Comparison of liposomal gel with and without chamomile to prevent radiation dermatitis in breast cancer patients: a randomized controlled trial.

PURPOSE: To compare a liposomal gel with and without chamomile extract for the prevention of radiation dermatitis in breast cancer patients undergoing radiotherapy. METHODS: This study was a double-blind randomized clinical trial. A total of 100 participants undergoing radiotherapy for breast cancer were recruited. The primary outcome was the occurrence of dry desquamation. Cumulative dose of ionizing radiation at the first occurrence of dry desquamation, occurrence of erythema, moist desquamation, global radiation dermatitis, and any signs and symptoms self-reported by participants were secondary outcomes. RESULTS: Dry desquamation occurred in 6.0% of the participants using chamomile liposomal gel and 12.2% of those using liposomal gel (p = 0.32). The mean cumulative dose of ionizing radiation for the first occurrence of dry desquamation was 45.1 Gy in the chamomile liposomal gel group and 43.7 Gy in the liposomal gel group. There were no differences between the two gels in the occurrence of erythema, dry desquamation, moist desquamation, and radiation dermatitis compared to liposomal gel. There was a lower proportion of reported symptoms in the chamomile liposomal gel group compared to liposomal gel group in the first 3 weeks of radiation, especially for itching (p = 0.05). CONCLUSION: No statistically significant differences between the two gels were found in radiation dermatitis occurrence and dose at first occurrence. Comparing to the literature, it seems that both interventions may be effective, which might explain the lack of statistical difference between the groups.

Organ Damage and Quality of Life in Takayasu Arteritis　- Evidence From a National Registry Analysis.

BACKGROUND: Takayasu arteritis, affecting primarily young women, damages large arteries and organs. We examined the impact of disease duration and sex on organ damage and quality of life using Japan's Intractable Disease Registry. METHODS AND RESULTS: After refining data, 2,013 of 2,795 patients were included in the study. Longer disease duration was related to a lower prevalence of disease activity symptoms, a higher prevalence of organ damage, and a higher proportion of patients requiring nursing care. Compared with men, women tended to have an earlier onset age, exhibiting longer disease duration. A higher proportion of women had aortic regurgitation and required nursing care. The proportion of female patients in employment was lower than that of the general female population, whereas no difference was observed between male patients and the general male population. Logistic regression analysis revealed that age at surveillance, brain ischemia, visual impairment/loss, and ischemic heart disease were significant factors associated with high nursing care needs (Level ≥2, with daily activity limitations). CONCLUSIONS: Early diagnosis and effective treatment, particularly to prevent brain ischemia, visual impairment, and ischemic heart disease, may improve the quality of life of patients with Takayasu arteritis, especially women.

Regional Collaboration for Heart Failure Patients Certified as Needing Support or Care in Long-Term Care Insurance System.

BACKGROUND: Heart failure (HF) patients with complex care needs often experience exacerbations during the transitional phase as care providers and settings change. Regional collaboration aims to ensure continuity of care; however, its impact on vulnerable patients certified as needing support or care under the Japanese long-term care insurance (LTCI) system remains unclear. METHODS AND RESULTS: We implemented a regional collaborative program for HF patients involving 3 pillars of transitional care with general practitioners and nursing care facilities: (1) standardized health monitoring using a patient diary and identification of exacerbation warning signs; (2) standardized information sharing among care providers; and (3) standardized HF management manuals. We evaluated outcomes within 1 year of discharge for patients hospitalized with HF and referred to other facilities for outpatient follow-up in 2017-2018 before program implementation (n=110) and in 2019-2020 after implementation (n=126). Patients with LTCI frequently received non-cardiologist follow up and care services and had a higher risk of all-cause mortality and HF readmission compared with those without LTCI (P<0.05). Program implementation was significantly associated with a greater reduction in HF readmissions among patients with LTCI compared with those without (P<0.05 for interaction), although mortality rates remained unchanged. CONCLUSIONS: A regional collaborative program significantly reduces HF readmissions in HF patients with LTCI who are at high risk of worsening HF.

Profile, reasons for hospitalization and nursing diagnoses of refugee-native patients admitted to internal medicine clinic-an evaluation from nursing perspective.

PURPOSE: The study aims to evaluate the hospitalization diagnoses and nursing diagnoses of the refugee and local population hospitalized in internal medicine clinics, which are especially important in the early diagnosis, treatment, and rehabilitation of chronic diseases, and to emphasize their importance in nursing care. METHODS: The study was carried out in a descriptive retrospective design. The files of 3563 patients admitted to the internal medicine clinic of a training and research hospital in Türkiye in 2022 were evaluated. SPSS 26.0 program was used for data analysis. RESULTS: In the study, 95.3% of hospitalizations were native and 4.7% were refugee patients. It was determined that refugee patients admitted to the internal medicine service had a lower mean age compared to the native population (p < 0.05), but there was no difference in the duration of hospitalization (p > 0.05). When the medical diagnoses of hospitalization were examined, it was determined that the highest number of hospitalizations in the native and refugee populations were for bacterial infections in both genders. In nursing diagnoses, it was determined that both populations and genders were diagnosed with infection risk by the medical diagnoses of the patients. CONCLUSION: As a result of the study, it was observed that the duration of hospitalization, reasons for hospitalization, and nursing diagnoses of local and refugee patients were similar. In addition, it was determined that the patients' medical hospitalization diagnoses and nursing diagnoses were compatible.

Influence of Comprehensive Nursing Care on Heart Failure Patient Management: A Systematic Review and Meta-Analysis.

INTRODUCTION: Heart failure is a common chronic illness associated with high readmission rates and death. Comprehensive nursing care, management of symptoms, and psychological support are increasingly seen as critical components of successful heart failure therapy. OBJECTIVE: This systematic review and meta-analysis aimed to determine the effect of comprehensive nursing care on clinical outcomes and quality of life in heart failure patients. METHODS: We searched electronic databases (PubMed, PROSPERO, and Web of Science) for randomised controlled trials and observational studies on comprehensive nursing care treatments for heart failure patients. Data on readmission rates, mortality rates, and quality of life were obtained and examined. RESULTS: A total of 693 studies satisfied the inclusion criteria. A meta-analysis found that comprehensive nursing care reduced heart failure-related readmissions considerably when compared to conventional therapy (odds ratio [OR]: 0.77; 95% CI: 0.66-0.88, p = 0.0002). There was a significant difference in all-cause mortality (OR: 0.76; 95% CI: 0.60-0.97, p = 0.03), but comprehensive treatment enhanced quality of life and functional status (standardised mean difference -0.05, 95% CI: -0.21 to 0.10, p = 0.49). CONCLUSION: Comprehensive nursing care improves clinical outcomes and quality of life for heart failure patients. This study stresses the need to add comprehensive nurse interventions in normal heart failure treatment programmes.

Nurse Supervised at Institutes versus Nurse Counseling Home-Based Resistance Exercise Training for Acute Pancreatitis.

BACKGROUND: The physical and mental quality of life of patients with acute pancreatitis is poor. Professional nurses have the necessary knowledge, art, and skills to aid in resistance exercise training. AIMS: To evaluate the effectiveness of 6 months of nurse-supervised resistance exercise training plus nutritional supplements and 6 months of nurse counseling home-based resistance exercise training plus nutritional supplements for patients with pancreatitis. METHODS: Patients with acute pancreatitis (age ≥ 18 years) received nurse-supervised resistance exercise training at the institute (NEN cohort, n = 103), nurse counseling for home-based resistance exercise (HEN cohort, n = 123), or usual care (UCN cohort, n = 155) for 6 months. All patients received advice regarding nutritional especially protein supplements. RESULTS: Before non-treatment intervention(s) (BL), quality of life score of patients was 53, mild-to-moderate self-reported pain episodes, or worse pain, and a total of 22% of patients were disabled. Patients in the NEN cohort had improved quality of life and decreased pain and disability after 6 months of non-treatment intervention(s) (EL) compared to their BL condition and those of the UCN and HEN cohorts at EL (p < 0.05 for all). A smaller number of patients were hospitalized and died in the NEN cohort than in the UCN and HEN cohorts (p ≤ 0.001 for both) during the follow-up period. CONCLUSION: The quality of life, pain, and disability condition(s) of patients with acute pancreatitis should be improved. Nurse-supervised resistance exercise training at the institute associated with improvement in the quality of life and decrease of pain, disability, hospitalization, and death of patients with acute pancreatitis.

Mixed methods process evaluation of an advance care planning intervention among nursing home staff.

BACKGROUND: We developed the ACP+ intervention to support nursing home staff with implementation of advance care planning. While ACP+ was found to improve staff's self-efficacy, it did not change their knowledge about advance care planning. AIM: To describe the level of implementation, mechanisms of impact, and contextual factors. DESIGN: Process evaluation embedded in a cluster randomized controlled trial in nursing homes (NCT03521206). Throughout and immediately following the 8-month ACP+ implementation, we collected weekly diaries, post-training surveys, attendance records, facility data, and conducted interviews (n = 32). We applied descriptive statistics and thematic analysis. SETTING AND PARTICIPANTS: Management, staff, and ACP+ trainers in seven intervention homes. RESULTS: Although most participants reported they valued ACP+, 33% of eligible staff across nursing homes attended training (range: 6%-69%) and only a few reported they felt ready to engage in actual care planning conversations. Half of all nursing homes adapted parts of the intervention (e.g., more/fewer/shortened training; assigning a coordinating role for practical management). Enough time to consolidate skills, and management support were key for staff engagement in advance care planning, and limited time and staff shortages were significant barriers. Staff reported increased awareness of the importance of advance care planning and felt there was a more systematic way of organizing advance care planning. CONCLUSIONS: There was limited staff engagement. Management ownership, clear roles, and collaborative practices may enhance nursing home advance care planning. Accessible and ongoing training for all staff, and ample practical learning opportunities are needed.

Clinical competency of nurses trained in competency-based versus objective-based education in the Democratic Republic of the Congo: a qualitative study.

BACKGROUND: Designing competency-based education (CBE) programmes is a priority in global nursing education for better nursing care for the population. In the Democratic Republic of the Congo (DRC), object-based education (OBE) remains mainstream in pre-service nursing education programmes. Recently, the Ministry of Health developed a self-assessment tool and quantitatively compared the clinical competency of CBE- and OBE-trained nurses. This study aimed to qualitatively triangulate the results of self-evaluation by exploring perception of supervisors, incumbent CBE-, and OBE-trained nurses in comparison with the competence of the two types of nurses, and to identify influential factors or barriers to their competence in clinical settings. METHODS: A qualitative descriptive approach with conventional content analysis was applied. Twenty interviews with clinical supervisors who oversaw both CBE- and OBE-trained nurses, 22 focus group discussions (FGDs) with CBE-trained nurses, and 21 FGDs with OBA-trained nurses currently working in health facilities were conducted. Participants of the FGDs were selected from the participants of the DRC self-assessment competency comparison study where there was no statistically significance between CBE- and OBE-trained nurses in the demographic characteristics. Data were analysed in terms of the competencies identified by the Ministry of Health. RESULTS: The supervisors recognised that the CBE-trained nurses had stronger competencies in professional communication, making decisions about health problems, and engaging in professional development, but were weak in clinical skills. This study identified challenges for supervisors in assuring standardised care in health facilities with OBE- and CBE-trained nurses, as well as barriers for CBE-trained nurses as a minority in the workplace in demonstrating their competencies. CONCLUSIONS: The study results support the Ministry of Health's policy to expand CBE in pre-service education programmes but reveal that its slow implementation impedes full utilisation of the acquired competencies at health facilities. Implementation could be accelerated by strengthening cooperation among the Ministry of Health's three human resource departments, and developing and implementing a well-planned, legally binding, long-term CBE reform strategy, including an approach to the Continuing Professional Development system.

Therapeutic adherence in patients with Obstructive Sleep Apnea Syndrome: a retrospective cohort study.

INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated episodes of partial or complete airway obstruction. Continuous Positive Airway Pressure therapy (CPAP) is effective in improving sleep quality and daytime sleepiness. The aim of the study was to evaluate therapeutic adherence in a sample of patients with OSAS from the Pneumology ward of the "Cardinal Massaia" Hospital in Asti. MATERIALS AND METHODS: A sample of 221 patients with OSAS were collected and retrospectively analyzed from January 2019 to December 2021. Ventilation hours during device titration (T1), possible second titration (T2) and one-year control (T3) were considered. The use of the CPAP device equal to or greater than 4 h/night was considered as therapeutic adherence. Age, gender, severity of OSAS, smoking, interface used and Epworth Sleepiness Scale (ESS) score were considered. RESULTS: The analysis data showed that the percentage of adhesion during T1 was 84%. Only 9% needed T2, with 84% adherence. At T3 the adherence was 86%. Correlation studies showed that only smoking had a positive correlation with adherence, while OSAS severity, gender, ESS score, interface used and age had no statistically significant correlation. CONCLUSION: It was important to understand that OSAS is a disease with prolonged treatment, which affects the life of the person and his family. Therefore, the concept of assistance network was born, which sees the healthcare operators, the person and his family as the main actors involved in a care process.

Listen to the voices of nurses: the role of community chief nurses and registered nurses in the provision of care for older people in Sweden during the COVID-19 pandemic - a cross-sectional study.

BACKGROUND: During the pandemic in Sweden, the aim was to protect older people, especially those among them who were sick, frail and vulnerable in residential care facilities. A ban was put on visits at all residential care facilities in March 2020 to prevent the spread of infection among the older people. This study aims to describe the experiences of Community Chief Nurses and Registered Nurses who provided medical and nursing care for older people in residential care facilities and home care during the first wave of the COVID-19 pandemic, and to examine factors associated with the quality of care. METHODS: The study has a mixed method cross-sectional design (STROBE). Data were collected using a web-based survey that comprised two questionnaires, for Community Chief Nurses and Registered Nurses developed for the study. Data were analysed using descriptive statistics and logistic regression models, as well as qualitative content analyses. RESULTS: The majority of Community Chief Nurses reported adequate opportunities to work with management to handle the COVID-19 pandemic. The Registered Nurses reported that the quality of care, as well as the person's safety, was negatively affected during the pandemic. Factors associated with good care were as follows: information-sharing; ability to comply with hygiene practices; competence in how to care for older persons with COVID-19; a physician at bedside assessing their health; and support from frontline managers. CONCLUSION: The study highlights crucial facets that care organizations must address to enhance their readiness for future pandemics or disasters, ensuring the security and well-being of the older people.

Assessing family function: older adults vs. care nurses: a cross-sectional comparative study.

BACKGROUND: This study aimed to assess family function in home care for older adults. Understanding family dynamics is essential for providing quality care to older adults choosing to age in place. METHODS: In a cross-sectional study, 53 patients aged 65 or older receiving home care were evaluated, along with four home care nurses. The General Function of Family Assessment Device (FAD-GF) was used for self-assessment to examine family resources. RESULTS: Only 5.7% of older adults reported good family function. Strong correlations were found between assessments by nurses and older adults. Among the six aspects of family function, "problem solving," "communication," "affective responsiveness," and the overall results showed no disparities between the evaluations of older adults and nurses. CONCLUSIONS: Home care nurses can effectively assess family function using the FAD-GF, particularly after six months of care. This assessment can help identify family issues and enhance home care quality through nurse training in FAD-GF application.

Caregivers' response to cardiorespiratory events in preterm infants in the NICU - A quantitative overview.

AIM: Cardiorespiratory events in preterm infants pose a major challenge in the Neonatal Intensive Care Unit as they require a prompt response. We aimed to describe caregivers' responses to these events. METHODS: We performed a prospective observational study in 19 preterm infants (28 ± 2 weeks) on non-invasive respiratory support using video recordings of the inside of the incubator for 72 (55-72) h. Caregivers' responses to these events were then identified from the videos. RESULTS: We recorded and assessed 1851 cardiorespiratory events with a median duration of 11.0 (5.0-23.0) s. No response was observed in the majority of the events (91.5%). In the remaining 8.5% events, caregivers responded by pausing the alarm, adjusting devices and/or providing tactile stimulation with an average response time of 25.4 (13.8-35.9) s. Stimulation was the most observed response and was applied in 38 different ways. On average, stimulation lasted 18.7 (11.6-44.6) s and the cardiorespiratory events were resolved 30.6 (19.5-47.6) s after stimulation started. CONCLUSION: Our study showed that cardiorespiratory events are common in preterm infants in the NICU, but often not followed by intervention of the caregiver. The indication, timing and execution of responses to cardiorespiratory events is highly variable.

Experimental study on radiational characteristics and nursing care of a novel radioisotope 188Re memory alloy esophageal stent.

Radioactive esophageal stent, known for inhibiting tumor growth and delaying restenosis in malignant esophageal tumors, presents challenges due to potent radiation, leading to side effects. This study aims to support the clinical use of 188Re radioactive esophageal stent. The 188Re stent with 128 MBq initial activity was placed in a biomimetic esophageal membrane. Radiation absorption doses were measured by thermoluminescence and calculated using mathematical software. Under simulated positioning, the stent was implanted in the esophagus of an experimental pig, followed by the feeding of Kangfuxin solution and nursing care (KFX-RT). Non-implanted and implanted-only pigs served as normal (CR) and experimental (RT) controls. Blood samples collected on days 7 and 21 were analyzed for inflammatory factors (TGF-ß1, TNF-α, IL-6) using enzyme-linked immunosorbent assay. Esophageal tissue cells were assessed for deoxyribonucleic acid index (DI) and subdiploid content through flow cytometry. Absorbed doses at 0.5 mm and 5 mm reference points were 223.91 cGy and 20.55 cGy, respectively, with 92.64% absorbed within a 1 mm thickness. Radiation dose significantly decreased at 6.5 mm, with only 4.72% absorbed at depths ≥6.5 mm. On days 7 and 21, levels of inflammatory factors, DI and subdiploid content were significantly increased in the KFX-RT and RT groups compared to the CR group, while all levels in the KFX-RT group were significantly lower than in the RT group. The 188Re esophageal stent exhibits high radiation absorption in superficial tissues and low absorption in deeper tissues. Kangfuxin solution combined with nursing care alleviates radiation-induced inflammatory damage.

Nurses' perceptions of compassionate care in pediatric oncology: a qualitative interview study.

BACKGROUND: Compassion is a crucial aspect in the management of pediatric oncology patients as it has the potential to enhance nurse satisfaction levels, thereby further enhancing the quality and safety of the care they deliver. This study aimed to investigate nurses' understanding and experience of compassionate care when working in pediatric oncology departments. METHODS: This research utilized a qualitative descriptive design. Content analysis was used to make sense of data collected via individual and semi-structured interviews conducted with nurses (n = 32) working in pediatric oncology departments. RESULTS: Nurses' understanding of compassionate care for children with cancer was organized into two categories: Humanistic compassionate care and compassionate end-of-life care. The humanistic compassionate care category comprised of three subcategories: (1) empathy, (2) altruism, and (3) respect for the cultural values and beliefs of the family. The compassionate end-of-life care category comprised of two subcategories: (1) facilitating parents' presence at the child's bedside and (2) creating suitable conditions for accepting the death of a child. CONCLUSION: Compassionate care for children with cancer is marked by a strong emphasis on humanistic, cultural, and end-of-life considerations. Our findings further emphasize the paramount importance of taking families' presence, wishes and beliefs into consideration within this context.

Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review.

BACKGROUND: Unfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic. METHODS: Systematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing. RESULTS: Twenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care. CONCLUSIONS: Two continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study.

BACKGROUND: Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS: This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS: In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS: The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Bridging the gaps in pediatric complex healthcare: the case for home nursing care among children with medical complexity.

BACKGROUND: Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC). METHODS: This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews. RESULTS: Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families. CONCLUSIONS: Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers' insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.

Assessing cost and cost savings of teleconsultation in long-term care facilities: a time-driven activity-based costing analysis within a value-based healthcare framework.

BACKGROUND: Quebec's healthcare system faces significant challenges due to labour shortage, particularly in long-term care facilities (CHSLDs). The aging population and increasing demand for services compound this issue. Teleconsultation presents a promising solution to mitigate labour shortage, especially in small CHSLDs outside urban centers. This study aims to evaluate the cost and cost savings associated with teleconsultation in CHSLDs, utilizing the Time-Driven Activity-Based Costing (TDABC) model within the framework of Value-Based Healthcare (VBHC). METHODS: This study focuses on CHSLDs with fewer than 50 beds in remote regions of Quebec, where teleconsultation for nighttime nursing care was implemented. Time and cost data were collected from three CHSLDs over varying periods. The TDABC model, aligned with VBHC principles, was applied through five steps, including process mapping, estimating activity times, calculating resource costs, and determining total costs. RESULTS: Teleconsultation increased the cost per minute for nursing care compared to traditional care, attributed to additional tasks during remote consultations and potential technical challenges. However, cost savings were realized due to reduced need for onsite nursing staff during non-eventful nights. Overall, substantial savings were observed over the project duration, aligning with VBHC's focus on delivering high-value healthcare. CONCLUSIONS: This study contributes both theoretically and practically by demonstrating the application of TDABC within the VBHC framework in CHSLDs. The findings support the cost savings from the use of teleconsultation in small CHSLDs. Further research should explore the long-term sustainability and scalability of teleconsultation across different CHSLD sizes and settings within the VBHC context to ensure high-value healthcare delivery.

Association between being at-risk of malnutrition and discontinued home medical care among older patients: a 1-year follow-up study.

BACKGROUND: Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. METHODS: Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. RESULTS: In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished). CONCLUSIONS: At-risk of malnutrition was associated with discontinuation of home medical care among older patients.

Dysphagia Screening in Residential Long-Term Care Settings in the Republic of Ireland: A Cross-Sectional Survey.

Dysphagia affects up to 70% of older adults living in residential long-term care settings (RLTCS) and may lead to serious complications if not identified and adequately managed. However, there is a dearth of clinical guidelines tailored to older adults at risk of dysphagia in RLTCS. An online survey consisting of 40 questions was conducted to identify dysphagia screening practices, referral patterns and interventions implemented by nurses in cases of suspected dysphagia, to quantify the number of residents with dysphagia, episodes of aspiration pneumonia in the previous year, and use of modified texture diets and fluids and explore differences between groups of RLTCS. The survey was developed using Qualtrics XM Platform and circulated via email, with one response per RLTCS sought. Data were analysed using RStudio. Of the 429 RLTCS contacted, 45 completed and returned the survey, a 10.5% response rate. Dysphagia screening practices, referral patterns, and dysphagia management interventions varied across participating RLTCS. All participants reported that they observe for signs and symptoms of dysphagia at mealtimes to identify residents at-risk of dysphagia. Ninety six percent of RLTCS reported referring residents with suspected dysphagia to speech and language therapy dysphagia services. A diagnosis of dysphagia was reported in 35.3% of residents. All participating RLTCS reported providing modified texture diets and fluids if residents had suspected dysphagia. The implementation of standardised and validated dysphagia screening protocols in RLTCS in the Republic of Ireland may be useful in supporting the identification of at-risk residents.