78,498 research outputs found
Patients' Perspectives and Feasibility of Home Monitoring in Acute Care: The AcuteCare@Home Flash Mob Study
No full textObjective: To determine patients’ perspectives on home monitoring at emergency department (ED) presentation and shortly after admission and compare these with their physicians’ perspectives. Methods: Forty Dutch hospitals participated in this prospective flash mob study. Adult patients with acute medical conditions, treated by internal medicine specialties, presenting at the ED or admitted at the admission ward within the previous 24 h were included. The primary outcome was the proportion of patients who were able and willing to undergo home monitoring. Secondary outcomes included identifying barriers to home monitoring, patient’s prerequisites, and assessing the agreement between the perspectives of patients and treating physicians. Results: On February 2, 2023, in total 665 patients [median age 69 (interquartile range: 55–78) years; 95.5% community dwelling; 29.3% Modified Early Warning Score ‡3; 29.5% clinical frailty score ‡5] were included. In total, 19.6% of ED patients were admitted and 26% of ward patients preferred home monitoring as continuation of care. Guaranteed readmission (87.8%), ability to contact the hospital 24/7 (77.3%), and a family caregiver at home (55.7%) were the most often reported prerequisites. Barriers for home monitoring were feeling too severely ill (78.8%) and inability to receive the required treatment at home (64.4%). The agreement between patients and physicians was fair (Cohens kappa coefficient 0.26). Conclusions: A substantial proportion of acutely ill patients stated that they were willing and able to be monitored at home. Guaranteed readmission, availability of a treatment team (24/7), and a home support system are needed for successful implementation of home monitoring in acute care
Sydney Area Transportation Study (SATS): Home Interview Survey, 1971
No full textThe objective of the Home Interview Survey (HIS) was to obtain information on the patterns and modes of travel by people living within the Sydney Study Area. Information was also collected about the characteristics of the people making the trips and their households. Three types of information were collected in the home interview survey: household data, person data, and trip data. The data are available in two separate files, a file of 'trip' records and a file of 'person' records. The household data is therefore repeated for each trip made by its members and person data is repeated for each trip made by that person. The Person Data File contains person data and household data for all persons interviewed in the selected homes. Each record of the Trip Data File contains the origin, destination, mode, purpose, parking and other trip information, as well as the person data for the person making the trip, and the household data for that person: number of card, type of housing, telephone in house, household size, family income, and changes in job location (head of household only). The household data is therefore repeated for each trip made by its members and person data is repeated for each trip made by that person. The Person Data File contains person data and household data for all persons interviewed in the selected homes. Backgournd variables include age, sex, occupation, employment sector, personal income, household income and employment status
Outpatient management of cancer-associated pulmonary embolism: A post-hoc analysis from the HOME-PE trial
No full textIntroduction: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE. Methods: In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization. Results: Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15–21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15–9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48–42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15–9.74). Conclusions: Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes
Outpatient management of cancer-associated pulmonary embolism: A post-hoc analysis from the HOME-PE trial.
No full textpeer reviewedINTRODUCTION: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE. METHODS: In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization. RESULTS: Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15-21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15-9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48-42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15-9.74). CONCLUSIONS: Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes
Residual disability and psychosocial status after Guillain Barré syndrome: a 3 to 5 year follow-up study
No full textGuillain-Barré syndrome (GBS) is the most common cause of acute not-traumatic neuromuscular paralysis. Even if the disease usually has a good prognosis, recovery is not always complete and residual motor or sensory signs may remain. Little is known on the incidence of disability and long term psychosocial status in GBS. We present the results of a 3 to 5 year follow-up study of the residual signs, including fatigue, pain and psychosocial status in 75 GBS patients, aged from 20–82 years (mean 56). The functional grading at the onset and at the follow up was performed using the Hughes scale and the data about residual symptoms were obtained at the follow up by phone interview. Among the 56 patients interviewed, 44 (78%) were asymptomatic or had minimal signs of neuropathy (0–1 grade of Hughes scale), 7 (13%) remained moderately disabled (grade 2), 4 (7%) were unable to walk independently (grade 3), and one patient died. 51 (92%) were able to live independently at home while only 3 (5%) needed continuous or partial assistance. 33% of patients (18) reported fatigue in all their activities while 27% (15) had residual pain, which rarely caused restriction in daily living. 23% of patients (13) changed or temporarily or definitively suspended their job. 59% reached the maximum improvement in the first year while 21% continued to improve in the three following years. We observed that patients>40 years old were more severely impaired than the younger ones (76% vs 60% of patients had grade 4 or 5 of Hughes scale) while permanent disability was only observed in those aged>60 years (14% of patients vs none of the younger patients had grade 3). No difference was found in the outcome between patients with or without assisted ventilation. Patients reaching maximal worsening within 10 days achieved maximal improvement more quickly and remained less disabled than the others while those with>10 days plateau duration remained more severely impaired than those with a shorter duratio
Association between SARS-CoV-2 Seroprevalence in Nursing Home Staff and Resident COVID-19 Cases and Mortality: A Cross-Sectional Study
No full textThe burden of COVID-19 has disproportionately impacted the elderly, who are at increased risk of severe disease, hospitalization, and death. This cross-sectional study aimed to assess the association between SARS-CoV-2 seroprevalence among nursing home staff, and cumulative incidence rates of COVID-19 cases, hospitalizations, and deaths among residents. Staff seroprevalence was estimated within the SEROCoV-WORK+ study between May and September 2020 across 29 nursing homes in Geneva, Switzerland. Data on nursing home residents were obtained from the canton of Geneva for the period between March and August 2020. Associations were assessed using Spearman’s correlation coefficient and quasi-Poisson regression models. Overall, seroprevalence among staff ranged between 0 and 31.4%, with a median of 8.3%. A positive association was found between staff seroprevalence and resident cumulative incidence of COVID-19 cases (correlation coefficient R = 0.72, 95%CI 0.45–0.87; incidence rate ratio [IRR] = 1.10, 95%CI 1.07–1.17), hospitalizations (R = 0.59, 95%CI 0.25–0.80; IRR = 1.09, 95%CI 1.05–1.13), and deaths (R = 0.71, 95%CI 0.44–0.86; IRR = 1.12, 95%CI 1.07–1.18). Our results suggest that SARS-CoV-2 transmission between staff and residents may contribute to the spread of the virus within nursing homes. Awareness among nursing home professionals of their likely role in the spread of SARS-CoV-2 has the potential to increase vaccination coverage and prevent unnecessary deaths due to COVID-19
Symptom and problem clusters in German specialist palliative home care - a factor analysis of non-oncological and oncological patients’ symptom burden
No full textAbstract Background Specialist palliative home care (SPHC) aims to maintain and improve patients’ quality of life in the community setting. Symptom burden may differ between oncological and non-oncological patients. However, little is known about diagnosis-related differences of SPHC patients. This study aims to describe the prevalence of physical symptom burden and psychosocial problems of adult patients in SPHC, and to evaluate diagnosis-related symptom clusters. Methods Secondary analysis of data from a prospective, cross-sectional, multi-centre study on complexity of patients, registered at the German Register for Clinical Studies (DRKS trial registration number: DRKS00020517, 12/10/2020). Descriptive statistics on physical symptom burden and psychosocial problems at the beginning of care episodes. Exploratory and confirmatory factor analyses to identify symptom and problem clusters. Results Seven hundred seventy-eight episodes from nine SPHC teams were included, average age was 75 years, mean duration of episode 18.6 days (SD 19.4). 212/778 (27.2%) had a non-oncological diagnosis. Main burden in non-oncological episodes was due to poor mobility (194/211; 91.9%) with significant diagnosis-related differences (χ² = 8.145, df = 1, p = .004; oncological: 472/562; 84.0%), and due to weakness (522/565; 92.4%) in oncological episodes. Two symptom clusters (psychosocial and physical) for non-oncological and three clusters (psychosocial, physical and communicational/practical) for oncological groups were identified. More patients in the non-oncological group compared to the oncological group showed at least one symptom cluster (83/212; 39.2% vs. 172/566; 30.4%). Conclusion Patients with non-oncological diseases had shorter episode durations and were more affected by symptom clusters, whereas patients with oncological diseases showed an additional communicational/practical cluster. Our findings indicate the high relevance of care planning as an important part of SPHC to facilitate anticipatory symptom control in both groups.Innovationsfonds des gemeinsamen BundesausschussesUniversitätsklinik Münche
The Oxfordshire home visiting study : 3 year follow-up
Get PDFBackground
The Oxfordshire Home Visiting Study is one of the few UK-based randomised controlled trials to evaluate the effectiveness of a professionally delivered, intensive home visiting programme beginning during the antenatal period, in improving parenting and child outcomes including the prevention of abuse and neglect.
Method
One hundred and thirty-one high-risk women registered with 40 GP practices across two counties were randomly allocated to receive intensive home visiting (n=68) or standard services (n=63). Women in the home visiting arm received weekly visits by specially trained health visitors beginning during the second trimester of pregnancy and continuing for a period of 18 months. All mothers and babies were followed up at 2-months, 6-months, and 12-months, and these results have been published elsewhere (McIntosh et al 2009; Barlow et al 2007; Kirkpatrick et al 2007; McIntosh and Barlow 2006; Barlow et al 2005; Brocklehurst et al 2004).
This report summarises the results of the 3-year follow-up of 131 women – Intervention group (n=51) and control group (n=46).
Results
Primary and secondary outcomes
The significant improvement in maternal sensitivity and infant co-operativeness that was identified at 12-month follow-up was not maintained at 3-years. The few significant differences between the intervention and control group for the remaining outcomes favoured the control group, although many non-significant findings favoured the intervention group.
Child abuse data
Non-significant trends were identified suggesting that children in the intervention group who suffered maltreatment were more likely to be identified, and more likely to suffer maltreatment for shorter periods of time. These differences may be clinically important, and may have reached statistical significance in a larger trial.
Economic Evaluation
The results suggest that intensive home visiting improved maternal sensitivity at 12-months and better enabled health visitors to identify infants in need of further protection at an incremental cost of £3,985 (95% bootstrapped CI for the cost difference: £192 - £5,297) per woman at 36 months. Looking at the ‘health service only’ costs, at 36-months the incremental cost was £4,232 (95% bootstrapped CI for the cost difference: £1,949 - £5,709). The extent to which these potential benefits are worth the costs, however, is a matter of judgment.
User perspectives
The majority of participants who were interviewed continued to view the home visiting service, in positive terms. Most were highly appreciative of the help and support they had received at the time, and reported significant ways in which they perceived the service to have been of help to them. Longer-term benefits included the close bond that they felt they had established with the study child, the introduction of parenting practices that helped them to address difficult behaviour, and a better ability to utilize other health services. However, only half of the women invited to take part in a 3-year follow-up interview accepted, and the views expressed in these interviews may not therefore be representative of the wider group of women who received the home visiting service.
Conclusion
This study did not identify any quantitative benefits from an eighteen-month intensive home visiting programme, and given the success of some other programmes of this nature, it seems likely that this may have been due to the
duration of the programme (many of the most effective programmes continue until the infant is 2-years of age), and the content of the visits (the lack of focus on specific child developmental outcomes), in conjunction with the fact that this study recruited a very high-risk group of women; just under a half of the sample were known to Child and Family Services by the time the child was three years of age.
However, data from in-depth interviews that were conducted with a range of stakeholders at both 12- and 36-months suggests that the partnership model of working that was provided to health visitors was effective in enabling the home visitors to gain the trust of a group of very vulnerable women, many of whom viewed all professionals very negatively, and that many of the participating women also felt that the service had had an ongoing impact in terms of their ability to parent, and their relationship with the study child.
Effective interventions for this very high-risk group of mothers and infants have yet to be identified, and will most probably involve the use of more intensive therapeutic interventions such as parent-infant psychotherapy (ref) or mentalisation-based parenting programmes (ref) or a multimodal approach that combines a number of these strategies. In the absence of effective interventions, early identification of infants in need of removal from the home remains the optimal strategy, and the data from this study suggest that home visited children were much more likely to be identified as abused, and more likely to suffer maltreatment for shorter periods of time. These findings may be particularly significant given what we now know about the impact of abuse during the first few years of life. While the findings of the economic analysis suggest that the costs of an intensive intervention of this nature are always likely to be significantly more, society must ultimately decide whether such additional costs are worthwhile
Can we improve the identification of cold homes for targeted home energy-efficiency improvements?
No full textObjective: To investigate the extent to which homes with low indoor-temperatures can be identified from dwelling and household characteristics.Design: Analysis of data from a national survey of dwellings, occupied by low-income households, scheduled for home energy-efficiency improvements. Setting: Five urban areas of England: Birmingham, Liverpool, Manchester, Newcastle and Southampton.Methods: Half-hourly living-room temperatures were recorded for two to four weeks in dwellings over the winter periods November to April 2001-2002 and 2002-2003. Regression of indoor on outdoor temperatures was used to identify cold-homes in which standardized daytime living-room and/ or nighttime bedroom-temperatures were < 16 degrees C (when the outdoor temperature was 5 degrees C). Tabulation and logistic regression were used to examine the extent to which these cold-homes can be identified from dwelling and household characteristics.Results: Overall, 21.0% of dwellings had standardized daytime living-room temperatures < 16 degrees C and 46.4% had standardized nighttime bedroom-temperatures below the same temperature. Standardized indoor-temperatures were influenced by a wide range of household and dwelling characteristics, but most strongly by the energy efficiency (SAP) rating and by standardized heating costs. However, even using these variables, along with other dwelling and household characteristics in a multi-variable prediction model, it would be necessary to target more than half of all dwellings in our sample to ensure at least 80% sensitivity for identifying dwellings with cold living-room temperatures. An even higher proportion would have to be targeted to ensure 80% sensitivity for identifying dwellings with cold-bedroom temperatures.Conclusion: Property and household characteristics provide only limited potential for identifying dwellings where winter indoor temperatures are likely to be low, presumably because of the multiple influences on home heating, including personal choice and behaviour. This suggests that the highly selective targeting of energy-efficiency programmes is difficult to achieve if the primary aim is to identify dwellings with cold-indoor-temperatures. (c) 2006 Published by Elsevier Ltd
Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults
Get PDFObjective: We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults. Design: A randomised controlled trial. Subjects: Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group. Setting: Hyvinkää town municipality, Finland. Main outcome measures: We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers. Results: At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was −0.015 (95% CI −0.029 to −0.0016; p = 0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up. Conclusion: Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end.Key points We are exploring preventive home visits as means to support the health-related quality-of-life (HRQoL) of home-dwelling older adults Multiprofessional preventive home visits in this intervention study helped to maintain the HRQoL when measured using 15D The effects on HRQoL diminished when the intervention ended, so could further benefits be attained with a longer intervention?The clinical trial registration number: ACTRN1261600141143
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