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1.
Artigo em Inglês | MEDLINE | ID: mdl-33322181

RESUMO

Homecare nurses manage patients with extreme homecare dependence through interprofessional collaboration. The quality of the collaboration depends on situations, and the difficulties of homecare nurses are complicated in rural settings because of a few healthcare resources. This study determined rural homecare nurses' difficulties during interprofessional collaboration in providing seamless patient care. Focus groups, followed by one-on-one interviews, were conducted with 13 rural homecare nurses working in rural Japan. Using thematic analysis, four themes were extracted: collaboration with physicians, the collaboration with the government, the collaboration with care workers, and the collaboration among hospital nurses. Rural homecare nurses have difficulties in their working relationships with other professionals, with vague definitions of each professional's roles and responsibilities, and with information-sharing. Interprofessional education and information-sharing should respect rural professional and cultural backgrounds. Respect can accomplish mutual understanding among professional care, leading to seamless patient care in rural home care.


Assuntos
Serviços de Assistência Domiciliar , Enfermeiras e Enfermeiros , Comportamento Cooperativo , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Relações Interprofissionais , Japão , Enfermeiras e Enfermeiros/estatística & dados numéricos , Assistência ao Paciente/normas , Assistência ao Paciente/estatística & dados numéricos , Pesquisa Qualitativa , População Rural
2.
Am J Respir Crit Care Med ; 202(10): e121-e141, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-33185464

RESUMO

Background: Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations.Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1) strong recommendations for long-term oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2) a conditional recommendation against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3) conditional recommendations for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4) a conditional recommendation for ambulatory liquid-oxygen use in patients who are mobile outside the home and require >3 L/min of continuous-flow oxygen during exertion (very-low-quality evidence), and 5) a recommendation that patients and their caregivers receive education on oxygen equipment and safety (best-practice statement).Conclusions: These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.


Assuntos
Medicina Baseada em Evidências/normas , Serviços de Assistência Domiciliar/normas , Doenças Pulmonares Intersticiais/terapia , Oxigenoterapia/métodos , Oxigenoterapia/normas , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sociedades Médicas , Estados Unidos
3.
Angiol. (Barcelona) ; 72(4): 186-197, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193581

RESUMO

Los pacientes infectados por el nuevo coronavirus COVID-19 presentan un riesgo incrementado de enfermedad tromboembólica venosa (ETEV). La presente guía de práctica clínica del Capítulo Español de Flebología y Linfología y la Sociedad Española de Angiología y Cirugía Vascular pretende dar una serie de recomendaciones sobre profilaxis y tratamiento de la ETEV en los pacientes infectados por COVID-19, tanto a nivel hospitalario como ambulatorio, y consejos sobre su seguimiento clínico y ecográfico. Se recomienda que todos los pacientes con infección por COVID-19 hospitalizados, tengan o no factores de riesgo protrombótico asociados, reciban profilaxis antitrombótica, si no existe contraindicación. En caso de pacientes ambulatorios, según perfil clínico e historial médico, se recomienda valorar tromboprofilaxis con heparina de bajo peso molecular (HBPM), en ausencia de contraindicación. Ante el diagnóstico de TVP en paciente con COVID-19, tanto hospitalizado o ambulatorio, debe iniciarse el tratamiento anticoagulante con HBPM a dosis terapéuticas. No existen interacciones farmacológicas descritas de las HPBM con los fármacos empleados contra el COVID-19. Los niveles elevados de dímero-D son un hallazgo común en pacientes con COVID-19, por lo que este parámetro, de forma aislada, no es indicativo para realizar una ecografía Doppler de rutina. Se aconseja la realización de ecografía Doppler a un paciente COVID-19 positivo (con las medidas de protección necesarias) para descartar TVP solo en pacientes con alta sospecha clínica de TVP y cuando se dé una de las dos situaciones clínicas: alto riesgo de sangrado, o que exista un incremento brusco e inesperado de los niveles de dímero-D


Patients infected with the new coronavirus COVID-19 have an increased risk of venous thromboembolic disease (VTEV). The present clinical practice guide of the Spanish Chapter of Phlebology and Lymphology and the Spanish Society of Angiology and Vascular Surgery, aims to give a series of recommendations on prophylaxis and treatment of VTE in patients infected with COVID-19, both at the hospital and outpatient, and advice on their clinical and ultrasound monitoring. It is recommended that all hospitalized patients with COVID-19 infection, whether or not they have associated prothrombotic risk factors, should receive antithrombotic prophylaxis, if there is no contraindication. In the case of outpatients, according to clinical profile and medical history, it is recommended to evaluate thromboprophylaxis with low molecular weight heparin (LMWH), in the absence of contraindication. Given the diagnosis of DVT in a patient with COVID19, both hospitalized and outpatient, anticoagulant treatment with LMWH should be started at therapeutic doses. There are no described pharmacological interactions of HPBMs with the drugs used against COVID19. High levels of D-dimer are a common finding in patients with COVID-19, so this parameter, in isolation, is not indicative for routine Doppler ultrasound. Doppler ultrasound is recommended for a COVID-19 positive patient (with the necessary protective measures), to rule out DVT, only in patients with high clinical suspicion of DVT, and when one of the two clinical situations occurs: high risk of bleeding, or a sudden and unexpected increase in D-dimer levels


Assuntos
Humanos , Anticoagulantes/farmacologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/tratamento farmacológico , Fibrinolíticos/farmacologia , Pneumonia Viral/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Sociedades Médicas/normas , Pandemias , Fatores de Risco , Heparina de Baixo Peso Molecular/uso terapêutico , Ultrassonografia , Infecções por Coronavirus/fisiopatologia , Serviços de Assistência Domiciliar/normas
4.
Rev Bras Enferm ; 73Suppl 2(Suppl 2): e20200310, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32609252

RESUMO

OBJECTIVE: To suggest recommendations for the practice of Home Nursing in the context of COVID-19. METHOD: Reflective study, originated from readings associated with the theme, available in current guidelines from the Pan American Health Organization, World Health Organization and the Ministry of Health. RESULTS: Recommendations were developed from current scientific evidence for prevention of infections, control of epidemics and pandemics in the Brazilian home scenario. FINAL CONSIDERATIONS: the reflections achieved contribute to guiding actions for better assistance to the patient, family caregivers and the community in the perspective of safe home care with COVID-19, and it is characterized as an introductory discussion on the theme, encouraging new studies to be carried out from the unfolding of the current scenario.


Assuntos
Betacoronavirus , Cuidadores/educação , Infecções por Coronavirus/enfermagem , Serviços de Assistência Domiciliar/normas , Assistência Domiciliar/normas , Educação de Pacientes como Assunto , Pneumonia Viral/enfermagem , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
5.
PLoS One ; 15(7): e0235068, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645015

RESUMO

Advances in digital health technologies have revolutionised home medical care. Yet many home medical devices (HMEDs, which includes devices referred to as 'life support equipment') rely upon a stable and resilient electricity supply. For users of HMEDs, interruptions to electricity supply can compromise treatment, well-being or survival. This paper addresses a challenge critical to the continued innovation in digital health technologies: the reliable supply of electricity. We bridge the current gap between electricity networks and digital health technologies through a novel method for the remote detection of the phase (that is, which part of the network that each house is connected to), in order to eliminate avoidable interruptions to supply for HMED users. We present an unsupervised phase identification algorithm capable of remote phase detection at scale, and without transformer data. This method translates data insights into actionable energy provision for HMED users and other vulnerable customers, enables more accurate management and planning, and improves electricity reliability which is critical for HMED users and the continued advances in digital health technologies.


Assuntos
Eletricidade , Equipamentos e Provisões , Serviços de Assistência Domiciliar , Algoritmos , Equipamentos e Provisões/normas , Serviços de Assistência Domiciliar/normas , Humanos
6.
Ann Am Thorac Soc ; 17(9): 1040-1046, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32521167

RESUMO

During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as "silent hypoxemia." To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone-based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.


Assuntos
Infecções por Coronavirus/diagnóstico , Serviços de Assistência Domiciliar/normas , Monitorização Fisiológica/normas , Oximetria/normas , Pandemias , Pneumonia Viral/diagnóstico , Guias de Prática Clínica como Assunto , Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia
7.
PLoS One ; 15(6): e0234651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544174

RESUMO

BACKGROUND: Imipenem, an intravenous antibiotic is recommended for use in drug resistant tuberculosis (DR-TB) when an effective regimen with combination of other second line drugs is not possible. Though the treatment success rates with carbapenems are promising, the twice daily injection of Imipenem usually requires patients to be hospitalized. The Médecins Sans Frontières independent clinic in Mumbai, India implemented ambulatory and home based management of patients receiving Imipenem through the use of port-a-cath. OBJECTIVE: We aimed to describe the adverse events and treatment outcomes of ambulatory pre- and XDR-TB patients initiated on imipenem through port-a-cath between January 2015 and June 2018 and to explore the challenges with this regimen as perceived by healthcare providers and patients. METHODS: A convergent mixed methods study with quantitative (longitudinal descriptive study using the routine data) and qualitative (descriptive study) part conducted concurrently. For the quantitative component, all XDR-TB and pre-XDR-TB initiated on imipenem containing regimen during January 2015-June 2018 were included. For qualitative component, interviews were carried out including patients who initiated on imipenem (n = 5) and healthcare providers (n = 7) involved in providing treatment. Treatment outcomes, culture conversion and adverse events during treatment were described. Thematic analysis was carried out for qualitative component. RESULTS: Of the 70 patients included, the mean age was 28.1 (standard deviation: 11.2) years and 36 (51.4%) were females. Fifty one (72.9%) had XDR-TB. All patients were resistant to fluoroquinilone, levofloxacin. Vomiting was reported by 55 (78.6%) patients and at least one episode of QTC prolongation (more than 500 msec by Fredrecia method) was detected in 25 (35.7%). Port-a-cath block and infection was seen in 11 (15.7%) and 20 (28.6%) patients respectively. Favourable outcomes were seen in 43 (61.4%) patients. Mortality was seen in 22 (31.4%) patients, 2 (2.9%) were lost-to-follow-up and 3 (4.3%) were declared as treatment failure. The overarching theme of the qualitative analysis was: Challenges in delivering Imipenem via port-a-cath device in ambulatory care. Major challenges identified were difficulties in adhering to drug dose timelines, vomiting, restricted mobility due to port-a-cath, paucity of infection control and space constraints at patients' home for optimal care. CONCLUSION: Administration of imipenem was feasible through port-a-cath. Though outcomes with ambulatory based imipenem containing regimens were promising, there were several challenges in providing care. The feasibility of infusion at day care facilities needs to explored to overcome challenges in infusion at patients home.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Imipenem/administração & dosagem , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Instituições de Assistência Ambulatorial/normas , Antituberculosos/efeitos adversos , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/complicações , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Imipenem/efeitos adversos , Imipenem/normas , Índia , Controle de Infecções/normas , Masculino , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Dispositivos de Acesso Vascular , Vômito/induzido quimicamente
8.
Health Qual Life Outcomes ; 18(1): 193, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32563246

RESUMO

BACKGROUND: Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region. METHODS: The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My™). The SASC10-My™ was then tested on 175 post-stroke patients who were recruited at ten public primary care healthcentres across Peninsular Malaysia, in a trial-within a trial study. RESULTS: One item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My™ had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My™ was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My™ score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge. CONCLUSIONS: The SASC10-My™ questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes. TRIAL REGISTRATION: No.: ACTRN12616001322426 (Registration Date: 21st September 2016.


Assuntos
Assistência Ambulatorial/normas , Cuidadores/psicologia , Serviços de Assistência Domiciliar/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Reabilitação do Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Satisfação Pessoal , Psicometria , Qualidade de Vida/psicologia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Sobreviventes/psicologia , Traduções
9.
BMC Health Serv Res ; 20(1): 366, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349757

RESUMO

BACKGROUND: One way of measuring the quality of home care are quality indicators (QIs) derived from data collected with the Resident Assessment Instrument-Home Care (RAI-HC). In order to produce meaningful results for quality improvement and quality comparisons across home care organizations (HCOs) and over time, RAI-HC QIs must be valid and reliable. The aim of this systematic review was to identify currently existing RAI-HC QIs and to summarize the scientific knowledge on the validity and reliability of these QIs. METHODS: A systematic review was performed using the electronic databases PubMed, CINAHL, Embase, PsycINFO and Cochrane Library. Studies describing the development process or the psychometric characteristics of RAI-HC QIs were eligible. The data extraction involved a general description of the included studies as well as the identified RAI-HC QIs and information on validity and reliability. The methodological quality of the identified RAI-HC QI sets was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. RESULTS: Four studies out of 659 initial hits met the inclusion criteria. The included studies described the development and validation process of three RAI-HC QI sets comprising 48 unique RAI-HC QIs, which predominantly refer to outcome of care. Overall, the validity and reliability of the identified RAI-HC QIs were not sufficiently tested. The methodological quality of the three identified RAI-HC QI sets varied across the four AIRE instrument domains. None of the QI sets reached high methodological quality, defined as scores of 50% and higher in all four AIRE instrument domains. CONCLUSIONS: This is the first review that systematically summarized and appraised the available scientific evidence on the validity and reliability of RAI-HC QIs. It identified insufficient reporting of RAI-HC QIs validation processes and reliability as well as missing state-of-the-art methodologies. The review provides guidance as to what additional validity and reliability testing are needed to strengthen the scientific soundness of RAI-HC QIs. Considering that RAI-HC QIs are already implemented and used to measure and compare quality of home care, further investigations on RAI-HC QIs reliability and validity is recommended.


Assuntos
Serviços de Assistência Domiciliar/normas , Indicadores de Qualidade em Assistência à Saúde , Humanos , Reprodutibilidade dos Testes
10.
Medicine (Baltimore) ; 99(20): e20256, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443364

RESUMO

INTRODUCTION: Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise. METHODS AND ANALYSIS: This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome. DISCUSSION: This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction. TRIAL REGISTRATION NUMBER: This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Estimulação Elétrica/instrumentação , Terapia por Exercício/instrumentação , Serviços de Assistência Domiciliar/normas , Reabilitação/normas , Adulto , Ligamento Cruzado Anterior/anormalidades , Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/reabilitação , Lesões do Ligamento Cruzado Anterior/cirurgia , Protocolos Clínicos , Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Serviços de Assistência Domiciliar/tendências , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação/instrumentação , Reabilitação/métodos , Inquéritos e Questionários , Resultado do Tratamento
11.
Muscle Nerve ; 62(1): 103-110, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32319099

RESUMO

INTRODUCTION: Monitoring grip strength at home may detect improvement between intravenous immunoglobulin (IVIg) treatments in patients with chronic inflammatory neuropathies (CINs). METHODS: Fifteen patients recorded grip strength each day, from one IVIg treatment until the next. We analyzed grip strength changes comparing thresholds of 8 kPa and 14 kPa. "Random" fluctuations of grip strength were distinguished from treatment response by smoothing the data. RESULTS: "Random" fluctuations of at least 8 kPa occurred in 27% of patients. Smoothed daily grip strength increased by at least 8 kPa above baseline in 11 (73%) patients. Grip strength increased by at least 8 kPa for 3 consecutive days in 9 (60%) patients, and 5-day block mean increased by at least 8 kPa in 10 (67%) patients. DISCUSSION: Home monitoring of grip strength confirmed treatment response in most patients with CINs on IVIg. To detect improvement in an individual patient, we suggest a threshold of at least 8 kPa on 3 consecutive days or on 5-day block mean.


Assuntos
Força da Mão/fisiologia , Serviços de Assistência Domiciliar/tendências , Imunoglobulinas Intravenosas/administração & dosagem , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Adulto , Idoso , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Masculino , Pessoa de Meia-Idade , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/fisiopatologia , Autorrelato/normas
12.
Recenti Prog Med ; 111(4): 257-258, 2020 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-32319448

RESUMO

We report on the protocol adopted by the Oncological Home Care Service of the Tuscany Cancer Association during the CoViD-19 pandemic. Based on the experience in home cancer care gained during the 2009 earthquake, we have developed strategies to ensure continuity of care, non-abandonment and protection of operators. In this context, the double triage protocol plays a central role, aimed at identifying patients at risk for CoViD-19 infection and rationalizing home access. we describe the protocol and present the preliminary data.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por Coronavirus , Planejamento em Desastres , Serviços de Assistência Domiciliar , Pandemias , Pneumonia Viral , Alocação de Recursos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Terremotos , Alocação de Recursos para a Atenção à Saúde , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/provisão & distribução , Humanos , Itália , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
13.
BMC Health Serv Res ; 20(1): 277, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245450

RESUMO

BACKGROUND: Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. METHOD: The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework 'Organizing for Quality', focusing on the work needed to meet quality and safety challenges. RESULTS: Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. CONCLUSION: Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers' and employees' work on quality and safety in nursing homes and home care.


Assuntos
Serviços de Assistência Domiciliar/normas , Casas de Saúde/normas , Qualidade da Assistência à Saúde/normas , Competência Clínica , Grupos Focais , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Noruega , Segurança do Paciente/normas
14.
J Clin Nurs ; 29(13-14): 2429-2440, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32227641

RESUMO

AIM AND OBJECTIVES: To develop knowledge about homecare professionals' observational competence in early recognition of deterioration in frail older patients. BACKGROUND: The number of frail older patients in homecare has been rising, and these patients are at higher risk of deterioration and mortality. However, studies are scarce on homecare professionals' recognition and response to clinical deterioration in homecare. DESIGN: This study applies an explorative, qualitative, mixed-methods design. METHODS: The data were collected in two homecare districts in 2018 during 62 hr of participant observation, as well as from six focus group interviews. The data were subjected to qualitative content analyses. The Standards for Reporting Qualitative Research (SRQR) checklist was used to report the results. RESULTS: The data analyses revealed two main themes and five sub-themes related to homecare professionals' observational practices. The first main theme entailed patient-situated assessment of changes in patients' clinical condition, that is, the homecare professionals' recognised changes in patients' physical and mental conditions. The second theme was the organisational environment, in which planned, practical tasks and collaboration and collegial support were emphasised. CONCLUSIONS: The homecare professionals in the two districts varied in their ability to recognise signs of patient deterioration. Their routines are described in detailed work plans, which seemed to affect assessment of their patients' decline. RELEVANCE FOR CLINICAL PRACTICE: The results can inform homecare services on how homecare professionals' observational competence and an appropriate organisational system are essential in ensuring early detection of deterioration in frail older patients.


Assuntos
Deterioração Clínica , Idoso Fragilizado , Fragilidade/enfermagem , Serviços de Assistência Domiciliar/normas , Avaliação em Enfermagem/normas , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Pesquisa Qualitativa
16.
J Med Internet Res ; 22(2): e16248, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32130127

RESUMO

BACKGROUND: Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions. OBJECTIVE: This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research. METHODS: We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ≤18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. RESULTS: We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals. CONCLUSIONS: The strengths of the conclusions are limited by the studies' methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals. TRIAL REGISTRATION: PROSPERO CRD42018119051; https://tinyurl.com/rtsw5ky.


Assuntos
Serviços de Assistência Domiciliar/normas , Cuidados Paliativos/normas , Telemedicina/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pesquisa Qualitativa
17.
J Med Internet Res ; 22(3): e15548, 2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-32186521

RESUMO

BACKGROUND: Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure. OBJECTIVE: As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip's Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively. METHODS: Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews. RESULTS: A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems. CONCLUSIONS: User testing indicated a high degree of user acceptance of Philips' Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery.


Assuntos
Doenças Cardiovasculares/cirurgia , Serviços de Assistência Domiciliar/normas , Hospitais/normas , Monitorização Fisiológica/métodos , Interface Usuário-Computador , Idoso , Feminino , Humanos , Masculino , Período Pós-Operatório
18.
BMC Palliat Care ; 19(1): 33, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183803

RESUMO

BACKGROUND: Family caregivers of patients with severe illness and in need for a palliative care approach, face numerous challenges and report having insufficient preparedness for the caregiver role as well as a need for information and psychosocial support. Preparing to care for a severely ill family members also means becoming aware of death. Feelings of being prepared are associated with positive aspects and regarded protective against negative health consequences. METHODS: The study adheres to the SPIRIT-guidelines (Supplementary 1), uses a pre-post design and include a web-based intervention. Inclusion criteria are; being a family caregiver of a patient with severe illness and in need of a palliative care approach. The intervention which aims to increase preparedness for caregiving and death is grounded in theory, research and clinical experience. The topics cover: medical issues, symptoms and symptom relief; communication within the couple, how to spend the time before death, being a caregiver, planning for the moment of death and; considerations of the future. The intervention is presented through videos and informative texts. The website also holds an online peer-support discussion forum. Study aims are to: evaluate feasibility in terms of framework, content, usage and partners' experiences; explore how the use of the website, influences family caregivers' preparedness for caregiving and death; explore how the use of the website influences family caregivers' knowledge about medical issues, their communication with the patient and their considerations of the future; and to investigate how the family caregivers' preparedness for caregiving and death influences their physical and psychological health and quality of life 1 year after the patient's death. Data will be collected through qualitative interviews and a study-specific questionnaire at four time-points. DISCUSSION: This project will provide information about whether support via a website has the potential to increase preparedness for caregiving and death and thereby decrease negative health consequences for family caregivers of patients affected by severe illness. It will provide new knowledge about intervention development, delivery, and evaluation in a palliative care context. Identification of factors before death and their association with family caregivers' preparedness and long-term health may change future clinical work. TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov: NCT03676283.


Assuntos
Atitude Frente a Morte , Cuidadores/psicologia , Protocolos Clínicos , Serviços de Assistência Domiciliar/normas , Adaptação Psicológica , Idoso , Estado Terminal/psicologia , Estado Terminal/terapia , Família/psicologia , Feminino , Serviços de Assistência Domiciliar/tendências , Humanos , Intervenção Baseada em Internet , Masculino , Pessoa de Meia-Idade , Apoio Social , Inquéritos e Questionários
20.
Healthc Q ; 22(SP): 100-111, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049620

RESUMO

With Canada's aging population, innovations in technology and changes in patient preferences regarding where they receive care, there is a growing reliance on homecare services. Professionals in the homecare sector want to provide the best care possible for their clients, whereas homecare organizations look to foster a greater patient safety culture. The Canadian Patient Safety Institute and the Canadian Home Care Association conducted two learning collaboratives aimed at increasing quality improvement capability in homecare settings. Teams from across the country have increased their capacity and capability to engage patients and families, mitigate and prevent harm from homecare safety incidents such as falls and specifically address issues such as improving interprofessional collaboration, teamwork and communication.


Assuntos
Acidentes por Quedas/prevenção & controle , Serviços de Assistência Domiciliar/normas , Segurança do Paciente , Melhoria de Qualidade , Canadá , Família , Serviços de Assistência Domiciliar/organização & administração , Humanos , Colaboração Intersetorial , Participação do Paciente , Qualidade da Assistência à Saúde , Gestão da Segurança
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