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2.
BMC Neurol ; 19(1): 287, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729968

RESUMO

BACKGROUND: Fingolimod (Gilenya®) is approved for relapsing forms of multiple sclerosis in the USA. Owing to transient heart-rate effects when initiating fingolimod, eligible patients undergo precautionary baseline assessment and first-dose observation (FDO) for ≥6 h. Prior to 2014, FDO was undertaken only in clinics. As the FDO period is short, and fingolimod has accumulated evidence of a positive benefit:risk ratio, an in-home treatment-initiation program, Gilenya@Home, was developed to offer a convenient alternative. METHODS: Cardiac parameters and adverse events (AEs) were recorded by healthcare professionals performing fingolimod FDOs in the US Gilenya@Home program or in US Gilenya Assessment Network clinics. Anonymized data were collated retrospectively from the first 34 months in the home setting and from 78 months in clinics; data are reported descriptively. Satisfaction with Gilenya@Home was rated by patients using a 7-item questionnaire that considered aspects such as ease of scheduling, courtesy, and competency. RESULTS: Data were captured as part of standard care from 5573 patients initiating fingolimod in-home (October 2014 to July 2017) and from 15,025 patients initiating in-clinic (July 2010 to December 2016). In the Gilenya@Home questionnaire, 91.7% of 1848 respondents rated their overall satisfaction as "very good," and 7.6% rated their satisfaction as "good." AEs were reported for 30.7 and 32.6% of in-home and in-clinic patients, respectively. In total, 557 in-home (10.0%) and 398 in-clinic (2.6%) patients were monitored for > 6 h; 15 (0.3%) in-home and 129 (0.9%) in-clinic patients were transferred to an emergency room for overnight monitoring. The mean (standard deviation) heart rate (HR; bpm) pre-FDO was 74.8 (12.2) in-home and 74.2 (11.3) in-clinic; reduction in HR at 6 h postdose was 10.6 (12.0) and 6.3 (9.6), respectively. New-onset first-degree atrioventricular block was experienced by 132 (2.4%) in-home and 74 (0.5%) in-clinic patients, and Wenckebach (Mobitz type I) second-degree atrioventricular block by four (0.07%) and nine (0.1%) patients, with no cases of third-degree atrioventricular block. CONCLUSIONS: A substantial number of patients have initiated fingolimod at home, reporting very high levels of satisfaction. Gilenya@Home was as rigorous as the clinic setting in detecting cardiovascular events. Overall, FDO safety outcomes were similar with Gilenya@Home and in-clinic.


Assuntos
Bloqueio Atrioventricular/induzido quimicamente , Cloridrato de Fingolimode/efeitos adversos , Serviços Hospitalares de Assistência Domiciliar , Imunossupressores/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Adulto , Bloqueio Atrioventricular/diagnóstico , Eletroencefalografia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 98(48): e18032, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770218

RESUMO

BACKGROUND: The medical management of chronic respiratory diseases becomes more difficult with the increase in the rate of the elderly population. Monitoring and treating chronic respiratory diseases at home are more comfortable for both the patient and their relatives. Therefore, countries need to develop policies regarding home health services (HHS) according to the state of their social, cultural, and financial infrastructure. OBJECTIVE: The objective of this study is to show the role and contribution of hospital-based HHS regarding respiratory disorders, and to evaluate the model and its efficiency. STUDY DESIGN: The design of this study was cross-sectional. Data were obtained from the Ministry of Health of Turkey with official permission. Data were collected for HHS concerning respiratory diseases between 2011 and 2017. Age and sex distribution, the number of recorded patients, the number of visits for pulmonary diseases, the distribution of institutional visits, and the quantitative alterations within the years were investigated. STUDY POPULATION: The study population was based on patients with respiratory disorders who were given HHS as directed by the Ministry of Health of Turkey. RESULTS: Between 2011 and 2017, the majority of patients with pulmonary diseases, mostly those with chronic obstructive pulmonary disease, asthma, and lung cancer, visited government hospitals (78%). The number of house visits concerning pulmonary disorders increased nearly ten times, but hospitalization due to respiratory diseases decreased (13.5% in 2011 to 12.9% in 2017). CONCLUSION: Hospital-based HHS in pulmonary diseases can be considered as an appropriate model for implementation for countries like Turkey, those that have inadequate hospice-type health service infrastructure.


Assuntos
Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Doenças Respiratórias/terapia , Idoso , Asma/terapia , Doença Crônica , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Humanos , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Turquia
4.
J Stroke Cerebrovasc Dis ; 28(10): 104303, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31371144

RESUMO

BACKGROUND: Aphasia is a quite common and very disabling symptom following stroke, negatively affecting patient's quality of life. Aim of the study is to evaluate the effectiveness of a rehabilitation training for aphasia that employ a touch-screen tablet using a virtual reality rehabilitation system (VRRS-Tablet). MATERIAL AND METHODS: Thirty patients with aphasia due to ischemic or hemorrhagic stroke were randomized into either the control or the experimental group and assessed by means of a specific neuropsychological evaluation. The study lasted 6 months and included 2 phases. During the former, the experimental group underwent an experimental linguistic treatment performed using the VRRS-Tablet, while the control group was trained with a traditional linguistic treatment. In the latter, the control groups were delivered to territorial services, while the experimental group was provided with the VRRS-Tablet. RESULTS: The experimental group improves in all the investigated areas, except for writing, while the control group only improves in comprehension, depression, and quality of life. CONCLUSIONS: Our study has demonstrated the effectiveness of a home-based telerehabilitation program specific for poststroke aphasia. The use of telerehabilitation by means of VRRS-Tablet could be one of the best solutions to treat aphasic patients after their discharge, promoting continuity of care by monitoring functional outcomes, maintaining preserved abilities, reducing depression, and improving linguistic functions, besides the psychological well-being.


Assuntos
Afasia/reabilitação , Continuidade da Assistência ao Paciente , Serviços Hospitalares de Assistência Domiciliar , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Telerreabilitação/métodos , Adulto , Afasia/diagnóstico , Afasia/fisiopatologia , Afasia/psicologia , Computadores de Mão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Projetos Piloto , Qualidade de Vida , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/instrumentação , Telerreabilitação/instrumentação , Resultado do Tratamento
5.
BMC Health Serv Res ; 19(1): 470, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288804

RESUMO

BACKGROUND: Public health policies tend to generalize the use of Hospital-At-Home (HAH) to answer the growing will of patients to be treated or to die at home. HAH is a model of care that provides acute-level services in the patient's home with the interventions of variety of health care professionals. Relatives participate also in the interventions by helping for sick patients at home, but we lack data on the care of patients and caregivers in HAH. The aim of this study was to make an inventory of the experiences of patients and family caregivers in HAH. METHODS: The research was qualitative using nineteen semi-directed interviews from nine patients and ten caregivers of one care unit of Greater Paris University Hospitals' HAH, and the grounded theory was used to analyze the transcripts. Caregivers were also asked, after the interview, to fill in the Zarit Burden Inventory. RESULTS: HAH remained mostly unknown for patients and caregivers before the admission proposition and the outlook of being admitted in HAH was perceived as positive, for both of them. Caregivers had a versatile role throughout HAH, leading to situations of suffering, but also had sources of support. The return home was considered satisfactory by both caregivers and patients, related to the quality of care and increased morale despite HAH's organizational constraints. We noted an impact of HAH on the relationship between the patient and the caregiver(s), but caused by multiple factors: the fact that the care takes places at home, its consequences but also the disease itself. CONCLUSION: HAH strongly involved the patient's caregiver(s) all along the process. HAH's development necessitates to associate both patients and caregivers and to take into account their needs at every step. This study highlights the need to better assess the ability of the caregiver to cope with his or her relative in HAH with acute and subacute care at home.


Assuntos
Cuidadores , Serviços Hospitalares de Assistência Domiciliar , Adaptação Psicológica , Adulto , Cuidadores/psicologia , Estudos de Avaliação como Assunto , Feminino , França , Política de Saúde , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
6.
Trials ; 20(1): 333, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174579

RESUMO

BACKGROUND: Virtual reality training (VRT) uses computer software to track a user's movements and allow him or her to interact with a game presented on a television screen. VRT is increasingly being used for the rehabilitation of arm function, balance and walking after stroke. Patients often require ongoing therapy post discharge from inpatient rehabilitation. Outpatient therapy may be limited or inaccessible due to waiting lists, transportation issues, distance etc.; therefore, home-based VRT could provide the required therapy in a more convenient and accessible setting. The objectives of this parallel randomized feasibility trial are to determine (1) the feasibility of using VRT in the home post stroke and (2) the feasibility of a battery of quantitative and qualitative outcome measures of stroke recovery. METHODS: Forty patients who can stand for at least 2 min and are soon to be discharged from inpatient or outpatient rehabilitation post stroke are being recruited in Ottawa, Canada and being randomized to control and experimental groups. Participants in the experimental group use home-based VRT to do rehabilitative exercises for standing balance, stepping, reaching, strengthening and gentle aerobic fitness. Control group participants use an iPad with apps selected to rehabilitate cognition, hand fine motor skills and visual tracking/scanning. Both groups are instructed to perform 30 min of exercise 5 days a week for 6 weeks. VRT intensity and difficulty are monitored and adjusted remotely. Weekly telephone contact is made with all participants. Ability to recruit participants, ability to handle the technology and learn the activities, compliance, safety, enjoyment, perceived efficacy and cost of program delivery will be assessed. A battery of assessments of standing balance, gait and community integration will be assessed for feasibility of completion within this population and potential for improvement following the intervention. Effect sizes will be calculated. DISCUSSION: The results of this study will be used to support the creation of a definitive randomized controlled trial on the efficacy of home-based VRT for rehabilitation post stroke. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03261713 . Registered on 21 August 2017. Registration amended on 1 June 2018 to decrease enrollment from 40 to 20 due to a cut in study funding and difficulty recruiting participants.


Assuntos
Serviços Hospitalares de Assistência Domiciliar , Alta do Paciente , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Telerreabilitação/métodos , Realidade Virtual , Estudos de Viabilidade , Humanos , Ontário , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
Implement Sci ; 14(1): 61, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196123

RESUMO

BACKGROUND: Stroke Early Supported Discharge (ESD) is a service innovation that facilitates discharge from hospital and delivery of specialist rehabilitation in patients' homes. There is currently widespread implementation of ESD services in many countries, driven by robust clinical trial evidence. In England, the type of ESD service patients receive on the ground is variable, and in some regions, ESD is still not offered at all. This protocol presents a study designed to investigate the mechanisms and outcomes of implementing ESD at scale in real-world conditions. This will help to establish which models of ESD are most effective and in what context. METHODS: A realist evaluation approach composed of two interlinking work packages will be adopted to investigate how and why ESD works, for whom and in what circumstances. Work package 1 (WP1) will begin with a rapid evidence synthesis to formulate preliminary realist hypotheses. Quantitative analyses of historical prospective Sentinel Stroke National Audit Programme (SSNAP) data will be performed to evaluate service outcomes based on the degree to which evidence-based ESD has been implemented. Work package 2 (WP2) will involve the qualitative investigation of purposively selected case study sites featuring in WP1 and covering different regions in England. The perspectives of clinicians, managers, commissioners, and service users will be explored qualitatively. Cost implications of ESD models will be examined using a cost-consequence analysis. Cross-case comparisons and triangulation of the data sources from both work packages will be performed to test, revise, and refine initial programme theories and address research aims. DISCUSSION: This study will investigate whether and how current large-scale implementation of ESD is achieving the outcomes suggested by the evidence base. The theory-driven evaluation approach will highlight key mechanisms and contextual conditions necessary to optimise outcomes and allow us to draw transferable lessons to inform the effective implementation and sustainability of ESD in clinical practice. In addition, the methodological framework will progress the theoretical understanding of implementation and evaluation of complex rehabilitation interventions in stroke care. TRIAL REGISTRATION: ISRCTN: 15568163, registration date: 26 October 2018.


Assuntos
Implementação de Plano de Saúde , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Alta do Paciente/normas , Reabilitação do Acidente Vascular Cerebral/normas , Inglaterra , Humanos , Inovação Organizacional , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa
9.
BMC Musculoskelet Disord ; 20(1): 231, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101039

RESUMO

BACKGROUND: There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR. METHODS: A controlled clinical trial was conducted at the Orthopedic University Hospital of Rion, Greece involving allocation concealment to patients. Fifty-two patients electing to undergo TKR were randomised to either early-initiated SMT [experimental] or functional exercise training [control] in a home-based environment. Groups were prescribed equivalent duration of exercise during 12-weeks, 3-5 sessions of ~ 40 min per week of home-based programmes. Muscle strength and activation (peak force [PF]; peak amplitude [Peak Amp.] and root mean square of integrated electromyography [RMS iEMG]), muscular size (including rectus femoris muscle cross-sectional area [CSARF]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery). RESULTS: Patients undertaking SMT rehabilitation showed significantly greater improvements over the 14 weeks compared to control in outcomes including quadriceps PF (25.1 ± 18.5 N vs 12.4 ± 20.8 N); iPeak Amp. (188 ± 109.5% vs 25 ± 105.8%); CSARF (252.0 ± 101.0 mm2 vs 156.7 ± 76.2 mm2), respectively (p < 0.005); Knee ROM did not offer clinically relevant changes (p: ns) between groups over time. At 14 weeks post-surgery, the SMT group's and control group's performances differed by relative effect sizes (Cohen's d) ranging between 0.64 and 1.06. CONCLUSION: A prescribed equivalent time spent in SMT compared to usual practice, delivered within a home-based environment, elicited superior restoration of muscle strength, activation and size in patients following TKR. TRIAL REGISTRATION: ISRCTN12101643 , December 2017 (retrospective registration).


Assuntos
Artroplastia do Joelho/reabilitação , Terapia por Exercício/métodos , Serviços Hospitalares de Assistência Domiciliar , Força Muscular/fisiologia , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Retroalimentação Sensorial/fisiologia , Feminino , Grécia , Humanos , Articulação do Joelho/cirurgia , Masculino , Osteoartrite do Joelho/reabilitação , Músculo Quadríceps/fisiologia , Recuperação de Função Fisiológica , Método Simples-Cego , Estudos de Tempo e Movimento , Resultado do Tratamento
10.
Rev. enferm. UFPE on line ; 13(5): 1485-1494, maio 2019. ilus, tab, graf
Artigo em Português | BDENF - Enfermagem | ID: biblio-1024766

RESUMO

Objetivo: identificar, na produção científica, como os cuidados paliativos são ofertados sob a percepção dos pacientes que necessitam dessa terapia. Método: trata-se de estudo bibliográfico, descritivo, tipo revisão integrativa, de estudos publicados entre 2006 e 2016, nas bases de dados MEDLINE, BDENF, IBECS e LILACS. Utilizaram-se descritores controlados contemplados no DeCS, e resultados apresentados em forma de tabelas e figuras, discutidos com a literatura. Resultados: identificaram-se 27 publicações, as quais compuseram a amostra final. Elaboraram-se duas categorias temáticas: A percepção dos pacientes quanto aos cuidados paliativos ofertados por equipes especializadas e pelas equipes não especializadas e, As diferenças dos cuidados paliativos segundo o ambiente: atenção domiciliar versus atenção hospitalar. Conclusão: evidenciase que os cuidados paliativos ofertados, segundo a percepção dos pacientes, devem abranger a totalidade do sujeito. Identificou-se que as equipes especializadas conseguem atender melhor os pacientes em cuidados paliativos. Ressalta-se que este estudo irá contribuir para a carência de publicações na temática, levando em consideração a ascensão dos cuidados paliativos, sendo necessário compreender a percepção do paciente sobre a oferta desse cuidado.(AU)


Objective: to identify, in scientific production, how palliative care is offered under the perception of patients who need this therapy. Method: this is a descriptive, descriptive, integrative review, of studies published between 2006 and 2016 in the MEDLINE, BDENF, IBECS and LILACS databases. Controlled descriptors were used, in DeCS, and results presented in the form of tables and figures, discussed with the literature. Results: 27 publications were identified, which comprised the final sample. Two thematic categories were elaborated: Patients' perception of palliative care offered by specialized teams and non-specialized teams; and Differences in palliative care according to the environment: home care versus hospital care. Conclusion: it is evident that the palliative care offered, according to the patients' perception, should cover the totality of the subject. It was identified that specialized teams are able to better serve patients in palliative care. It should be emphasized that this study will contribute to the lack of publications on the subject, taking into account the rise of palliative care, and it is necessary to understand the patient's perception about the provision of this care.(AU)


Objetivo: identificar, en la producción científica, cómo los cuidados paliativos son ofrecidos bajo la percepción de los pacientes que necesitan esa terapia. Método: se trata de estudio bibliográfico, descriptivo, tipo revisión integrativa, de estudios publicados entre 2006 y 2016, en las bases de datos MEDLINE, BDENF, IBECS y LILACS. Se utilizaron descriptores controlados contemplados en el DeCS, y resultados presentados en forma de tablas y figuras, discutidos con la literatura. Resultados: se identificaron 27 publicaciones, las cuales compusieron la muestra final. Se elaboraron dos categorías temáticas: La percepción de los pacientes en cuanto a los cuidados paliativos ofrecidos por equipos especializados y por los equipos no especializados y, Las diferencias de los cuidados paliativos según el ambiente: atención domiciliar frente a la atención hospitalaria. Conclusión: se evidencia que los cuidados paliativos ofrecidos, según la percepción de los pacientes, deben abarcar la totalidad del sujeto. Se identificó que los equipos especializados logran atender mejor a los pacientes en cuidados paliativos. Se resalta que este estudio contribuirá a la carencia de publicaciones en la temática, teniendo en cuenta la ascensión de los cuidados paliativos, siendo necesario comprender la percepción del paciente sobre la oferta de ese cuidado.(AU)


Assuntos
Humanos , Masculino , Feminino , Cuidados Paliativos , Pacientes , Percepção , Cuidados Paliativos na Terminalidade da Vida , Serviços Hospitalares de Assistência Domiciliar , Assistência Hospitalar , Epidemiologia Descritiva , MEDLINE , LILACS
11.
Clin Rehabil ; 33(9): 1431-1444, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31032629

RESUMO

OBJECTIVE: The aim of this study was to test and compare the effect of (1) a systematic discharge assessment with targeted advice and (2) a motivational interview followed by a home visit. DESIGN: This was a three-armed randomized controlled study. SETTING: This study was conducted in the Medical department in a university hospital. SUBJECTS: Patients ⩾65 years of age with health problems at discharge participated in the study. INTERVENTIONS: Group A (n = 117): patients were informed of health problems and self-care interventions; Group B (n = 116): a motivational conversation targeting activities of daily living with a home care nurse and a home visit. MAIN MEASURES: The main measures of this study were readmissions, handgrip strength, chair-to-stand test, health-related quality of life, depression signs, mortality, and call on municipality services. RESULTS: Risk of readmission was reduced for intervention groups by 30% (A; P = 0.26) and 22 % (B; P = 0.46). Mean number of days to first readmission was 49.5 (±51.0) days for the control group (n = 116) and 57.9 (±53.6) and 67.2 (±58.1) days for the intervention groups A (P = 0.43) and B (P = 0.10), respectively. Mean loss of handgrip strength was 10.6 (±16.6) kg for men in the control group and 7 (±19.2) and 1.4 (±17.1) kg for the intervention groups A (P = 0.38) and B (P = 0.01), respectively. Health-related quality of life improved with 0.3 (±23.7) points in the control group and 7.4 (±24.4) and 3.2 (±22.3) points in the intervention groups A (P = 0.04) and B (P = 0.37), respectively. In total, 17 (16.3%) in the control group were provided with assistive devices after three months and 8 (7.3%) and 19 (17.6%) in the intervention groups A (P = 0.04) and B (P = 0.81), respectively. CONCLUSION: The interventions reduced the risk of readmission and improved handgrip strength, quality of life, and use of assistive devices.


Assuntos
Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Idoso , Dinamarca , Feminino , Força da Mão , Serviços Hospitalares de Assistência Domiciliar , Hospitais Universitários , Humanos , Masculino , Entrevista Motivacional , Educação de Pacientes como Assunto , Qualidade de Vida , Equipamentos de Autoajuda/estatística & dados numéricos , Autogestão
12.
J Clin Nurs ; 28(15-16): 2966-2978, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31017322

RESUMO

AIMS AND OBJECTIVES: To present parents' lived experience of having a preterm infant cared for at the neonatal unit until discharge from hospital-based neonatal home care (HNHC). BACKGROUND: Becoming a parent to a preterm infant has been reported as an experience that may influence the parent's lifeworld also after discharge. Interventions have been implemented at the NICUs, for example introduction of family-centred care aiming to reduce parent-infant separation, increased integration of the parents, to support them in their altered parental role. DESIGN: A descriptive phenomenological interview study. METHODS: Six parent couples at a NICU in Sweden were included and interviewed individually after discharge from HNHC. The interviews were analysed from the perspective of caring sciences using a descriptive phenomenological method. The study followed the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULT: The journey from birth to discharge from hospital-based neonatal home care affected the parents' lifeworld. The parents' experiences differed. Mothers experienced more physiological reactions that triggered feelings of existential loneliness and guilt and difficulties in combining the role of mother with partner. The fathers faced conflicts managing their partners' demands, family challenges and employers who claimed their time and energy, which negatively affected their transition into fatherhood. Both mothers and fathers experienced ambivalent feelings in the relationships with the professional staff, which was more strongly expressed by the mothers. CONCLUSION: It is important for healthcare providers to help parents clarify their individual needs and values in caring for a preterm infant to help them achieve parental and family well-being. RELEVANCE TO CLINICAL PRACTICE: These findings can guide healthcare providers to help parents improve care for their preterm infants in the NICU. Integrating a person-centred approach such as supportive person-centred dialogues focused on parents' individual needs might be one way to support parents.


Assuntos
Pai/psicologia , Cuidado do Lactente/psicologia , Recém-Nascido Prematuro , Mães/psicologia , Adaptação Psicológica , Adulto , Feminino , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Humanos , Lactente , Recém-Nascido , Masculino , Poder Familiar/psicologia , Gravidez , Pesquisa Qualitativa , Suécia
13.
Soins Gerontol ; 24(135): 39-42, 2019.
Artigo em Francês | MEDLINE | ID: mdl-30765087

RESUMO

Heart failure, a serious and progressive disease, mainly affects the elderly. The Vendée coastline attracts high numbers of retired people to the region. Faced with this observation, Vendée departmental hospital deemed it necessary to put in place a monitoring unit providing adapted care in order to reduce the rate of mortality and rehospitalisation. The implementation of the Return Home programme has had a positive impact on the optimised care management of patients.


Assuntos
Insuficiência Cardíaca/terapia , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Idoso , Humanos , Avaliação de Programas e Projetos de Saúde
14.
Clin Rehabil ; 33(4): 681-692, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30642194

RESUMO

OBJECTIVE:: The objective of this study is to investigate whether home assessment visits prior to hospital discharge for patients recovering from hip fracture reduce falls and prevent hospital readmissions, within the first 30 days and six months after discharge home. DESIGN:: A randomized controlled trial was conducted. SETTING:: The study setting included hospital wards and the community. PARTICIPANTS:: The study included adults 50 years and over recovering from hip fracture ( n = 77). INTERVENTION:: Both groups received inpatient rehabilitation and hospital-based discharge planning. In addition, the intervention group received a home assessment visit by an occupational therapist prior to discharge from hospital. MAIN MEASURES:: Primary outcomes were falls and hospital readmissions. Secondary outcome measures included Functional Independence Measure, Functional Autonomy Measurement Scale, Nottingham Extended Activities of Daily Living Scale, EuroQol five dimension scale questionnaire and Falls Efficacy Scale-International. RESULTS:: The intervention group had fewer hospital readmissions in the first 30 days compared to the control group (intervention n = 1, control n = 10; odds ratio (OR) 12.9, 95% confidence interval (CI) 1.5 to 99.2). The intervention group was observed to have fewer falls than controls in the 30 days after discharge (intervention n = 6, control n = 14; incidence rate ratio (IRR) = 0.41, 95% CI 0.15 to 1.11). Between-group differences favoured the intervention group for functional independence at six months (11.2 units, 95% CI 4.2 to 18.2). There were no other between-group differences. CONCLUSION:: Home assessment visits by occupational therapists prior to hospital discharge for patients recovering from hip fracture reduced the number of readmissions to hospital, increased functional independence at six months and may have reduced the risk of falls in the first 30 days after discharge.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Fraturas do Quadril/terapia , Serviços Hospitalares de Assistência Domiciliar , Terapia Ocupacional , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Método Simples-Cego
15.
Home Healthc Now ; 37(1): 44-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30608467

RESUMO

The ability to maintain functional status is an essential aspect of self-care for older adults. Instrumental activities of daily living (IADLs) decline within hours of hospitalization and are often overlooked, underassessed, and underreported. The aim of this integrative review was to examine and compare methods used to assess IADLs to determine the best measure for use across the care continuum, especially during transitions of care. A literature search without date restrictions was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Embase databases. Twelve studies of moderate quality were included in this review. More than half (58%) of the studies utilized the Lawton and Brody Scale to measure IADL among home-based and hospitalized patients. Implementation of this scale as standard practice and sharing the results with healthcare providers would encourage continuity of care with the goal of supporting older adults aging in place and preventing rehospitalization. In turn, this communication process may improve the transition from the inpatient to home setting, where, since 1999, the Outcome and Assessment Information Set has been mandated.


Assuntos
Atividades Cotidianas , Serviços de Assistência Domiciliar/organização & administração , Enfermagem Domiciliar/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Idoso , Serviços de Saúde para Idosos/organização & administração , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Humanos , Masculino
17.
Arch Dis Child ; 104(5): 476-481, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30455364

RESUMO

OBJECTIVE: To evaluate the success rates of home cardiorespiratory polygraphy in children under investigation for sleep-disordered breathing and parent perspectives on equipment use at home. DESIGN: Prospective observational study. SETTING: Sheffield, Evelina London and Southampton Children's Hospitals. PATIENTS: Data are reported for 194 research participants with Down syndrome, aged 0.5-5.9 years across the three centres and 61 clinical patients aged 0.4-19.5 years from one centre, all of whom had home cardiorespiratory polygraphy including respiratory movements, nasal pressure flow, pulse oximetry, body position and motion. MAIN OUTCOME MEASURES: Percentage of home cardiorespiratory studies successfully acquiring ≥4 hours of artefact-free data at the first attempt. Parental report of ease of use of equipment and preparedness to repeat home diagnostics in the future. RESULTS: 143/194 (74%; 95% CI 67% to 79%) of research participants and 50/61 (82%; 95% CI 71% to 90%) of clinical patients had successful home cardiorespiratory polygraphy at the first attempt. Some children required multiple attempts to achieve a successful study. Overall, this equated to 1.3 studies per research participant and 1.2 studies per clinical child. The median artefact-free sleep time for successful research studies was 515 min (range 261-673) and for clinical studies 442 min (range 291-583). 84% of research and 87% of clinical parents expressed willingness to repeat home cardiorespiratory polygraphy in the future. 67% of research parents found the equipment 'easy or okay' to use, while 64% of clinical parents reported it as 'easy' or 'very easy'. CONCLUSIONS: Home cardiorespiratory polygraphy offers an acceptable approach to the assessment of sleep-disordered breathing in children.


Assuntos
Serviços Hospitalares de Assistência Domiciliar , Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Adolescente , Criança , Pré-Escolar , Síndrome de Down/complicações , Inglaterra , Humanos , Lactente , Monitorização Fisiológica/métodos , Oximetria , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Síndromes da Apneia do Sono/etiologia , Adulto Jovem
18.
Surgery ; 165(2): 423-430, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30545657

RESUMO

BACKGROUND: The 30-day readmission rate is increasingly utilized as a metric of quality that impacts reimbursement. To date, there are no nationally representative data on readmission rates after thyroid surgery. We aimed to determine national readmission rates after inpatient thyroidectomy operations and whether select clinical factors were associated with increased odds of postthyroidectomy readmission. METHODS: Using the 2014 Nationwide Readmissions Database, we identified patients undergoing inpatient thyroid surgery as defined by the International Classification of Diseases, Ninth Revision, procedure codes for thyroid lobectomy, partial thyroidectomy, complete thyroidectomy, and substernal thyroidectomy. Descriptive statistics were used to report readmission rates, most common diagnosis and causes of readmission, and timing of presentation after discharge. Multivariable logistic regression models controlling for potential confounders were used to determine whether select factors were associated with 30-day readmission. RESULTS: A total of 22,654 patients underwent inpatient thyroid surgery during the study period, 990 of whom (4.4%) were readmitted within 30 days. Among these, the most common diagnoses during readmission were disorders of mineral metabolism and hypocalcemia, accounting for 36.0% and 26.6% of readmissions, respectively. This held true regardless of the apparent indication for thyroid surgery (goiter, cancer, or thyroid function disorder) or timing of readmission after discharge. Calcium-related abnormalities were the top diagnoses at readmissions (22.1%). Most readmissions (54.6%) occurred within 7 days of discharge, with 24.6% within the first 2 days Factors associated with an increased odds of readmission included having Medicare (adjusted odds ratio [AOR] 1.47 and 95% confidence interval [CI] 1.03-2.11) or Medicaid insurance (AOR 1.44 [CI 1.04-1.99]), being discharged to inpatient post acute care (AOR 2.31 [CI 1.48-3.62]) or to home health care (AOR 1.78 [CI 1.21-2.63]), having an Elixhauser comorbidity score ≥ 4 (AOR 2.04 [CI 1.27-3.26]), and a duration of stay ≥2 days after the thyroid surgery (AOR 2.7 [CI 1.9-3.82]). The only complication during index admission associated with increased odds of readmission was hypocalcemia (AOR 1.5 [CI 1.1-2.06]. Indications for thyroid surgery were not associated with increased odds of readmission. CONCLUSION: Readmissions after thyroid surgery are relatively low and occur early after surgery. The most common diagnoses identified on readmission were calcium and mineral metabolism disorders, which also were the most common cause of readmission. Socioeconomic factors, comorbidities, and complications during the index admissions were found to be associated with nonelective, postthyroidectomy readmissions. Recognition of these risk factors may guide the development of interventions and protocols to decrease readmissions.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Tireoidectomia , Fatores Etários , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Humanos , Hipocalcemia/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Cuidados Semi-Intensivos/estatística & dados numéricos , Estados Unidos/epidemiologia
19.
BMJ Open ; 8(12): e024499, 2018 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-30559161

RESUMO

OBJECTIVES: The Heart Manual (HM) is the UK's leading facilitated home-based cardiac rehabilitation (CR) programme for individuals recovering from myocardial infarction and revascularisation. This audit explored patient-reported outcomes of home-based CR in relation to current Scottish, UK and European guidelines. SETTING: Patients across the UK returned their questionnaire after completing the HM programme to the HM Department (NHS Lothian). PARTICIPANTS: Qualitative data from 457 questionnaires returned between 2011 and 2018 were included for thematic analysis. Seven themes were identified from the guidelines. This guided initial deductive coding and provided the basis for inductive subthemes to emerge. RESULTS: Themes included: (1) health behaviour change and modifiable risk reduction, (2) psychosocial support, (3) education, (4) social support, (5) medical risk management, (6) vocational rehabilitation and (7) long-term strategies and maintenance. Both (1) and (2) were reported as having the greatest impact on patients' daily lives. Subthemes for (1) included: guidance, engagement, awareness, consequences, attitude, no change and motivation. Psychosocial support comprised: stress management, pacing, relaxation, increased self-efficacy, validation, mental health and self-perception. This was followed by (3) and (4). Patients less frequently referred to (5), (6) and (7). Additional themes highlighted the impact of the HM programme and that patients attributed the greatest impact to a combination of all the above themes. CONCLUSIONS: This audit highlighted the HM as comprehensive and inclusive of key elements proposed by Scottish, UK and EU guidelines. Patients reported this had a profound impact on their daily lives and proved advantageous for CR.


Assuntos
Reabilitação Cardíaca/normas , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Infarto do Miocárdio/reabilitação , Medidas de Resultados Relatados pelo Paciente , Guias de Prática Clínica como Assunto , Reabilitação Cardíaca/métodos , Auditoria Clínica , Europa (Continente) , Comportamentos Relacionados com a Saúde , Serviços Hospitalares de Assistência Domiciliar/economia , Humanos , Cooperação do Paciente , Educação de Pacientes como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Gestão de Riscos , Escócia , Apoio Social , Inquéritos e Questionários , Reino Unido
20.
Cochrane Database Syst Rev ; 12: CD012132, 2018 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-30536917

RESUMO

BACKGROUND: Pressure ulcers, which are a localised injury to the skin, or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, expensive to manage and have a negative impact on quality of life. While individual patient safety and quality care stem largely from direct healthcare practitioner-patient interactions, each practitioner-patient wound-care contact may be constrained or enhanced by healthcare organisation of services. Research is needed to demonstrate clearly the effect of different provider-orientated approaches to pressure ulcer prevention and treatment. OBJECTIVES: To assess the effects of different provider-orientated interventions targeted at the organisation of health services, on the prevention and treatment of pressure ulcers. SEARCH METHODS: In April 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-RCTs, non-RCTs, controlled before-and-after studies and interrupted time series, which enrolled people at risk of, or people with existing pressure ulcers, were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment, data extraction and GRADE assessment of the certainty of evidence. MAIN RESULTS: The search yielded a total of 3172 citations and, following screening and application of the inclusion and exclusion criteria, we deemed four studies eligible for inclusion. These studies reported the primary outcome of pressure ulcer incidence or pressure ulcer healing, or both.One controlled before-and-after study explored the impact of transmural care (a care model that provided activities to support patients and their family/partners and activities to promote continuity of care), among 62 participants with spinal cord injury. It is unclear whether transmural care leads to a difference in pressure ulcer incidence compared with usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.53 to 1.64; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).One RCT explored the impact of hospital-in-the-home care, among 100 older adults. It is unclear whether hospital-in-the-home care leads to a difference in pressure ulcer incidence risk compared with hospital admission (RR 0.32, 95% CI 0.03 to 2.98; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).A third study (cluster-randomised stepped-wedge trial), explored the impact of being cared for by enhanced multidisciplinary teams (EMDT), among 161 long-term-care residents. The analyses of the primary outcome used measurements of 201 pressure ulcers from 119 residents. It is unclear if EMDT reduces the pressure ulcer incidence rate compared with usual care (hazard ratio (HR) 1.12, 95% CI 0.74 to 1.68; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the number of wounds healed (RR 1.69, 95% CI 1.00 to 2.87; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the reduction in surface area, with and without EMDT, (healing rate 1.006; 95% CI 0.99 to 1.03; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if EMDT leads to a difference in time to complete healing (HR 1.48, 95% CI 0.79 to 2.78, very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).The final study (quasi-experimental cluster trial), explored the impact of multidisciplinary wound care among 176 nursing home residents. It is unclear whether there is a difference in the number of pressure ulcers healed between multidisciplinary care, or usual care (RR 1.18, 95% CI 0.98 to 1.42; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if this type of care leads to a difference in time to complete healing compared with usual care (HR 1.73, 95% CI 1.20 to 2.50; very low-certainty evidence; downgraded twice for very serious study limitations and twice for very serious imprecision).In all studies the certainty of the evidence is very low due to high risk of bias and imprecision. We downgraded the evidence due to study limitations, which included selection and attrition bias, and sample size. Secondary outcomes, such as adverse events were not reported in all studies. Where they were reported it was unclear if there was a difference as the certainty of evidence was very low. AUTHORS' CONCLUSIONS: Evidence for the impact of organisation of health services for preventing and treating pressure ulcers remains unclear. Overall, GRADE assessments of the evidence resulted in judgements of very low-certainty evidence. The studies were at high risk of bias, and outcome measures were imprecise due to wide confidence intervals and small sample sizes, meaning that additional research is required to confirm these results. The secondary outcomes reported varied across the studies and some were not reported. We judged the evidence from those that were reported (including adverse events), to be of very low certainty.


Assuntos
Administração de Serviços de Saúde , Lesão por Pressão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Controlados Antes e Depois , Serviços Hospitalares de Assistência Domiciliar , Hospitalização , Humanos , Incidência , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Traumatismos da Medula Espinal/complicações , Cicatrização
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