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1.
Pflege ; 32(6): 324-333, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576771

RESUMO

The potential of technological assistance to support distance caregiving - literature review and empirical results Abstract. Background: Due to demographic change, increasing labour mobility and changing family patterns, social relationships often exist over long distances. Supporting relatives over a distance is therefore a highly topical issue but still little discussed, also in Germany and Switzerland. Aim: The project "DiCa" (2016 - 2019) with an interdisciplinary research team from Germany (EH Ludwigsburg) and Switzerland (Careum School of Health, Zurich) aims to investigate different dimensions of "Distance Caregiving". This paper deals with the possible use of new technologies to support these care arrangements. Methods: Based on a literature review, qualitative interviews were conducted with "Distance Carers" and partner companies in Germany to investigate the use of new technologies in the context of "Distance Caregiving". Results: There are initial approaches concerning technical solutions in home care and in companies. So far communication options via telephone and smartphone and flexible working time and workplace regulations have played an important role. However, the potential of new technologies does not seem to be fully explored. Conclusions: In order to make the most of the various possibilities of innovative technologies in the context of "Distance Caregiving" for those affected but also for companies, well-researched information and independent advice and counseling are required for all parties involved in the care process.


Assuntos
Tecnologia Biomédica , Cuidadores , Invenções , Telemedicina/instrumentação , Humanos
4.
Z Gerontol Geriatr ; 52(6): 529-536, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31492973

RESUMO

BACKGROUND: The support of relatives living far away in terms of distance caregiving between children and their parents has gained in importance in Europe. At the same time, little is known about these care arrangements based on representative European survey data. OBJECTIVE: This article is concerned with the following questions: which statements are possible in Europe about the prevalence of persons caring for at least one parent from a geographical distance? Which forms of support are provided and which other specific socioeconomic and health-related aspects characterize these care situations? In this respect special attention is paid to differences to relatives who provide help close to their parents who are in need of care. MATERIAL AND METHODS: Data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from the sixth wave of the survey in 2015 were used to perform a descriptive analysis and multivariate logistic regression. RESULTS AND CONCLUSION: The analysis showed that distance caregiving is more than a marginal phenomenon in Europe with a prevalence of 11% for a relatively close terminology (over 100 km distance between locations) and 23% for a broader terminology (over 25 km); however, the various countries are very different in terms of prevalence. The findings also point to some significant differences in terms of resources, care tasks and quality of life compared to caregivers in the same household. In light of these dynamically developing distance caregiving arrangements, this article can provide further discussion, critical reflection, and advancement to the operationalization of informal care.


Assuntos
Envelhecimento , Cuidadores , Família , Aposentadoria , Telemedicina , Criança , Europa (Continente) , Humanos , Qualidade de Vida , Inquéritos e Questionários , Telemedicina/organização & administração
5.
Z Gerontol Geriatr ; 52(6): 521-528, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31444551

RESUMO

BACKGROUND: Demographic change, increasing work mobility as well as changed family patterns lead to social relationships over long distances; however, support from relatives from a distance is hardly debated in the German-speaking region. The project "DiCa" (2016-2019) studies various dimensions of long-distance caregiving. OBJECTIVE: This article presents the state of the art in research on specific characteristics of care arrangements from a distance. In addition, it presents the underlying challenges, strategies, and supportive as well as hindering conditions. MATERIAL AND METHODS: Systematic literature review. RESULTS: These studies, conducted largely in the Anglo-American region, draw a clear picture of who distance caregivers are (in general well-educated daughters or daughters-in-law) and that they make a substantial contribution to care in terms of organization, coordination, and emotional support in addition to visits. Distance impedes the flow of information about the health condition of the person in need of care and limits the possibilities to react to the needs at short notice or in crisis situations. Distance caregivers are often faced by financial as well as emotional burdens due to the care situation and lack of control even if there are some support strategies and compatibility between care and occupation, e.g. emergency management, local support networks, flexible working arrangements. CONCLUSION: In the German-speaking region, pertinent studies on long-distance caregiving are missing. Internationally, the numbers of cases are not always clear and there is a lack of sound knowledge on the assessment of the care arrangements on the part of the distance caregiver, the actual role of the distance, specific barriers, conflicts, effective strategies and solution options. This applies to people in family homecare as well primary care facilities and employers.


Assuntos
Cuidadores , Família , Telemedicina/organização & administração , Humanos , Telecomunicações
7.
Ther Umsch ; 72(9): 541-4, 2015 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-26323950

RESUMO

The research and development project "Long Independent Living Assistant (LILA)'; which is financially supported by the Commission for Technology and lnnoyation (KTI}, is based on the results and experiences of many years of the Medical Online Consultation Service at the University Hospital Zurich.The focus is on development and provision of a comprehensive, telemedicine service. Citizens and patients should be provided more safety at home and the family doctor should be supported by the service. Core elements of the project include the telemonitoring of vital signs combined with an individual teleconsultation via telephone, email and video. Technically, the. service is supported by a web-based documentation and communication platform with an integrated patient record. In a one-year planning phase, individual interviews and group discussions were conducted with the participants of the study. The results are continuously incorporated into the concept. The subsequent pilot phase analyzed the developed tetemedical approach and leads to further improvements. The aim of the study is the evaluation of the needs, feasibility and acceptance of telemedicine services from the perspective of the user, taking into account their social environment~


Assuntos
Atitude Frente aos Computadores , Hospitais Universitários , Monitorização Ambulatorial/métodos , Monitorização Fisiológica/métodos , Satisfação do Paciente , Consulta Remota/organização & administração , Telemedicina/organização & administração , Telemetria/métodos , Idoso , Humanos , Pessoa de Meia-Idade , Suíça
8.
Ther Umsch ; 72(9): 567-75, 2015 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-26323956

RESUMO

Telemedicine aims to create new forms of health care delivery by the use of information and communication technologies (ICT),for example, to improve the access to health care for patients in rural regions. There is a need for assistive technologies and innovative technological solutions due to the demographic change. Population trends of western societies show concurrently an ageing population and the wish of elderly people to live at home as long as possible while there is a tendency that older people live in greater distances to their kin nowadays. More complex diseases and multimorbidity urge improved interconnectedness between different health care professionals. Hence, different health systems pursue e-health strategies with the aim to implement electronic patient records (EPR) and similar technological solutions as a first approach to tackle those challenges. Telemedicine represents an open and evolving concept which is subject to a regular process of further development as a consequence of accelerated technological progress. The increased articulated demand for patient centered health care is one driver for the use of telemedicine. In the context of the trend of shorter hospital stays technological solutions can provide an opportunity for better support and care at home to reduce health risks and improve caregiving quality after hospital discharges. Despite the still prevalent reservations of elderly people about the use of ICT research shows that acceptance and the willingness to use technical devices is increasing. The article describes different aspects of telemedicine in the context of the aging population: definitions, an overview of trends and various fields of use with specific practical examples. A synoptic view of research results of evaluations of telemedicine applications regarding their effectiveness and cost-benefit analysis complement the paper.


Assuntos
Doença Crônica/terapia , Consulta Remota/métodos , Consulta Remota/organização & administração , Telemedicina/métodos , Telemedicina/organização & administração , Idoso , Comorbidade , Comportamento Cooperativo , Acesso aos Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Assistência Domiciliar/métodos , Assistência Domiciliar/organização & administração , Humanos , Comunicação Interdisciplinar , Sistemas Computadorizados de Registros Médicos/organização & administração , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Suíça
9.
Ther Umsch ; 72(9): 577-9, 2015 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-26323957

RESUMO

An autonomous life and quality .of life are essential objectives for the use of telemedicine among the elderly population. To make aging in place possible the elderly peoples' homes have to be embedded in an integrated health and aged care system. In addition to this, it is necessary to create coproduction with the patients and their relatives. However, to meet those targets it is required to achieve enormous rethinking and widely acceptance of telemedicine among all health care professionals. Medical institutions have to undergo vast changes towards a patient-centered health care delivery and an increased intersectoral and interdisciplinary collaboration. Political will for fair and just allocation processes is essential to avoid a potential digital divide among the population, e.g. for socioeconomic disadvantaged population groups or people living in rural areas. Therefore,flanking preparing measures and continuous support through easily accessible contact persons are essential. According adaptations of financial models and an extension of health insurance benefits will be necessary.


Assuntos
Doença Crônica/terapia , Vida Independente , Dinâmica Populacional , Qualidade de Vida , Idoso , Cuidadores/educação , Doença Crônica/epidemiologia , Comportamento Cooperativo , Estudos Transversais , Acesso aos Serviços de Saúde/organização & administração , Humanos , Comunicação Interdisciplinar , Educação de Pacientes como Assunto , Equipamentos de Autoajuda , Suíça
10.
Blood Coagul Fibrinolysis ; 18(6): 565-70, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17762533

RESUMO

The present prospective study was designed to evaluate the effectiveness and safety of prothrombin complex concentrate (PCC) for emergency reversal of oral anticoagulation with phenprocoumon, a long-acting coumarin. Patients were eligible for study entry if they required emergency reversal of phenprocoumon anticoagulation because they needed invasive surgical or diagnostic procedures or were actively bleeding. Patients received one or more infusions of pasteurized nanofiltered PCC (Beriplex P/N). Primary study endpoints were changes in International Normalized Ratio, Quick value, factors II, VII, IX and X, and protein C 10, 30 and 60 min following PCC infusion. Eight adult patients were enrolled, seven requiring urgent invasive procedures and one experiencing intracranial bleeding. In the first infusion, patients received a median 3600 IU PCC at median infusion rate 17.0 ml/min. Mean (SD) baseline International Normalized Ratio was 3.4 (1.2). The International Normalized Ratio 10 min after PCC infusion declined to 1.3 or less in seven of eight patients and to 1.4 in one patient. After PCC infusion, the Quick value increased by a mean of 57% [confidence interval (CI), 45-69%], circulating factor II concentration by 85% (CI, 68-103%), factor VII by 51% (CI, 40-62%), factor IX by 61% (CI, 47-76%), factor X by 115% (CI, 95-135%) and protein C by 100% (CI, 82-117%). Clinical effectiveness of PCC treatment was rated 'very good' in seven patients and 'satisfactory' in one. No thromboembolic or other adverse events occurred. PCC treatment rapidly, effectively and safely reversed phenprocoumon anticoagulation in patients undergoing urgent invasive procedures or actively bleeding.


Assuntos
Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/uso terapêutico , Hemorragia/tratamento farmacológico , Hemostasia/efeitos dos fármacos , Femprocumona/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/sangue , Feminino , Hemorragia/induzido quimicamente , Humanos , Coeficiente Internacional Normatizado , Masculino , Femprocumona/sangue , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios
11.
Eur J Gastroenterol Hepatol ; 15(1): 15-20, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12544689

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of intravenous infusions of an improved prothrombin complex concentrate (PCC) formulation. PATIENTS AND METHODS: Twenty-two adults with haemostatic defects due to severe liver disease (Quick's test 50%), which required rapid haemostasis because of bleeding or before urgent surgery or invasive intervention. Laboratory follow-up, including the response and in-vivo recovery of the substituted coagulation factors II, VII, IX and X and protein C took place before, then 10 min, 30 min and 60 min after PCC substitution. Clinical efficacy (avoidance or cessation of bleeding) was assessed using a scale ranging from 'very good' to 'none'. RESULTS: Patients received a median PCC dose of 25.7 IU/kg. The response of factor IX and protein C was 1.2-1.4 (IU/dl)/(IU/kg), the in-vivo recovery was 49.7-57.4%, and the Quick's test increased from 39% to a maximum of 65%. Levels of activation markers of the coagulation system factor VIIa, prothrombin fragment 1 + 2 and thrombin antithrombin complex (TAT) increased, but without evidence of any thromboembolic events. Clinical efficacy was judged as 'very good' in 76% of patients after the first (n = 21) treatment. There were no changes in serological status regarding transmission of HIV, hepatitis A virus, hepatitis B virus and hepatitis C virus. No PCC-related adverse reactions occurred. CONCLUSIONS: The infusion of pasteurized, nanometre-filtered PCC is an effective, well-tolerated method of correcting prothrombin complex deficiency in patients with severe liver disease with haemorrhage, or before an urgent surgical or invasive diagnostic intervention.


Assuntos
Fatores de Coagulação Sanguínea/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Técnicas Hemostáticas , Hepatopatias/complicações , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Biópsia , Coagulação Sanguínea , Fatores de Coagulação Sanguínea/efeitos adversos , Fatores de Coagulação Sanguínea/metabolismo , Esquema de Medicação , Feminino , Hemorragia Gastrointestinal/etiologia , Hemofiltração/métodos , Humanos , Infusões Intravenosas , Hepatopatias/sangue , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Viremia/diagnóstico , Inativação de Vírus
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