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1.
Gut ; 69(2): 201-223, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31776230

RESUMO

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.


Assuntos
Pólipos do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Vigilância da População/métodos , Colonoscopia/normas , Medicina Baseada em Evidências/métodos , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Recidiva Local de Neoplasia/diagnóstico , Seleção de Pacientes , Período Pós-Operatório
5.
BMJ ; 365: l1800, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31335316

RESUMO

OBJECTIVE: To determine whether extending initial prednisolone treatment from eight to 16 weeks in children with idiopathic steroid sensitive nephrotic syndrome improves the pattern of disease relapse. DESIGN: Double blind, parallel group, phase III randomised placebo controlled trial, including a cost effectiveness analysis. SETTING: 125 UK National Health Service district general hospitals and tertiary paediatric nephrology centres. PARTICIPANTS: 237 children aged 1-14 years with a first episode of steroid sensitive nephrotic syndrome. INTERVENTIONS: Children were randomised to receive an extended 16 week course of prednisolone (total dose 3150 mg/m2) or a standard eight week course of prednisolone (total dose 2240 mg/m2). The drug was supplied as 5 mg tablets alongside matching placebo so that participants in both groups received the same number of tablets at any time point in the study. A minimisation algorithm ensured balanced treatment allocation by ethnicity (South Asian, white, or other) and age (5 years or less, 6 years or more). MAIN OUTCOME MEASURES: The primary outcome measure was time to first relapse over a minimum follow-up of 24 months. Secondary outcome measures were relapse rate, incidence of frequently relapsing nephrotic syndrome and steroid dependent nephrotic syndrome, use of alternative immunosuppressive treatment, rates of adverse events, behavioural change using the Achenbach child behaviour checklist, quality adjusted life years, and cost effectiveness from a healthcare perspective. Analysis was by intention to treat. RESULTS: No significant difference was found in time to first relapse (hazard ratio 0.87, 95% confidence interval 0.65 to 1.17, log rank P=0.28) or in the incidence of frequently relapsing nephrotic syndrome (extended course 60/114 (53%) v standard course 55/109 (50%), P=0.75), steroid dependent nephrotic syndrome (48/114 (42%) v 48/109 (44%), P=0.77), or requirement for alternative immunosuppressive treatment (62/114 (54%) v 61/109 (56%), P=0.81). Total prednisolone dose after completion of the trial drug was 6674 mg for the extended course versus 5475 mg for the standard course (P=0.07). There were no statistically significant differences in serious adverse event rates (extended course 19/114 (17%) v standard course 27/109 (25%), P=0.13) or adverse event rates, with the exception of behaviour, which was poorer in the standard course group. Scores on the Achenbach child behaviour checklist did not, however, differ. Extended course treatment was associated with a mean increase in generic quality of life (0.0162 additional quality adjusted life years, 95% confidence interval -0.005 to 0.037) and cost savings (difference -£1673 ($2160; €1930), 95% confidence interval -£3455 to £109). CONCLUSIONS: Clinical outcomes did not improve when the initial course of prednisolone treatment was extended from eight to 16 weeks in UK children with steroid sensitive nephrotic syndrome. However, evidence was found of a short term health economic benefit through reduced resource use and increased quality of life. TRIAL REGISTRATION: ISRCTN16645249; EudraCT 2010-022489-29.


Assuntos
Assistência de Longa Duração , Síndrome Nefrótica , Prednisolona , Qualidade de Vida , Prevenção Secundária , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Glucocorticoides/economia , Humanos , Imunossupressores/uso terapêutico , Lactente , Análise de Intenção de Tratamento , Assistência de Longa Duração/economia , Assistência de Longa Duração/métodos , Masculino , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/tratamento farmacológico , Síndrome Nefrótica/economia , Síndrome Nefrótica/psicologia , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Prednisolona/economia , Prevenção Secundária/economia , Prevenção Secundária/métodos , Resultado do Tratamento
6.
Rev Bras Enferm ; 72(3): 825-829, 2019 Jun 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269152

RESUMO

OBJECTIVE: To describe the experience in the implementation of the Humanitude Care Methodology (MCH) in the humanization of care for the elderly. METHODOLOGY: This is an experience report about the implementation of the MCH, in a Health Service in Portugal, with capacity for 30 elderly people, most of them having cognitive alterations. RESULTS: The implementation of the MCH has shown positive results in the humanization of care for the elderly, namely in the reduction of agitation behaviors and better acceptance of care. There was a change in organizational culture, more focused on the person and on the humanization of care. CONCLUSION: The results reflect the need to introduce innovative care methodologies in the training of health professionals, with a focus on interaction, for a professionalized relational care that dignifies the person cared for and the care giver.


Assuntos
Assistência à Saúde/normas , Geriatria/normas , Humanismo , Assistência à Saúde/métodos , Geriatria/métodos , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Cultura Organizacional , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas
7.
Healthc Q ; 22(1): 14-21, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31244463

RESUMO

Scandinavian countries are widely acknowledged as leaders in innovative models of care for their aging populations. To learn what might be potentially applicable to the health system in Canada, the Canadian Frailty Network (CFN) led a contingent of government, administrative, research and patient representatives to Denmark to directly observe Danish approaches for providing healthcare for older adults living with frailty. In this paper and based on what we learned from these observations, we discuss healthcare challenges faced by Canada's aging population for which Danish strategies provide clues as to where and how to improve care and system efficiencies, thereby maximizing the value of Canadian healthcare.


Assuntos
Assistência à Saúde/organização & administração , Idoso Fragilizado , Idoso , Idoso de 80 Anos ou mais , Canadá , Disfunção Cognitiva , Dinamarca , Política de Saúde , Administração Hospitalar/métodos , Humanos , Vida Independente , Assistência de Longa Duração/métodos , Assistência de Longa Duração/organização & administração , Desnutrição/prevenção & controle , Centros de Reabilitação/organização & administração
8.
J Dermatol ; 46(8): 641-651, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31206779

RESUMO

We evaluated the efficacy of efinaconazole 10% topical solution in long-term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE-t, suggested that efinaconazole treatment improved the patients' quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long-term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.


Assuntos
Antifúngicos/administração & dosagem , Dermatoses do Pé/tratamento farmacológico , Onicomicose/tratamento farmacológico , Triazóis/administração & dosagem , Administração Tópica , Idoso , Antifúngicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Dermatoses do Pé/diagnóstico , Humanos , Incidência , Assistência de Longa Duração/métodos , Masculino , Pessoa de Meia-Idade , Onicomicose/diagnóstico , Qualidade de Vida , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Triazóis/efeitos adversos
9.
PLoS Med ; 16(6): e1002843, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31233541

RESUMO

BACKGROUND: Fall-related injuries exert an enormous health burden on older adults in long-term care (LTC). Softer landing surfaces, such as those provided by low-stiffness "compliant" flooring, may prevent fall-related injuries by decreasing the forces applied to the body during fall impact. Our primary objective was to assess the clinical effectiveness of compliant flooring at preventing serious fall-related injuries among LTC residents. METHODS AND FINDINGS: The Flooring for Injury Prevention (FLIP) Study was a 4-year, randomized superiority trial in 150 single-occupancy resident rooms at a single Canadian LTC site. In April 2013, resident rooms were block randomized (1:1) to installation of intervention compliant flooring (2.54 cm SmartCells) or rigid control flooring (2.54 cm plywood) covered with identical hospital-grade vinyl. The primary outcome was serious fall-related injury over 4 years that required an emergency department visit or hospital admission and a treatment procedure or diagnostic evaluation in hospital. Secondary outcomes included minor fall-related injury, any fall-related injury, falls, and fracture. Outcomes were ascertained by blinded assessors between September 1, 2013 and August 31, 2017 and analyzed by intention to treat. Adverse outcomes were not assessed. During follow-up, 184 residents occupied 74 intervention rooms, and 173 residents occupied 76 control rooms. Residents were 64.3% female with mean (SD) baseline age 81.7 (9.5) years (range 51.1 to 104.6 years), body mass index 25.9 (7.7) kg/m2, and follow-up 1.64 (1.39) years. 1,907 falls were reported; 23 intervention residents experienced 38 serious injuries (from 29 falls in 22 rooms), while 23 control residents experienced 47 serious injuries (from 34 falls in 23 rooms). Compliant flooring did not affect odds of ≥1 serious fall-related injury (12.5% intervention versus 13.3% control, odds ratio [OR]: 0.98, 95% CI: 0.52 to 1.84, p = 0.950) or ≥2 serious fall-related injuries (5.4% versus 7.5%, OR: 0.74, 95% CI: 0.31 to 1.75, p = 0.500). Compliant flooring did not affect rate of serious fall-related injuries (0.362 versus 0.422 per 1,000 bed nights, rate ratio [RR]: 1.04, 95% CI: 0.45 to 2.39, p = 0.925; 0.038 versus 0.053 per fall, RR: 0.81, 95% CI: 0.38 to 1.71, p = 0.560), rate of falls with ≥1 serious fall-related injury (0.276 versus 0.303 per 1,000 bed nights, RR: 0.97, 95% CI: 0.52 to 1.79, p = 0.920), or time to first serious fall-related injury (0.237 versus 0.257, hazard ratio [HR]: 0.92, 95% CI: 0.52 to 1.62, p = 0.760). Compliant flooring did not affect any secondary outcome in this study. Study limitations included the following: findings were specific to 2.54 cm SmartCells compliant flooring installed in LTC resident rooms, standard fall and injury prevention interventions were in use throughout the study and may have influenced the observed effect of compliant flooring, and challenges with concussion detection in LTC residents may have prevented estimation of the effect of compliant flooring on fall-related concussions. CONCLUSIONS: In contrast to results from previous retrospective and nonrandomized studies, this study found that compliant flooring underneath hospital-grade vinyl was not effective at preventing serious fall-related injuries in LTC. Future studies are needed to identify effective methods for preventing fall-related injuries in LTC. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01618786.


Assuntos
Acidentes por Quedas/prevenção & controle , Pisos e Cobertura de Pisos/normas , Assistência de Longa Duração/normas , Instituições Residenciais/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Pisos e Cobertura de Pisos/métodos , Seguimentos , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/tendências , Masculino , Pessoa de Meia-Idade
10.
Geriatr Gerontol Int ; 19(7): 679-683, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037823

RESUMO

AIM: Improving the availability of dental care is essential to maintain older adults' general health and wellbeing. Domiciliary dental care is a feasible alternative. The present study aimed to investigate factors affecting the use of domiciliary dental care among home-dwelling dependent older adults. METHODS: A retrospective nested case-control study was carried out. We identified long-term care recipients who used home care services between April 2012 and March 2014 using Japan's nationwide long-term care service claim database. One-to-one case-control matching was carried out between those with and without domiciliary dental care, based on sex, age and the time home care service use was started. We carried out multivariable conditional logistic regression analyses to assess various factors associated with using domiciliary dental care. RESULTS: We identified 3 377 998 eligible homebound long-term care beneficiaries aged ≥65 years. Of these, 278 302 (8.2%) received domiciliary dental care. Factors associated with a higher probability of receiving domiciliary dental care were: higher level of care need (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.93-2.06), exemption from out-of-pocket payment (OR 1.35, 95% CI 1.32-1.39]), living in a group home (OR 7.93, 95% CI 7.71-8.16), using other domiciliary services such as physician visits (OR 3.15, 95% CI 3.08-3.22) and a large number of dental clinics providing domiciliary dental care in their municipality (OR 1.74, 95% CI 1.70-1.77). Significant barriers to receiving domiciliary dental care were living alone (OR 0.64, 95% CI 0.62-0.66) and dementia (OR 0.89, 95% CI 0.88-0.91). CONCLUSIONS: Our findings might help to improve the availability of dental care in this population. Geriatr Gerontol Int 2019; 19: 679-683.


Assuntos
Assistência Odontológica para Idosos , Acesso aos Serviços de Saúde/organização & administração , Serviços de Assistência Domiciliar/estatística & dados numéricos , Pacientes Domiciliares , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Assistência Odontológica para Idosos/métodos , Assistência Odontológica para Idosos/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Japão/epidemiologia , Assistência de Longa Duração/métodos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Estudos Retrospectivos
11.
Geriatr Gerontol Int ; 19(7): 598-603, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037829

RESUMO

AIM: The present population-based study investigated the predictive ability of the Kihon Checklist (a self-reported frailty questionnaire) and the cognitive domain therein for incident long-term care need certification. This is the first large population-based study to investigate an association between the Kihon Checklist and the outcome measure, long-term care need certification. METHODS: The study population consisted of community-dwelling citizens aged >65 years who responded to the Kihon Checklist in Kobe City. The Kihon Checklist is a simple 26-item questionnaire to identify frail citizens, including three items (Q18-20) on subjective cognitive function (the cognitive domain). RESULTS: A total of 182 099 citizens were included for statistical analysis. The overall incidence of long-term care need certification was 1.6%, 3.5% and 5.4% at 1, 2 and 3 years. Associations were found between the Kihon Checklist questions and long-term care need certification. Furthermore, each unfavorable answer on the cognitive domain was associated with the risk for long-term care need (HR 1.493 for Q18, 1.285 for Q19, 1.321 for Q20, all P < 0.0001), independent of age, sex and other items on the Kihon Checklist. Also, after 3 years, as the number of unfavorable answers to the cognitive domain increased from 0 to 1, 2 and 3, the incidence of long-term care need certification progressively increased from 3.5% to 6.4%, 12.6% and 29.6%. CONCLUSIONS: The Kihon Checklist, especially the cognitive domain therein, appears to be predictive of long-term care need in community-dwelling citizens, suggesting the potential utility of the questionnaire for early detection of high-risk individuals. Geriatr Gerontol Int 2019; 19: 598-603.


Assuntos
Lista de Checagem , Disfunção Cognitiva/diagnóstico , Avaliação da Deficiência , Definição da Elegibilidade/métodos , Vida Independente , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem/métodos , Lista de Checagem/normas , Cognição , Feminino , Idoso Fragilizado/psicologia , Avaliação Geriátrica/métodos , Humanos , Incidência , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Assistência de Longa Duração/métodos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Medição de Risco/métodos , Autorrelato , Inquéritos e Questionários
13.
World J Gastroenterol ; 25(15): 1817-1827, 2019 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-31057296

RESUMO

The aging of the organ function causes sensitivity to the disease progression and need careful consideration for the medical treatment. With the increase of aging population, the opportunity to provide medical treatment for people in very old age is rapidly increasing therefore, the understanding of the various physiological changes of cellular function, size and function of organs are essential for the decision of therapeutic options. Among the various chronic conditions seen in elderly people, we have focused on liver cirrhosis, since despite specific therapeutic options for many of liver diseases including direct acting antivirals for hepatitis C virus, nucleoside analogs for hepatitis B, and corticosteroids for autoimmune hepatitis, there is currently no standard therapy to treat liver cirrhosis, which is the final stage of these liver diseases. Therefore, management of the various symptoms of liver cirrhosis is essential, and aging-related parameters must be considered in the decision making for therapeutic strategies and dosage of the available medicine. In this mini-review, we have summarized the therapeutic options to manage various symptoms of liver cirrhosis, carefully considering the physiological changes of various organs associated with aging.


Assuntos
Envelhecimento/fisiologia , Gastroenterologia/métodos , Cirrose Hepática/terapia , Fatores Etários , Idoso , Tomada de Decisões , Progressão da Doença , Gastroenterologia/normas , Humanos , Fígado/patologia , Fígado/fisiopatologia , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Cirrose Hepática/fisiopatologia , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Equipe de Assistência ao Paciente/normas , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Qualidade de Vida
14.
Z Gastroenterol ; 57(5): 593-599, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083747

RESUMO

BACKGROUND: In current guidelines, Helicobacter pylori eradication is recommended as first-line therapy in patients with gastric MALT lymphoma. This leads to complete lymphoma regression in the majority of patients. Those who show persisting histological residuals of lymphoma after eradication of the bacterium and normalization of endoscopic findings are managed by a watch-and-wait strategy. We aim to show that such an approach can be extended to patients with persisting endoscopic abnormalities. METHODS: Thirteen patients (7 female and 6 male; 62 years, range: 43 - 80) with gastric MALT lymphoma of stages I and II1 had received exclusive H. pylori eradication. Control endoscopies performed every 3 - 4 months during the first 2 years and 6 and 12 times monthly 2 - 5 and > 5 years after diagnosis, respectively, revealed successful eradication of H. pylori but persisting endoscopic abnormalities. Histologically, complete regression of the lymphoma or minor residuals were observed. RESULTS: Persisting endoscopic changes included thickened folds with or without superficial erosions, nodular mucosal surface with or without angiectasia, focal or diffuse atrophy, focal erythema, or a mixture of these findings. During a follow-up of 89.9 (12 - 329) months, the outcome of these patients was excellent with no single case of lymphoma progression. CONCLUSION: A watch-and-wait strategy can be recommended for patients with gastric MALT lymphoma showing persisting endoscopic abnormalities after eradication of H. pylori. There is no need for any oncological treatment provided that regular endoscopic-bioptic controls do not reveal any progressive changes. A standardized description of the endoscopic changes as well as a thorough bioptic technique should be included.


Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma de Zona Marginal Tipo Células B/terapia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Conduta Expectante , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Biópsia , Endoscopia Gastrointestinal , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Assistência de Longa Duração/métodos , Linfoma de Zona Marginal Tipo Células B/microbiologia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Neoplasias Gástricas/microbiologia , Resultado do Tratamento
15.
Artigo em Inglês | MEDLINE | ID: mdl-30991706

RESUMO

Most of the baby boomers born after the Second World War (WWII) have passed the age of 65, meaning they have gradually lost their social functions and positions, and are facing the need for care. In Taiwan, the lack of a long-term care mechanism is having a certain degree of impact on society as a whole, and thus, it is important to have a mechanism to take care of the elderly. In order to make this system sustainable, sufficient funds and continuous improvement are important factors. In the past, in order to avoid the illegal transfer of benefits, the social welfare mechanism avoided the use of for-profit organizations. However, as the economic environment declines, the role of for-profit organizations should be considered. This study defines the long-term ageing health care system using five major dimensions and 20 criteria. The DANP-mV model was used to analyze Taiwan's current system and identify problems, and then to develop a continuous improvement strategy from the perspective of the source of the problem in order to improve long-term ageing health care.


Assuntos
Assistência de Longa Duração/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Modelos Teóricos , Taiwan
16.
Artigo em Inglês | MEDLINE | ID: mdl-31014022

RESUMO

Long-term hospital stays might have a negative psychosocial impact on our patients. One way to positively activate hospitalized patients is to introduce animal-assisted therapy (AAT). A total of 72 individuals participated in this research. The experimental group comprised 33 patients (8 males, 25 females), while the control group contained 39 patients (11 men, 28 women). The participants in the control group were aged from 58 to 100 years and the experimental group featured participants aged from 51 to 95, for whom AAT was included alongside standard care. Blood pressure, heart rate, Barthel index, and general mood were measured in both groups. Results did not reveal any changes in blood pressure, heart rate, or Barthel index in comparison between groups. A great influence was noted in assessment of the mood of the patients. The inclusion of AAT did not affect physiological parameters, but it exerted a significant effect on the psychological well-being of the patients.


Assuntos
Afeto , Terapia Assistida por Animais/métodos , Frequência Cardíaca , Assistência de Longa Duração/métodos , Idoso , Idoso de 80 Anos ou mais , República Tcheca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
17.
Br J Gen Pract ; 69(682): e363-e372, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30962225

RESUMO

BACKGROUND: About 15.4 million people in the UK live with a long-term condition. Of the health and social care spend, 70% is invested in caring for this population. Evidence suggests that group-work interventions offer patient support, improved outcomes, and reduce the costs of care. AIM: To review the current evidence base examining the effectiveness of group work in long-term physical disease where such groups are facilitated by healthcare professionals. DESIGN AND SETTING: Systematic review and narrative synthesis of studies of group-work interventions led by health professionals for adults with specified long-term illnesses. METHOD: MEDLINE, EMBASE, PsycINFO, and Cochrane databases were systematically searched using terms relating to group work and long-term conditions. Studies were included if they were randomised controlled trials (RCTs) with a control group that did not include group work. RESULTS: The 14 included studies demonstrated a high degree of heterogeneity in terms of participant characteristics, interventions, and outcome measures and were of varying quality. The studies demonstrated some statistically significant improvements in pain, psychological outcomes, self-efficacy, self-care, and quality of life resulting from intervention. CONCLUSION: This review demonstrates significant benefits resulting from group participation, in adults with long-term disease. Results were mixed and some benefits were short-lived. Nevertheless, these results suggest that group work should be more widely used in the management and support of adults with long-term illness. There is a need for larger and better-quality studies to explore this potentially important area further.


Assuntos
Doença Crônica/reabilitação , Assistência de Longa Duração , Psicoterapia de Grupo/métodos , Sobreviventes/psicologia , Doença Crônica/psicologia , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/psicologia , Facilitação Social , Apoio Social
18.
Geriatr Gerontol Int ; 19(7): 667-672, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30968552

RESUMO

AIM: The present study aimed to evaluate drug costs per resident at Japanese intermediate care facilities for older adults (called Roken) in relation to drug utilization after admission to these facilities. The payment, including coverage of drugs, is mainly determined by the resident's long-term care needs. METHODS: A nationwide drug utilization survey was carried out. The participants were 1324 residents of 350 Roken (up to five individuals per facility) who were admitted in 2015 and agreed to participate in this study. Drug costs per resident per month at admission and 2 months later were calculated for drugs prescribed for regular use. Associations between characteristics of the residents and drug costs were examined. RESULTS: A wide variation in drug costs with a long right tail was observed. Median drug costs were $77 (interquartile range $34-147) at admission, and $46 (interquartile range $19-98) in month 2. There was no apparent association between the level of long-term care needs and drug costs, adjusting for sex, age and main place of residence before admission. Anti-dementia drugs accounted for the largest portion of total drug costs at admission (15.4%) and in month 2 (12.4%). The average drug cost per user was also the highest for anti-dementia drugs ($90.2 per user per month), followed by drugs for Parkinson's disease ($70.3). The proportion of generic drugs across all drug classes examined increased after admission. CONCLUSIONS: These findings might suggest that implementation of the bundled payment scheme would be effective for the reduction of medication costs in institutional long-term care. Geriatr Gerontol Int 2019; 19: 667-672.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/métodos , Assistência de Longa Duração , Nootrópicos/uso terapêutico , Instituições de Cuidados Especializados de Enfermagem , Idoso , Controle de Custos/métodos , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Japão , Assistência de Longa Duração/economia , Assistência de Longa Duração/métodos , Masculino , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos
19.
JAMA Netw Open ; 2(3): e190230, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30821830

RESUMO

Importance: Collaborative chronic care models (CCMs) have extensive randomized clinical trial evidence for effectiveness in serious mental illnesses, but little evidence exists regarding their feasibility or effect in typical practice conditions. Objective: To determine the effectiveness of implementation facilitation in establishing the CCM in mental health teams and the impact on health outcomes of team-treated individuals. Design, Setting, and Participants: This quasi-experimental, randomized stepped-wedge implementation trial was conducted from February 2016 through February 2018, in partnership with the US Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention. Nine facilities were enrolled from all VA facilities in the United States to receive CCM implementation support. All veterans (n = 5596) treated by designated outpatient general mental health teams were included for hospitalization analyses, and a randomly selected sample (n = 1050) was identified for health status interviews. Individuals with dementia were excluded. Clinicians (n = 62) at the facilities were surveyed, and site process summaries were rated for concordance with the CCM process. The CCM implementation start time was randomly assigned across 3 waves. Data analysis of this evaluable population was performed from June to September 2018. Interventions: Internal-external facilitation, combining a study-funded external facilitator and a facility-funded internal facilitator working with a designated team for 1 year. Main Outcomes and Measures: Facilitation was hypothesized to be associated with improvements in both implementation and intervention outcomes (hybrid type II trial). Implementation outcomes included the clinician Team Development Measure (TDM) and proportion of CCM-concordant team care processes. The study was powered for the primary health outcome, mental component score (MCS). Hospitalization rate was derived from administrative data. Results: The veteran population (n = 5596) included 881 women (15.7%), and the mean (SD) age was 52.2 (14.5) years. The interviewed sample (n = 1050) was similar but was oversampled for women (n = 210 [20.0%]). Facilitation was associated with improvements in TDM subscales for role clarity (53.4%-68.6%; δ = 15.3; 95% CI, 4.4-26.2; P = .01) and team primacy (50.0%-68.6%; δ = 18.6; 95% CI, 8.3-28.9; P = .001). The percentage of CCM-concordant processes achieved varied, ranging from 44% to 89%. No improvement was seen in veteran self-ratings, including the primary outcome. In post hoc analyses, MCS improved in veterans with 3 or more treated mental health diagnoses compared with others (ß = 5.03; 95% CI, 2.24-7.82; P < .001). Mental health hospitalizations demonstrated a robust decrease during facilitation (ß = -0.12; 95% CI, -0.16 to -0.07; P < .001); this finding withstood 4 internal validity tests. Conclusions and Relevance: Implementation facilitation that engages clinicians under typical practice conditions can enhance evidence-based team processes; its effect on self-reported overall population health status was negligible, although health status improved for individuals with complex conditions and hospitalization rate declined. Trial Registration: ClinicalTrials.gov Identifier: NCT02543840.


Assuntos
Assistência de Longa Duração , Transtornos Mentais , Serviços de Saúde Mental/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde , Veteranos/psicologia , Adulto , Feminino , Disparidades nos Níveis de Saúde , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/organização & administração , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental/normas , Modelos Organizacionais , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos
20.
BMC Geriatr ; 19(1): 82, 2019 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866827

RESUMO

BACKGROUND: Informal caregivers are an essential pillar for ensuring and maintaining the outpatient care of the frail elderly. Due to demographic changes, including an increase in the number of people in need of care as well as changing social structures (full-time employment of women, increasing number of single households, etc.) these informal care structures are fraught by considerable challenges. To support and facilitate informal caregivers in their role of nursing, it is important to identify their preferences, needs, and thus create a preference-oriented system. METHODS: A systematic review was conducted to identify preferences and needs regarding the organization of informal care. The database searches were performed by using EMBASE, Scopus and Dimdi. RESULTS: A total of 44 studies were included in the present review. Studies from 17 different countries provide broad international perspectives. Besides the preferences for long-term care structure, the following four principal topics were identified: (1) informational needs; (2) support needs; (3) organizational needs, and (4) needs for societal recognition. CONCLUSION: To meet the current challenges in the outpatient or home-based care of elders, it is essential to strengthen the role of informal caregivers. Therefore, it is necessary to adopt and further develop informal care structures according to the needs of informal caregivers. However, demographic, financial and cultural aspects of each country need to be considered as these may influence the preferences and needs of informal caregivers.


Assuntos
Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Cuidadores/psicologia , Idoso Fragilizado/psicologia , Necessidades e Demandas de Serviços de Saúde , Preferência do Paciente/psicologia , Idoso , Idoso de 80 Anos ou mais , Serviços de Assistência Domiciliar , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/psicologia
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