Analysis of the Effect of Nursing Intervention for Thyroid Diseases Based on Family Nursing Methods.

Patients with thyroid disease must take long-term antithyroid drugs and go to the outpatient clinic for regular check-ups. This requires patients to have good compliance behaviors in order to better control their thyroid hormone levels. In order to improve patients' compliance behavior and seek effective family care interventions, this paper combines family care methods to evaluate the nursing effect of thyroid disease and combines investigation and analysis and experimental methods to verify the effectiveness of the method proposed in this paper. In addition, this paper compares family nursing methods with conventional methods under the guidance of family philosophy and objectively analyzes and evaluates the application value of accelerated rehabilitation surgery concepts and methods in thyroid surgery. Finally, this paper sets up a control group and a test group to carry out the nursing effect of home nursing in thyroid diseases. Through comparative experiments, it can be seen that the nursing intervention for thyroid diseases based on home nursing in this paper has a good nursing effect.

Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España: años 2018 y 2019 / The NADYA-SENPE Home Enteral Nutrition Registry in Spain: years 2018 and 2019

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2018 y 2019 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2018 y en las mismas fechas para 2019, procediendo al análisis descriptivo y analítico de los datos. Resultados: en el año 2018 se registraron 4756 pacientes activos con una tasa de prevalencia de 101,79 pacientes/millón de habitantes; en 2019 fueron 4633 con una tasa de prevalencia de 98,51 pacientes/millón de habitantes. Procedían de 46 hospitales. Fueron el 51,3 % los varones registrados y la edad mediana fue de 71,0 años en ambos periodos. El diagnóstico más frecuente fue el de enfermedad neurológica que cursa con afagia o disfagia severa (58,7 % y 58,2 %), respectivamente. La causa principal de finalización de los episodios fue el fallecimiento. Los pacientes pediátricos registrados fueron 116 en 2018 y 115 en 2019. Las niñas representaron el 57,8 % y 59,1 %, respectivamente, en cada uno de los periodos. La edad mediana de inicio de la NED fue de 5 y 7 meses. El grupo diagnóstico más registrado (42,2 % y 42,6 %) se englobó dentro del grupo de otras patologías, seguido de la enfermedad neurológica que cursa con afagia o disfagia severa de los niños (41,4 % y 41,7 %). Se alimentaban a través de gastrostomía el 46,6 % y 46,1 %, respectivamente, en cada uno de los periodos. Conclusiones: el registro de NED del grupo NADYA-SENPE sigue operativo de forma ininterrumpida desde sus inicios. El número de pacientes registrados y el de hospitales participantes permanece estable en el último bienio analizado (AU)

Aim: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2018 and 2019. Material and methods: from January 1, 2018 to December 31, 2019 the home enteral nutrition registry was recorded, and afterwards a further descriptive and analytical analysis was done. Results: in 2018, 4756 active patients were registered and the prevalence was 101.79 patients per one million inhabitants; in 2019 there were 4633 patients with a prevalence of 98.51 patients per one million inhabitants. They originated in 46 hospitals: 51.3 % were male, and median age was 71.0 years in both periods. The most frequent diagnosis was a neurological disorder that presents with aphagia or severe dysphagia — 58.7 % and 58.2 %, respectively. The main cause of episode termination was death. A total of 116 pediatric patients were registered in 2018 and 115 in 2019. Females represented 57.8 % and 59.1 %, respectively, in each of the periods. Median age at the beginning of HEN was 5 and 7 months. The most commonly recordered diagnostic group (42.2 % and 42.6 %) was included within the other pathologies group, followed by neurological disorders that present with aphagia or severe dysphagia in 41.4 % and 41.7 % of children. The route of administration was gastrostomy in 46.6 % and 46.1 %, respectively, in each of the periods. Conclusions: the NED registry of the NADYA-SENPE group continues to operate uninterruptedly since its inception. The number of registered patients and the number of participating hospitals remained stable in the last biennium analyzed (AU)

The Development and Operation of a Home Management System during the COVID-19 Pandemic: Experience of the Local Government Gyeonggi-do in Korea.

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient's condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government's COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.

Atención en domicilio de pacientes NANEAS: experiencia del hospital de niños Dr. Roberto del Río / Home care of NANEAS patients: experience of the children's hospital Dr. Roberto del Río

El avance de las tecnologías de soporte vital ha aumentado la sobrevida de niños con patologías y secuelas graves, categorizados como NANEAS (Niños y Adolescentes con Necesidades Especiales de Atención en Salud) de mediana y alta complejidad. En el Hospital de Niños Dr. Roberto del Río se organizó un equipo de atención para NANEAS en 2014, que realiza visitas domiciliarias desde 2015 a pacientes médicamente complejos. OBJETIVO: Caracterizar la población atendida en domicilio y la modalidad de atención. PACIENTES Y MÉTODO: Estudio retrospectivo descriptivo mediante revisión de registro clínico electrónico y ficha clínica de NANEAS atendidos en domicilio del 2015 al 2018. RESULTADOS: Se analizaron 581 visitas a 81 pacientes, mediana 8 años, 78% hombres, 64% institucionalizados, 78% con patología neurológica de base, 75% de alta y mediana complejidad según clasificación SOCHIPE. De las visitas, 71% fue en comunas rurales, la mediana de tiempo de viaje 60 minutos y de atención 26 minutos. Un 60% de las visitas se realizó a pacientes con dispositivos médicos. En un 99% asistió pediatra, 33% enfermera y 68% otro profesional, que en 61% correspondió al neuropediatra. CONCLUSIONES: La mayor proporción de pacientes atendidos son de alta y mediana complejidad, usuarios de dispositivos médicos y la mayoría con patología neurológica de base, por lo que resulta fundamental contar con un neurólogo en el equipo interdisciplinario. Las visitas se realizan principalmente a comunas distantes por la dificultad de traslado de estos pacientes. Esta modalidad de atención promueve una mejor calidad de vida para niños y niñas médicamente complejos y para sus familias.

The advancement of life support technologies has increased the survival of children with serious pathologies and sequelae, categorized as NANEAS (Children and Adolescents with Special Health Care Needs) of medium and high complexity. At the Hospital de Niños Dr. Roberto del Río, a care team for NANEAS was organized in 2014, which has made home visits to medically complex patients since 2015. OBJECTIVE: To characterize the population attended at home and the care modality. PATIENTS AND METHOD: Retrospective descriptive study by reviewing the clinical file of NANEAS patients seen at home in this period. RESULTS: 581 visits were analyzed in 81 patients, median 8 years, 78% men, 63% institutionalized, 78% with neurological diseases. 75% were of high and medium complexity according to the SOCHIPE classification. Of the visits, 71% were in rural places, median travel time 60 minutes and direct attention 26 minutes. 60% of the visits were made to patients with medical devices, 99% attended by a pediatrician, 33% a nurse and 68% another professional, who in 61% corresponded to the child neurologist. CONCLUSIONS: The highest proportion of patients seen are of high and medium complexity with medical devices and with underlying neurological pathology, so it is important to have a neurologist in the interdisciplinary team. Many of the visits are made in places distant from the hospital center due to the difficulty of transferring these patients. This modality of care promotes a better quality of life for medically complex children and their families.

Lugar de la muerte de las personas tributarias de recibir cuidados paliativos en las Illes Balears / Place of death of people candidate to recive palliative care in the Balearic Islands

OBJETIVO: Describir dónde fallecen las personas tributarias de recibir atención por servicios específicos de cuidados paliativos en la Comunidad Autónoma de les Illes Balears (CAIB) en los años 2015 y 2016. MÉTODO: Estudio descriptivo. Sujetos: personas fallecidas en la CAIB por causas susceptibles de requerir atención paliativa prestada por los servicios específi cos de CP. VARIABLES: lugar de fallecimiento, sector sanitario, causa, sexo y edad. Fuentes: registro de mortalidad de la CAIB y memorias de actividad de los Equipos de Soporte de Atención Domiciliaria y de la Unidad de Cuidados Paliativos Pediátricos del Hospital Son Espases. RESULTADOS: En 2015 fallecieron en el domicilio 852 personas, mientras que en el año 2016 fueron 837. Representan el 31,2 y el 28,9 %, respectivamente, del total de fallecidos tributarios de recibir cuidados paliativos específicos. El número de personas que fallecen en el domicilio es distinto entre los sectores sanitarios de las islas con porcentajes que oscilan entre el 20,6 y el 48 %. También se han hallado diferencias en función del sexo de las personas fallecidas en domicilio, siendo menor en los hombres que en las mujeres. CONCLUSIONES: Los porcentajes de fallecidos en domicilio en CAIB se encuentran alejados de las preferencias manifestadas en los estudios revisados. Existe variabilidad entre los sectores sanitarios de la Comunidad. Se han reducido los porcentajes de muerte en domicilio entre los años 2015 y 2016. Se identifi can diferencias en función del sexo y de las patologías analizadas. Necesitamos avanzar en la disponibilidad de estándares

OBJECTIVE: To describe where people candidate to receive specific palliative care (PC) services died in the autonomous community of the Balearic Islands (CAIB) from 2015 through 2016. METHOD: This was a descriptive study. Subjects: people who died in the CAIB from causes susceptible to requiring palliative care by specific PC services. VARIABLES: place of death, health care sector, cause, sex, and age. Sources: CAIB death registry and activity reports by home care suport teams (ESAD) and the pediatric palliative care unit (PPCUN) at Hospital Son Espases. RESULTS: In 2015 a total of 852 patients died in their homes, whereas in 2016 the number of home deaths was 837. These represent 31.2 % and 28.9 % of all deaths in patients candidate to receive specific palliative care, respectively. The number of patients who die in their homes varies among health care sectors in the Islands, with percentages oscillating between 20.6 % and 48 %. Differences were also found according to the gender of those who died in their homes, with numbers being lower for men as compared to women. CONCLUSIONS: The percentages of home deaths in the CAIB are far removed from the preferences reported in the studies reviewed. There is variability among health care sectors in our autonomous community. Home death percentages decreased from 2015 to 2016. Differences may be identified according to gender and health condition. We need to move forward to having some standards available

Un plan protocolizado de rehabilitación domiciliaria tuvo mejores resultados que el tratamiento habitual en pacientes operados de prótesis total de rodilla: cohorte prospectiva / A protocolized home rehabilitation program had better outcomes than the usual care following total knee replacement: a prospective cohort study

Objetivo: comparar los resultados funcionales y de calidad de vida, y algunos indicadores de calidad y satisfacción, entre dos estrategias de cuidados posoperatorios de prótesis total de rodilla: 1) Cuidados protocolizados brindados por la Unidad de Rehabilitación del Hospital Italiano (URED) para pacientes que residen en CABA; 2) Cuidados habituales brindados por el sistema tercerizado de rehabilitación kinésica. Materiales y métodos: cohorte prospectiva de pacientes que fueron sometidos a una cirugía de reemplazo articular de la rodilla en el Hospital Italiano. Fueron evaluados mediante cuestionarios de funcionalidad y calidad de vida percibida, y goniometría, a los 45 días, por kinesiólogos entrenados. Resultados: se incluyeron 81 pacientes en el grupo de cuidados protocolizados y 28 en el de cuidados habituales. Se observaron diferencias estadísticamente significativas en todas las variables evaluadas y destacamos la relevancia clínica de que solamente el 2,43% de los pacientes atendidos en la URED continuaban usando andador a los 45 días frente al 35,71% de los que habían sido atendidos con los cuidados habituales (p = 0,004), así como la menor proporción de pacientes con déficit de flexión (2,47% vs. 46%, respectivamente; p < 0,001) y de extensión (18,52 vs. 75%; p < 0,001) en el mismo lapso, requisitos que son importantes para lograr una marcha funcional. Conclusión: un programa de rehabilitación domiciliaria protocolizada y supervisada por kinesiólogos entrenados mostró ser eficaz para una progresión más rápida hacia una marcha independiente con un menor riesgo de déficit de flexión o de extensión a los 45 días. (AU)

Objective: to compare functionality and quality of life, and some indicators of patient satisfaction, between two postoperative rehabilitation care following total knee replacement: 1) Protocolized care provided by the Italian Hospital Rehabilitation Unit for patients who live in CABA; 2) Usual care provided by the outsourced rehabilitation system. Materials and methods: prospective cohort of patients who underwent total knee replacement at the Italian Hospital were evaluated using questionnaires of functionality and quality of life at 45 days. Results: 81 patients were included in the protocolized care group and 28 in the usual care group. Statistically significant differences were observed in all the variables evaluated, highlighting clinical relevance that only 2.43% of the patients treated by the URED continued using the walker at 45 days vs 35.71% of those who had been treated with the usual care (p = 0.004); as well as the lower proportion of patients with flexion deficit (2.47 vs. 46%, respectively; p < 0.001) and extension (18.52 vs. 75%; p < 0.001) at the same time. Conclusion: a home protocolarized rehabilitation program supervised by a physical therapist proved to be effective for a quicker progression to an independent walk with lower risks of flexion or extension deficits at 45 days. (AU)

Identifying Caregiver Needs for Children With a Tracheostomy Living at Home.

This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.

Place-provider-matrix of bystander cardiopulmonary resuscitation and outcomes of out-of-hospital cardiac arrest: A nationwide observational cross-sectional analysis.

AIMS: This study aims to test the association between the place-provider-matrix (PPM) of bystander cardiopulmonary resuscitation (CPR) and outcomes of out-of-hospital cardiac arrest (OHCA). METHODS: Adult patients with OHCA with a cardiac etiology from 2012 to 2017 in Korea were analyzed, excluding patients who had unknown information on place, type of bystander, or outcome. The PPM was categorized into six groups by two types of places (public versus home) and three types of providers (trained responder (TR), family bystander, and layperson bystander). Outcomes were survival to discharge and good cerebral performance category (CPC) of 1 or 2. Multivariable logistic regression analysis was performed to test the association between PPM group and outcomes with adjustment for potential confounders to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) (reference = Public-TR). RESULTS: A total of 73,057 patients were analyzed and were categorized into Public-TR (0.6%), Home-TR (0.3%), Public-Family (1.8%), Home-Family (79.8%), Public-Layperson (9.9%), and Home-Layperson (7.6%) groups. Compared with the Public-TR group, the AORs (95% CIs) for survival to discharge were 0.61 (0.35-1.05) in the Home-TR group, 0.85 (0.62-1.17) in the Public-Family group, 0.38 (0.29-0.50) in the Home-Family group, 1.12 (0.85-1.49) in the Public-Layperson group, and 0.42 (0.31-0.57) in the Home-Layperson group. The AORs (95% CIs) for good CPC were 0.58 (0.27-1.25) in the Home-TR group, 0.88 (0.61-1.27) in the Public-Family group, 0.38 (0.28-0.52) in the Home-Family group, 1.20 (0.87-1.65) in the Public-Layperson group, and 0.42 (0.30-0.59) in the Home-Layperson group. CONCLUSION: The OHCA outcomes of the Home-Family and Home-Layperson groups were worse than those of the Public-TR group. This finding suggests that OHCA occurring in private places with family or layperson bystanders requires a new strategy, such as dispatching trained responders to the scene to improve CPR outcomes.

Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association.

Many individuals living with heart failure (HF) rely on unpaid support from their partners, family members, friends, or neighbors as caregivers to help manage their chronic disease. Given the advancements in treatments and devices for patients with HF, caregiving responsibilities have expanded in recent decades to include more intensive care for increasingly precarious patients with HF-tasks that would previously have been undertaken by healthcare professionals in clinical settings. The specific tasks of caregivers of patients with HF vary widely based on the patient's symptoms and comorbidities, the relationship between patient and caregiver, and the complexity of the treatment regimen. Effects of caregiving on the caregiver and patient range from physical and psychological to financial. Therefore, it is critically important to understand the needs of caregivers to support the increasingly complex medical care they provide to patients living with HF. This scientific statement synthesizes the evidence pertaining to caregiving of adult individuals with HF in order to (1) characterize the HF caregiving role and how it changes with illness trajectory; (2) describe the financial, health, and well-being implications of caregiving in HF; (3) evaluate HF caregiving interventions to support caregiver and patient outcomes; (4) summarize existing policies and resources that support HF caregivers; and (5) identify knowledge gaps and future directions for providers, investigators, health systems, and policymakers.

Readmission drivers for children with medical complexity: Home nursing shortages cause health crises.

OBJECTIVE: Children with medical technology dependence (MTD) are frequently readmitted to the hospital. However, due to their medical fragility, it is often difficult to untangle the root causes for readmissions to identify the most effective preventive approaches. We sought to explore environmental and family factors driving hospital readmissions for children with MTD. DESIGN: Semi-structured, in-person interviews were conducted with state-wide care coordinators for children with MTD in Illinois with at least 1 year of experience. Interview topics related to children with MTD transitioning from hospital-to-home, essential supports for living in the community, and factors which influenced and prevented hospital readmission. The interview guide served as an initial codebook which was iteratively modified as themes emerged. RESULTS: Fifteen care coordinators with on average 6.6 years of experience were interviewed. They described that lack of home nursing was one of the primary drivers of readmissions due to parental exhaustion and lack of medical expertize in the home. Unavoidable medical admissions, a lack of a plan for emergencies, and home environmental factors also contributed to readmissions. CONCLUSION: Hospital readmission is an expected occurrence for children with MTD, yet still may be substantially reduced through consistent, quality home health nursing to bolster family capacity and allow for respite from constant caregiving. Improved incentives for the home health workforce to increase manpower would be ultimately offset by reduced hospitalizations for children with MTD. Additionally, more research is needed to understand which home nursing structures and skills optimally support families in the reality of manpower scarcity.

Sustainability of Palliative Care in a Rural Hospital in Tanzania: A Longitudinal and Prospective 4-Year Study.

BACKGROUND: Palliative care has been developed in recent years in many sub-Saharan countries in Africa due to activities of African Association for Palliative Care. Palliative care units have been established also in most hospitals in Tanzania. Yet very little is known about their functions. Long-term studies about the sustainability of palliative care have not been carried out. METHODS: The attitudes of 101 members of hospital staff and persons in charge of palliative care services of Ilembula District Designated Hospital (IDDH), Tanzania, were assessed using a modified and prevalidated questionnaire annually in 2014 to 2017. The inquiries were executed on randomly allocated days. Also, the patient and economy registries were analyzed. Additional qualitative data were obtained in personal interviews and during observational visits twice a year at the IDDH. RESULTS: Ilembula District Designated Hospital has a true multiprofessional palliative care team, which provides services in the hospital, in the villages, and at homes. The activities are based on careful 5-year planning and budgeting. Up to 17 villages have been included in the services. Ninety-five percent of the patients were HIV infected. Short-acting morphine oral solution was the only available strong opioid. The hospital staff evaluated palliative care as good or excellent; 50% of the staff would need more support in the end-of-life care. CONCLUSIONS: A sustainable palliative care service can be built in a Tanzanian rural hospital if an advanced planning and budgeting are made. In Tanzania, the biggest group of palliative care patients are still HIV-infected individuals. There is a lack of opioids in the country.

The relationship between Home-time, quality of life and costs after ischemic stroke: the impact of the need for mobility aids, home and car modifications on Home-time.

Purpose: Home-time (the number of days spent at home during the first 3 months after stroke) shows a strong association with the modified Rankin scale (mRS). We studied whether Home-time was also a determinant of quality-of-life and medical care costs after ischemic stroke, and assessed factors delaying discharge home.Materials and methods: Five hundred and sixty nine patients participated in a retrospective study when returning for an in-person visit after an ischemic stroke. Home-time, mRS, EQ-5D-3L, inpatient and outpatient resource utilization, use of mobility aids, changes to home and car, comorbidities were recorded.Results: Each additional Home-time day was significantly associated with an increase in utility of 0.0056 (p < 0.0001) and an in- and outpatient cost saving of $99 (p = 0.0158). Requiring extra material support significantly decreased Home-time by 76 days (including: requiring home changes: -68 days, car alterations: -49 days, needing a wheelchair: -80 days or walker: -71 days, needing bed or bath rails: -79 days). This univariable effect was confirmed in multivariable analysis when comparing with patients having the same disability level without requiring material support.Conclusions: Home-time is a stroke outcome associated with disease severity, healthcare costs and patient wellbeing. Streamlining the discharge process for those requiring extra material support may lead to cost savings and higher quality-of-life.Implications for rehabilitationDelays in discharge from the acute hospital or rehabilitation facility are incurred when patients need extra material support in order to return home.Staff from the discharging facility should assist families by giving timely information on the availability and the cost of wheel chairs and walkers; and explaining and planning the need of a stair lift, bed and bath rails as well as car modifications.Planning the discharge process with the families will lead to a more rapid return home and will result in reduced overall health care costs and higher quality of life for the patients.

Utilization of Formal and Informal Home Care: How Do Older Canadians' Experiences Vary by Care Arrangements?

This study investigates how the receipt of formal, informal, and/or a combination of both types of care at home relates to older adults' perceived loneliness, life satisfaction, and day-to-day lives. Quantitative analyses using the Canadian Community Health Survey (n = 3,928) reveal that older adults who only received formal care reported lower levels of loneliness and higher levels of life satisfaction when compared with respondents who received informal or a blend of home care. Qualitative analyses of persons aged 65+ years receiving formal and informal home care in Ontario (n = 34) suggest that formal care bolstered care recipients' autonomy and reduced their sense of being a burden on family. In turn, receiving formal care served to improve these older adults' social connectedness and well-being. Findings underscore older adults' symbolic, functional, and emotional attachment to formal care services, as well as the limitations of a reliance on informal support.

Association between family management and asthma control in children with asthma.

PURPOSE: The purpose of this study is to investigate the association between family management and asthma control in children with asthma. DESIGN AND METHODS: This cross-sectional descriptive study recruited 142 children with asthma and their parents. We used the Family Management Measure (FaMM), the Childhood Asthma Control Test (C-ACT), and fractional exhaled nitric oxide (FeNO) detectors to assess family management and asthma control. The McNemar's test was used to determine the proportional difference between C-ACT and FeNO in evaluating asthma control. Pearson correlation analysis and multiple linear regression analysis were used to assess the relationship between family management and asthma control in children with asthma. RESULTS: There was no significant difference in the proportion of C-ACT and FeNO in evaluating asthma control (McNemar's test p = .593). Child's Daily Life, Condition Management Ability, and Parental Mutuality were positively correlated with C-ACT (r = 0.398 to 0.655; all p < .05) and negatively correlated with FeNO (r = -0.245 to -0.402; all p < .05); Condition Management Effort, Family Life Difficulty, and View of Condition Impact were negatively correlated with C-ACT (r = -0.416 to -0.672; all p < .05) and positively with FeNO (r = 0.248 to 0.427; all p < 0.05). Child's Daily Life, Condition Management Effort, and View of Condition Impact dimensions significantly predicted the C-ACT results, and the Condition Management Effort and View of Condition Impact dimensions significantly predicted the FeNO results (p < .05). PRACTICAL IMPLICATIONS: Pediatric nurses could provide family management education for parents to improve asthma control in children. In addition, pediatric nurses might assess asthma control condition of asthmatic children in combination with C-ACT and FeNO levels.

RDQA - Relatório Detalhado do Quadrimestre Anterior da Secretaria de Saúde do Estado do Tocantins [1º Quadrimestre de 2020] / RDQA - Detailed Report for the Previous Quadrimester of the Tocantins State Health Department [1st Quadrimester of 2020]

O Relatório Detalhado do Quadrimestre Anterior (RDQA) apresentam os resultados alcançados com a execução da PAS a cada quadrimestre e orientam eventuais redirecionamentos. Eles têm a função de comprovar a aplicação de todos os recursos do Fundo de Saúde. É instrumento indissociável do Plano e de suas respectivas Programações, sendo a principal ferramenta para subsidiar o processo de monitoramento e avaliação da gestão. Tem seu modelo padronizado pela Resolução nº 459 do Conselho Nacional de Saúde - CNS, de 10 de outubro de 2012, publicada no DOU de 21/12/2012, conforme dispõe o Parágrafo 4º do Artigo 36 da Lei Complementar nº 141/2012. A Programação Anual de Saúde (PAS) é a referência de execução das ações e serviços públicos em saúde, cujo processo de sua gestão é demonstrado no Relatório de Gestão: a cada quadrimestre no RDQA e ao final do exercício no Relatório Anual de Gestão (RAG).

The Detailed Report for the Previous Quadrimester (RDQA) presents the results achieved with the execution of the PAS every four months and guides any redirections. They have the function of proving the application of all the resources of the Health Fund. It is an inseparable instrument of the Plan and its respective Programs, being the main tool to support the process of monitoring and evaluation of management. Its model is standardized by Resolution No. 459 of the National Health Council - CNS, of October 10, 2012, published in the DOU of 12/21/2012, as provided in Paragraph 4 of Article 36 of Complementary Law No. 141/2012. The Annual Health Program (PAS) is the benchmark for executing public health actions and services, whose management process is demonstrated in the Management Report: every four months in the RDQA and at the end of the year in the Annual Management Report (RAG) ).

El Informe Detallado del Cuatrimestre Anterior (RDQA) presenta los resultados obtenidos con la ejecución del PAS cada cuatro meses y orienta las redirecciones. Tienen la función de acreditar la aplicación de todos los recursos del Fondo de Salud, instrumento inseparable del Plan y sus respectivos Programas, siendo la principal herramienta de apoyo al proceso de seguimiento y evaluación de la gestión. Su modelo se encuentra estandarizado por la Resolución No. 459 del Consejo Nacional de Salud - CNS, de 10 de octubre de 2012, publicada en el DOU de 21/12/2012, según lo dispuesto en el numeral 4 del artículo 36 de la Ley Complementaria No. 141/2012. El Programa Anual de Salud (PAS) es el referente para la ejecución de acciones y servicios de salud pública, cuyo proceso de gestión se demuestra en el Informe de Gestión: cuatrimestral en el RDQA y al final del año en el Informe Anual de Gestión (RAG) ).

Le rapport détaillé du quadrimestre précédent (RDQA) présente les résultats obtenus avec l'exécution du PAS tous les quatre mois et guide les éventuelles réorientations. Ils ont pour fonction de prouver l'application de toutes les ressources du Fonds de la Santé, instrument indissociable du Plan et de ses Programmes respectifs, étant le principal outil d'appui au processus de suivi et d'évaluation de la gestion. Son modèle est normalisé par la résolution n ° 459 du Conseil national de la santé - CNS du 10 octobre 2012, publiée au DOU du 21/12/2012, comme prévu au paragraphe 4 de l'article 36 de la loi complémentaire n ° 141/2012. Le Programme Annuel de Santé (PAS) est la référence pour la mise en œuvre d'actions et de services de santé publique, dont le processus de gestion est démontré dans le rapport de gestion: tous les quatre mois dans le RDQA et en fin d'année dans le rapport annuel de gestion (RAG) ).

Intensity of care for cancer patients treated mainly at home during the month before their death: An observational study.

BACKGROUND: Little is known regarding healthcare for cancer patients treated mainly at home during the month before they die. The aim of this study was to provide information on how they were treated and what were their causes of death. METHODS: This population-based observational study analysing information obtained from the French national healthcare data system (SNDS) included adult health insurance beneficiaries treated for cancer who died in 2015 after having spent at least 25 of their last 30 days at home. RESULTS: Among the cancer patients who died in 2015, 25,463 (20%) were included [mean age (±SD) 74±13.2 years, men 62%]; 54% of them died at home. They were slightly older (75 vs. 73 years) than those who died in hospital, had less frequently received hospital palliative care during the year preceding their deaths (19% vs. 41%) and had less often used medical transport (41% vs. 73%) to an emergency department (8% vs. 62%), to hospital-based (11% vs. 17%) or community-based (16% vs. 12%) chemotherapy, to a general practitioner (73% vs. 78%) or to a community-based nursing service (63% vs. 73%). However, when they consulted a general practitioner (median 3 visits vs. 2) or a nurse (median 22 nursing procedures vs. 10) during their last month of life, visits were more frequent. The leading cause of death was tumour, which represented 69% of deaths at home vs. 74% of deaths in hospital. CONCLUSIONS: In France, home management during the last month of life is uncommon and even when it is occurs, in one out of two cases patients pass away in a hospital setting. This study is an interrogation on medical choices, given the wish of many of the French to die at home and placing their choices in an international perspective.

Associations between home deaths and end-of-life nursing care trajectories for community-dwelling people: a population-based registry study.

BACKGROUND: Few studies have estimated planned home deaths compared to actual place of death in a general population or the longitudinal course of home nursing services and associations with place of death. We aimed to investigate trajectories of nursing services, potentially planned home deaths regardless of place of death; and associations of place of death with potentially planned home deaths and nursing service trajectories, by analyzing data from the last 90 days of life. METHODS: A retrospective longitudinal study with data from the Norwegian Cause of Death Registry and National registry for statistics on municipal healthcare services included all community-dwelling people who died in Norway 2012-2013 (n = 53,396). We used a group-based trajectory model to identify joint trajectories of home nursing (hours per week) and probability of a skilled nursing facility (SNF) stay, each of the 13 weeks leading up to death. An algorithm estimated potentially planned home deaths. We used a multinomial logistic regression model to estimate associations of place of death with potentially planned home deaths, trajectories of home nursing and short-term SNF. RESULTS: We identified four home nursing service trajectories: no (46.5%), accelerating (7.6%), decreasing (22.1%), and high (23.5%) home nursing; and four trajectories of the probability of a SNF stay: low (69.0%), intermediate (6.7%), escalating (15.9%), and increasing (8.4%) SNF. An estimated 24.0% of all deaths were potentially planned home deaths, of which a third occurred at home. Only high home nursing was associated with increased likelihood of a home death (adjusted relative risk ratio (aRRR) 1.29; CI 1.21-1.38). Following any trajectory with elevated probability of a SNF stay reduced the likelihood of a home death. CONCLUSIONS: We estimated few potentially planned home deaths. Trajectories of home nursing hours and probability of SNF stays indicated possible effective palliative home nursing for some, but also missed opportunities of staying at home longer at the end-of-life. Continuity of care seems to be an important factor in palliative home care and home death.

A systematic review of observational studies of adult home care.

The home-care workforce is in high demand globally. Home-care workers provide care for people at home, including practical and personal care, as well as other tasks such as medication management. We conducted a systematic review with the aims of understanding methods of observation that have been employed to study home care and to explore how these methods have enabled researchers to understand the quality of home care. We searched the literature using PubMed and CINAHL databases in May 2018, with no limits applied to date of publication. We searched for MeSH terms of 'Home Care Services', 'Home Health Care', 'Home Nursing' and 'Observation*'. Across 15 eligible studies, the types of observation methods employed were categorised as structured, guided and unstructured. The characteristics of these methods, such as the level of participation adopted by the observer, varied across the studies. Three themes were developed through a narrative synthesis of the included studies' findings: 'The impact of care delivery and organisational factors', 'Observing relationships and communications', and 'People and places behind closed doors'. We conclude that methods of observation are a fairly novel, yet rich and meaningful way of exploring home-care practice. Researchers undertaking observations should consider elements such as the number of researchers observing and the potential for variations, how and when to record the observations, possible triangulation of data, the researcher's reflective stance as an observer, as well as ethical considerations.

Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis.

BACKGROUND: A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level. METHODS: We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis. RESULTS: We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60-80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5-4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively. CONCLUSIONS: Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency.

Caregiver outcomes of the REACH-HF multicentre randomized controlled trial of home-based rehabilitation for heart failure with reduced ejection fraction.

BACKGROUND: Caregivers frequently provide support to people living with long-term conditions. However, there is paucity of evidence of interventions that support caregivers in their role. Rehabilitation EnAblement in Chronic Heart Failure (REACH-HF) is a novel home-based, health-professional-facilitated, self-management programme for patients with heart failure (HF) and their caregivers. METHODS: Based on the random allocation of individual adult patients with reduced ejection fraction (HFrEF) and left ventricular ejection fraction <45% within the past five years, the caregiver of patients was allocated to receive the REACH-HF intervention over 12 weeks (REACH-HF group) or not (control group). Caregiver outcomes were generic health-related quality of life (EQ-5D-5L), Family Caregiver Quality of Life Scale questionnaire (FamQol), Caregiver Burden Questionnaire HF (CBQ-HF), Caregiver Contribution to Self-care of HF Index questionnaire (CC-SCHFI) and Hospital Anxiety and Depression Scale (HADS). Outcomes were compared between groups at 4, 6 and 12 months follow-up. Twenty caregivers receiving REACH-HF were purposively selected for qualitative interviews at 4 and 12 months. RESULTS: Compared with controls (44 caregivers), the REACH-HF group (53 caregivers) had a higher mean CC-SCHFI confidence score at 12 months (57.5 vs 62.8, adjusted mean difference: 9.3, 95% confidence interval: 1.8-16.8, p = 0.016). No significant between group differences were seen in other caregiver outcomes. Qualitative interviews showed that most caregivers who received the REACH-HF intervention made positive changes to how they supported the HF patient they were caring for, and perceived that they had increased their confidence in the caregiver role over time. CONCLUSION: Provision of the REACH-HF intervention for caregivers of HF patients improved their confidence of self-management and was perceived for some to be helpful in supporting their caregiver role.