habitantes/año 2019. El diagnóstico más frecuente en los adultos fue "oncológico paliativo" y "otros" (21,0 %). En los niños fue la enfermedad de Hirschsprung junto a la enterocolitis necrotizante, las alteraciones de la motilidad intestinal y la pseudoobstrucción intestinal crónica, con 4 casos cada uno (12,9 %). El primer motivo de indicación fue el síndrome del intestino corto tanto en los niños (51,6 %) como en los adultos (37,3 %). El tipo de catéter más utilizado fue el tunelizado tanto en los niños (75,9 %) como en los adultos (40,8 %). Finalizaron 68 episodios, todos en adultos: la causa más frecuente fue el fallecimiento (54,4 %). Pasaron a la vía oral el 38,2 %. Conclusiones: el número de centros y profesionales colaboradores con el registro NADYA va incrementándose. Se mantienen estables las principales indicaciones y los motivos de finalización de la NPD.

Home Blood Pressure Monitoring.

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.

Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool.

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.

Home-based primary care: A systematic review of the literature, 2010-2020.

BACKGROUND: Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS: We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS: The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION: The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.

Using Simulation to Teach Home Health Care.

To describe development, use and outcomes of a Home Healthcare (HHC) simulation experience. Quasi-experimental pre/posttest. Setting: A simulation center for nursing students (N = 108) completing an 8-hour simulation experience, followed by data collection on perceived benefits to their learning; and influence on their desire to work in HHC. 93% (n = 101) reported the simulation was helpful; 57.4% (n = 62) reported participation increased their desire to work in HHC. Use of a HHC-focused simulation had positive learning outcomes in this setting. In this sample, results suggest value in maintaining the simulation experience for future cohorts.

Patient-Directed Home Drain Removal in Head and Neck Surgery.

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, 131:2471-2477, 2021.