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Sample records for 24-hour home care

  1. Patients in 24-hour home care striving for control and safety

    PubMed Central

    2012-01-01

    Background This article concerns Swedish patients receiving 24-hour home care from health care assistants (HC assistants) employed by the municipality. Home care is a complex interactive process involving the patient, family, HC assistants as well as professional care providers. Previous studies exploring patient perspectives on home care have been based mainly on patient interviews. In contrast, the present study took a broad perspective on patients’ experiences and thoughts by combining field observations on care situations with patient and HC assistant interviews. The aim of the study presented in this article was to promote a new and broadened understanding of patients receiving 24-hour home care by constructing a theoretical model to illuminate their main concern. Methods Field observations and semi-structured interviews were conducted with four patients receiving 24-hour home care and their HC assistants. Grounded theory methodology was used. Results The core process identified was Grasping the lifeline, which describes compensatory processes through which patients strived for control and safe care when experiencing a number of exposed states due to inadequate home care. Patients tried to take control by selecting their own HC assistants and sought safe hands by instructing untrained HC assistants in care procedures. When navigating the care system, the patients maintained contacts with professional care providers and coordinated their own care. When necessary, a devoted HC assistant could take over the navigating role. The results are illuminated in a theoretical model. Conclusions The results accentuate the importance to patients of participating in their own care, especially in the selection of HC assistants. The model illustrates some challenging areas for improvement within the organisation of 24-hour home care, such as personnel continuity and competence, collaboration, and routines for acute care. Furthermore, it may be used as a basis for reflection

  2. 24-hour care programs.

    PubMed

    Hergenrader, R

    1996-06-01

    Twenty-four-hour care programs, which combine group health programs with workers' compensation and disability benefits, hold considerable potential for cost savings and greater efficiency. This article explains these programs and uses a care history to show the savings they can achieve. PMID:10157798

  3. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study

    PubMed Central

    2013-01-01

    Introduction Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors. Methods This observational study was conducted in the adult ICU of a tertiary referral hospital in Australia, enrolling 57 patients. Polysomnography (PSG) was performed over a 24-hour period to assess the quantity (total sleep time: hh:mm) and quality (percentage per stage, duration of sleep episode) of patients' sleep while in ICU. Rechtschaffen and Kales criteria were used to categorise sleep. Interrater checks were performed. Sound pressure and illuminance levels and care events were simultaneously recorded. Patients reported on their sleep quality in ICU using the Richards Campbell Sleep Questionnaire and the Sleep in Intensive Care Questionnaire. Data were summarised using frequencies and proportions or measures of central tendency and dispersion as appropriate and Cohen's Kappa statistic was used for interrater reliability of the sleep data analysis. Results Patients' median total sleep time was 05:00 (IQR: 02:52 to 07:14). The majority of sleep was stage 1 and 2 (medians: 19 and 73%) with scant slow wave and REM sleep. The median duration of sleep without waking was 00:03. Sound levels were high (mean Leq 53.95 dB(A) during the day and 50.20 dB(A) at night) and illuminance levels were appropriate at night (median <2 lux) but low during the day (median: 74.20 lux). There was a median 1.7 care events/h. Patients' mean self-reported sleep quality was poor. Interrater reliability of sleep staging was highest for slow wave sleep and lowest for stage 1 sleep. Conclusions The quantity and quality of sleep in intensive care patients are poor and may be related to noise, critical illness itself and treatment events that disturb sleep. The study highlights the

  4. Physical and Mental Health of Patients Immediately After Discharge From Intensive Care Unit and 24 Hours Later

    PubMed Central

    Momennasab, Marzieh; Ghahramani, Tahereh; Yektatalab, Shahrzad; Zand, Farid

    2016-01-01

    Background: Monitoring the health status of patients discharged from intensive care units is a crucial method of service evaluation. Objectives: This study aimed to assess the physical and mental health status of patients immediately after discharge from the ICU and 24 hours later. Patients and Methods: This descriptive comparative study was conducted on 104 patients discharged from the ICUs of a referral trauma center in Shiraz, Southwest Iran. Physical parameters, including respiratory rate, need for supplemental oxygen, heart rate, blood pressure, and need for cardiac monitoring, were assessed. Hospital anxiety and depression scale (HADS) was used for mental health evaluation. The mental and physical status of patients were assessed before ICU discharge and 24 hours later; data were recorded in information forms and were analyzed using SPSS statistical software version 17. Results: At the time of discharge, the respiratory rate of 28% of the participants was more than 24 minutes, and 95.2% received supplemental oxygen. However, after 24 hours these values decreased to 10% and 21.6%, respectively. The mean heart rate and systolic blood pressure were within the normal range at both time points. Additionally, 63% of the patients had anxiety scores above 11 at both time points, reflecting high anxiety. The number of patients who reported depression increased from 58.7% at ICU discharge to 69.6% after 24 hours. Conclusions: Despite the considerable improvement in most of the patients’ physical condition in the first 24 hours after discharge from ICU, a significant number of them remain at risk for the development of adverse effects from this transition. The high prevalence of mental health disorders in these patients reveals the necessity to conduct follow-up consultations. PMID:27218059

  5. Home Care

    MedlinePlus

    ... Help Related Topics Assisted Living Community-Based Care Nursing Homes Related Video Join our e-newsletter! Aging & Health A to Z Home Care Basic Facts & Information Role of Health Care Professionals in Home Care Your physician is the leader ...

  6. Impact of 24 hour critical care physician staffing on case-mix adjusted mortality in paediatric intensive care.

    PubMed

    Goh, A Y; Lum, L C; Abdel-Latif, M E

    2001-02-10

    The 24 h availability of intensive care consultants (intensivists) has been shown to improve outcomes in adult intensive care units (ICU) in the UK. We tested whether such availability would improve standardised mortality ratios when compared to out-of-hours cover by general paediatricians in the paediatric ICU setting of a medium-income developing country. The standardised mortality ratio (SMR) improved significantly from 1.57 (95%CI 1.25-1.95) with non-specialist care to 0.88 (95%CI 0.63-1.19) with intensivist care (rate ratio 0.56, 95% CI 0.47-0.67). Mortality odds ratio decreased by 0.234, 0.246 and 0.266 in the low, moderate and high-risk patients. 24 h availability of intensivists was associated with improved outcomes and use of resources in paediatric intensive care in a developing country. PMID:11273070

  7. Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care

    PubMed Central

    Chmiel, Corinne; Rosemann, Thomas; Senn, Oliver

    2014-01-01

    Background To investigate characteristics of and satisfaction with psychiatric 24-hour emergency primary care performed by mandatory rotation of licensed psychiatrists as a viable baseline for possible reorganizational measures. Methods This was a questionnaire-based cross-sectional study (November 2010–April 2011). The number of patient–psychiatrist encounters, modes of contact, and patient and psychiatrist characteristics were assessed. Diagnoses were coded with ICD-10 (International Classification of Diseases, version 10). Results From 167 duty episodes, 74 (44%) were recorded. Of the psychiatrists (n=44), 52% were female, and mean age (standard deviation) was 49.9 (5.2) years. The median number of encounters per episode was 4 (interquartile range 0–8), mainly in the evenings. Demand for “face-to-face” (direct) patient visits was significantly more common (64.0%) than practice (1.3%) or telephone consultations (34.7%). In 83.8%, psychiatrists judged the encounter as adequate at the patient’s location. A total of 43 different diagnoses were recorded: mainly schizophrenic disorders (23.9%), suicidal behavior (15.2%), and acute stress reactions (10.3%). Psychiatrists felt burdened by services (62.5%): in 39.2%, they felt threatened; and in 6.8%, violence occurred. In 32.4%, bills were not paid for. If services were optional, 45.2% would participate. Conclusion Our findings indicate justified demand for direct mobile patient visits, suggesting that emergency care should be multifaceted, and sole provision of psychiatric care at stationed emergency facilities may not always be appropriate. Reorganization of 24-hour emergency services should carefully evaluate patient and provider’s needs before changing established structures. PMID:24707172

  8. Care homes. Home truths.

    PubMed

    Schneider, J; Netten, A; Mozley, C; Levin, E; Mann, A; Blizard, B; Topan, C; Abbey, A; Kharicha, K; Todd, C

    1998-01-15

    Proposed joint inspectorates of care homes open the way for health input into residential care. An investigation into quality-of-care measures concluded that health professionals should be included in inspectorate teams, particularly in view of the increasing dependency of residents. No association was shown between cost and quality, but higher costs were associated with short-term car provision. When costing residential care, the impact on community and primary healthcare services may need to be taken into account. PMID:10176463

  9. Home Health Care

    MedlinePlus

    ... Page Resize Text Printer Friendly Online Chat Home Health Care Home health care helps older adults live independently for as long ... need for long-term nursing home care. Home health care may include occupational and physical therapy, speech therapy, ...

  10. Home Care Services

    MedlinePlus

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  11. Home health care

    MedlinePlus

    ... Skilled nursing - home health; Skilled nursing - home care; Physical therapy - at home; Occupational therapy - at home; Discharge - home ... being in the hospital, skilled nursing center, or rehabilitation facility. You should probably be able to go ...

  12. Respiratory Home Health Care

    MedlinePlus

    ... Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition ... Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at home can contribute to improved ...

  13. Home health care

    MedlinePlus

    ... and exercises, wound care, and daily living. Home health care nurses can help manage problems with your wound, ... Centers for Medicare and Medicaid Services. Home health care: what it is and what to expect. ... ...

  14. Home Care Services

    MedlinePlus

    ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with bathing, ... insurance will help cover the cost of certain home care services.

  15. [Identification of paroxysmal, transient arrhythmias: Intermittent registration more efficient than the 24-hour Holter monitoring].

    PubMed

    Hendrikx, Tijn; Rosenqvist, Mårten; Sandström, Herbert; Persson, Mats; Hörnsten, Rolf

    2015-01-01

    Many patients suffer from palpitations or dizziness/presyncope. These patients are often referred for Holter ECG (24 hour), although the sensitivity for detecting arrhythmias is low. A new method, short intermittent regular and symptomatic ECG registrations at home, might be a convenient and more sensitive alternative also suitable for primary health care. In this case report we present a patient who had contacted health care several times during a seven year period for paroxysmal palpitations. Routine examination with 24 hour Holter ECG and event recorder did not result in a diagnosis. Using intermittent handheld ECG registration at home, a paroxysmal supraventricular arrhythmia was diagnosed. Further investigation revealed that the patient had a concealed Wolff-Parkinson-White (WPW) syndrome. PMID:25584602

  16. Home assessment and care.

    PubMed Central

    Ferrier, C.; Lysy, P.

    2000-01-01

    OBJECTIVE: To describe the scope of home care and to give practical advice for incorporating home visits into family practice. QUALITY OF EVIDENCE: Most of the literature is based on expert opinion, but there are some randomized trials and well done surveys. MAIN MESSAGE: Although physicians make fewer housecalls than they used to, home visiting is essential to providing good care to certain patients. An approach to evaluating patients and their home environments is presented. Management plans should be formulated in collaboration with home care teams. We offer practical advice for incorporating home visits into practice. CONCLUSION: Home visits can be a valuable and rewarding complement to family practice and are essential for the development of home care. PMID:11072585

  17. 24-Hour Academic Libraries: Adjusting to Change

    ERIC Educational Resources Information Center

    Bowman, Adam C.

    2013-01-01

    The purpose of this study was to explore the adaptive measures that academic libraries perform when implementing and operating a 24-hour schedule. Five in-depth interviews were conducted with current managerial-level librarians at 24-hour academic libraries. The exploratory interviews revealed similar measures for security, budgeting, employee…

  18. [Home hospice care at a clinic].

    PubMed

    Arai, F; Osako, M; Shimoaraiso, Y; Sakamoto, T; Miyashita, T; Yamanouchi, H; Kadokura, K; Yoshida, K; Dozono, F; Mamitsuka, K; Dozono, H

    1999-12-01

    For the people who want to stay at home until their last day, the primary doctor and clinic where they were diagnosed will be the most reliable supports. We have been operating a 19 bed clinic since 1996. In these three years, we have established what we call a "combination palliative care system." A team composed of two doctors, 13 nurses, 3 care aids, a social worker, and a counselor provides home care services as well as outpatient and inpatient care. From April, 1998 to March, 1999, 59 patients died of cancer. Among them, 25 patients died at home. Their primary cancers were lung (7), colon (3), pancreatic (2), breast (2), ovarian (2), brain (1), stomach (1), hepatoma (1), neck (1) and others. First of all, sufficient consultation with patients and family makes this care successful. Through this, the patient can choose his style of care. The whole staff is involved in this care in turn, so that all of us become acquainted with each patient. Home care includes: 1) medical and nursing service available 24 hours a day, 2) activation of social resources for the support of the patient user, 3) constructive cooperation with relevant institutions, 4) relieving the patient's physical and mental suffering, 5) aroma therapy, oil massage, hair cuts and music therapy, and 6) support by volunteers. In this way, as a neighborhood clinic, the combination palliative care system is valuable. PMID:10630230

  19. Marketing home care services.

    PubMed

    Moore, S T

    1987-08-01

    With the decline in inpatients, hospital administrators and marketers are seeking revenue opportunities in meeting the needs of a new market, home care patients. The challenge for managers in the home care arena is to target their marketing efforts towards the important decision makers. Managers who can best meet the goal of patients, families and professionals will be most successful. PMID:10301949

  20. The 24 Hours before Hospitalization: Factors Related to Suicide Attempting.

    ERIC Educational Resources Information Center

    Chiles, John A.; And Others

    1986-01-01

    Psychiatric inpatients (N=59) were interviewd concerning psychological and environmental events that occurred in the 24 hours prior to their hospitalization. Suicide attempters were more likely to have used alcohol or marijuana and less likely to have contacted a health care professional than suicide ideators, even when past history of suicide…

  1. The 24-Hour Mathematical Modeling Challenge

    ERIC Educational Resources Information Center

    Galluzzo, Benjamin J.; Wendt, Theodore J.

    2015-01-01

    Across the mathematics curriculum there is a renewed emphasis on applications of mathematics and on mathematical modeling. Providing students with modeling experiences beyond the ordinary classroom setting remains a challenge, however. In this article, we describe the 24-hour Mathematical Modeling Challenge, an extracurricular event that exposes…

  2. Home-cooked care.

    PubMed

    Dean, Erin

    Hospital patients undoubtedly benefit when visitors bring in home-cooked meals. Patients are more likely to be well-nourished if they can eat food they enjoy. But it can present practical difficulties. Banning such food can prevent visitors from showing they care and present nurses with a dilemma. PMID:22880341

  3. American Academy of Home Care Medicine

    MedlinePlus

    ... Newsletter Certification/Training Donate Featured Members Home Care Medicine in America The American Academy of Home Care ... Resources with the American Academy of Home Care Medicine. The American Academy of Home Care Medicine understands ...

  4. Enhancing family physician capacity to deliver quality palliative home care

    PubMed Central

    Marshall, Denise; Howell, Doris; Brazil, Kevin; Howard, Michelle; Taniguchi, Alan

    2008-01-01

    ABSTRACT PROBLEM BEING ADDRESSED Family physicians face innumerable challenges to delivering quality palliative home care to meet the complex needs of end-of-life patients and their families. OBJECTIVE OF PROGRAM To implement a model of shared care to enhance family physicians’ ability to deliver quality palliative home care, particularly in a community-based setting. PROGRAM DESCRIPTION Family physicians in 3 group practices (N = 21) in Ontario’s Niagara West region collaborated with an interprofessional palliative care team (including a palliative care advanced practice nurse, a palliative medicine physician, a bereavement counselor, a psychosocial-spiritual advisor, and a case manager) in a shared-care partnership to provide comprehensive palliative home care. Key features of the program included systematic and timely identification of end-of-life patients, needs assessments, symptom and psychosocial support interventions, regular communication between team members, and coordinated care guided by outcome-based assessment in the home. In addition, educational initiatives were provided to enhance family physicians’ knowledge and skills. CONCLUSION Because of the program, participants reported improved communication, effective interprofessional collaboration, and the capacity to deliver palliative home care, 24 hours a day, 7 days a week, to end-of-life patients in the community. PMID:19074714

  5. "Uberizing" home care in Ontario.

    PubMed

    Wojtak, Anne; Stark, Linda

    2016-07-01

    This article looks at home care in Ontario and its role as a foundation for a sustainable healthcare system in the future. Beginning with the history and evolution of the service delivery model, it examines current challenges and opportunities to unleash the potential of home care within a more integrated model for patient-centred care for the future. An in-depth look at how to better coordinate, integrate, and fund care for patients is highlighted. PMID:27269814

  6. Home health care in France.

    PubMed

    Charles, B

    1990-02-23

    Home health care in France has a long tradition, but is limited in its development. Since 1970 hospitals are by law permitted to extend services at home. Apart from this, patient associations are a driving force in the organization of home health care. There is a trend to more home health care, but this is hampered by splitting of responsibilities of local, departmental or central authorities. The hospital pharmacist is recommended to focus on his scientific and technical competence. Improved relations between community pharmacists and hospital pharmacists are advocated. PMID:2314994

  7. [Hygienic requirements in home care].

    PubMed

    Sonntag, H G

    1993-02-01

    Hygiene deals with the basis of the prevention of diseases as well as with the preservation and stabilization of health. In this context hygiene deals with animated and inanimated factors which have a promoting or damaging influence on health. Due to the analysis of these factors, the explanation of their functioning and their evaluation from the medical point of view, hygiene develops principles for the protection of health and works on preventive measures for the general public and the individual person. Home care comprises the individual medical care as well as home care, i.e a qualified domestic basic and medical treatment with individuals who fulfil the criteria of this need. Objectives of this home care and home medical care are the cure, the improvement, the prevention of aggravation, the alleviation of pain and the prolongation of live expectancy of people in need for this care. Hygienic requirements on home and medical care, therefore, present a broad spectrum of measures which contribute to the maintenance of health of those persons in need for such a treatment. These requirements have partly been written down in the "Festlegungen der Unfallverhütungsvorschrift, Gesundheitsdienst (VBG 103)" and concerning the field of home medical care in the "Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege". Herein the following topics are considered: Occupational medial provision of the persons responsible for taking care, notification of infectious diseases, protective clothing, care taking techniques and handling of medical technical equipment and means of aid. Requirements on hygiene which refer directly to the sick person comprise, beside others, problems of the individual hygiene including physical hygiene, alimentary hygiene and home hygiene. It is attempted to present in a clearly arranged catalogue the variety of hygienical requirements resulting from the persons responsible for care taking and the persons in need or care and, furthermore, to

  8. Coordinated Home Care Training Manual.

    ERIC Educational Resources Information Center

    Michigan Univ., Ann Arbor. Home Care Training Center.

    This manual is intended as a source of information and assistance in the planning, organization, implementation, and evaluation of home care programs. There are ten major sections: (1) Introduction (review of the history of home care and definition of pertinent terms), (2) Program Planning, (3) Organizational Structure, (4) Coordination and…

  9. Family Child Care Home Standards.

    ERIC Educational Resources Information Center

    Nebraska State Dept. of Health and Human Services, Lincoln.

    This guide enumerates regulations for anyone caring for four or more children at any one time in their home, from families other than their own, in the state of Nebraska. The purpose of the regulations is to protect and promote the health and safety of children in home based child care. The first section of the guide lists specific regulations for…

  10. [Isolation of Mycobacterium avium complex from the "24-hour bath"].

    PubMed

    Saito, H; Murakami, K; Ishii, N; Kwon, H H

    2000-01-01

    The "24-HOUR BATH" is an apparatus which circulates the bath water, keeps it clean and warm, and makes it possible to take a bath at any time during the day or night. It consists of apparatus for cleaning (sponge or mesh filter and filter material), heating (ceramic heater), and sterilizing (UV lamp). Recently, three cases of skin disease due to M. avium infection in private homes, in which "24-HOUR BATH" water was suspected to be the source of infection, have been reported. We attempted to isolate M. avium complex from the water (32 specimens), sponge filter (29 specimens), and filter material (32 specimens) of the "24-HOUR BATH". One hundred-ml samples of bath water, and 50-ml samples of rinse from a sponge filter or filter material were centrifuged at 3000 rpm for 20 min. Sediment was suspended in distilled water and a smear was prepared, and then digested and decontaminated with 2% sodium hydroxide. The processed specimens were cultured on 2% Ogawa medium containing ofloxacin (1 microgram/ml) and ethambutol (2.5 micrograms/ml) for 8 weeks at 37 degrees C. Positive smears were 3 (9.4%), 25 (86.2%) and 25 (78.1%) specimens from the water, sponge and filter material, respectively. A few bacterial clumps were observed, especially in the sponge specimens. The number of positive culture was 5 (15.6%), 24 (82.8%) and 25 (78.1%) from the water, sponge and filter material, respectively. Among them the number of Runyon's Group III-positive cultures was 5 (100%), 22 (91.7%) and 20 (80%) in the water, sponge, and filter material specimens, respectively. In most cases, cultures were positive for both the sponge and filter material specimens. All of the Group III mycobacteria were smooth, grew at 28, 37, 42, and 45 degrees C, negative for niacin, nitrate reductase, semiquantitative catalase, urease and Tween80 hydrolysis, and positive for 68 degrees C catalase. All of the strains reacted with M. avium complex AccuProbe and M. avium AccuProbe, but none of the strains reacted

  11. Patterns in Home Care Use in Manitoba

    ERIC Educational Resources Information Center

    Mitchell, Lori; Roos, Noralou, P.; Shapiro, Evelyn

    2005-01-01

    Administrative home care data from the Manitoba Support Services Payroll (MSSP) system for fiscal years 1995/1996 to 1998/1999 were utilized to study home care client characteristics and changes in home care use over time. Patterns in home care access and use after hospitalization, before admission to a nursing home, and before death were…

  12. Human prolactin - 24-hour pattern with increased release during sleep.

    NASA Technical Reports Server (NTRS)

    Sassin, J. F.; Weitzman, E. D.; Kapen, S.; Frantz, A. G.

    1972-01-01

    Human prolactin was measured in plasma by radioimmunoassay at 20-minute intervals for a 24-hour period in each of six normal adults, whose sleep-wake cycles were monitored polygraphically. A marked diurnal variation in plasma concentrations was demonstrated, with highest values during sleep. Periods of episodic release occurred throughout the 24 hours.

  13. HEART RATE VARIABILITY AND 24-HOUR MINIMUM HEART RATE

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Heart rate variability (HRV) indices based on 24-hour electrocardiograph recordings have been used in clinical research studies to assess the aggregate activity of the autonomic nervous system. While 24-hour HRV is generally considered non-invasive, use in research protocols typically involves cons...

  14. Bringing cancer care home.

    PubMed

    Treco-Jones, S

    1991-01-01

    Community hospitals in the South are seeing new and more cancer patients. Hospitals aggressively seeking new and faster methods to treat patients in their home towns bring benefits to both. PMID:10115667

  15. Staffing in Ontario's Long-Term Care Homes: Differences by Profit Status and Chain Ownership.

    PubMed

    Hsu, Amy T; Berta, Whitney; Coyte, Peter C; Laporte, Audrey

    2016-06-01

    Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996-2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes - especially those owned by a chain organization - provided significantly fewer hours of care, after adjusting for variation in the residents' care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario's LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed. PMID:27223577

  16. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes...

  17. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes...

  18. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes...

  19. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes...

  20. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes...

  1. Patterns in home care use in Manitoba.

    PubMed

    Mitchell, Lori; Roos, Noralou P; Shapiro, Evelyn

    2005-01-01

    Administrative home care data from the Manitoba Support Services Payroll (MSSP) system for fiscal years 1995/1996 to 1998/1999 were utilized to study home care client characteristics and changes in home care use over time. Patterns in home care access and use after hospitalization, before admission to a nursing home, and before death were examined. The study found that the majority of home care clients were female, aged 65 and over, and not married. The proportion of Manitobans using home care increased slowly, but significantly, over the 4 years. The greatest increases were found among the older age groups. The average number of days that clients received home care before death or before admission to a nursing home was stable over time, while a significant increase over time in home care use after hospitalization was experienced. These findings can be useful to regional health authorities for planning and budgeting. PMID:16080138

  2. [Necessity of a 24-hour system of blood transfusion testing].

    PubMed

    Kishimoto, Yuji

    2003-01-01

    The preventive effects of a 24-hour system of blood transfusion testing on mistyping of transfused blood was examined. Blood transfusion tests have been performed by blood transfusion technologists during working hours and by physicians at other times. In March 2000, we introduced a system in which technologists perform blood transfusion tests after working hours. Technologists of the Blood Transfusion Unit and Central Clinical Laboratory perform the test jointly, and column agglutination technology was introduced as the test method. A computer system setup exclusively for the testing was also introduced to perform computer cross-matching. Since transfusion error is likely to occur during emergency blood transfusion, a manual was established to prioritize safety. After introduction of the system, mistyping that may have been caused by inaccurate blood test results markedly decreased, confirming the usefulness of this system for prevention of mistyping. In addition, transfusion errors also decreased in wards and the improved system increased the safety of the entire medical care system. The frequency of mistyping was about 1% when physicians performed blood typing, showing the importance of clinical technologists for blood transfusion tests. PMID:12652691

  3. Place of death: hospital-based advanced home care versus conventional care. A prospective study in palliative cancer care.

    PubMed

    Ahlner-Elmqvist, Marianne; Jordhøy, Marit S; Jannert, Magnus; Fayers, Peter; Kaasa, Stein

    2004-10-01

    The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire. PMID:15540666

  4. Guidebook for Licensed Child Care Homes.

    ERIC Educational Resources Information Center

    Henry, Jeanie

    This guidebook is a reference for family child care homes and family child care group homes licensed by the State of Alaska. It outlines licensing standards and procedures and serves as a simplified abstract of Alaska child care regulations. The first part is an overview that introduces home child care and licensing. Topics covered include…

  5. Effect of overtime work on 24-hour ambulatory blood pressure.

    PubMed

    Hayashi, T; Kobayashi, Y; Yamaoka, K; Yano, E

    1996-10-01

    Recently, the adverse effects of long working hours on the cardiovascular systems of workers in Japan, including "Karoshi" (death from overwork), have been the focus of social concern. However, conventional methods of health checkups are often unable to detect the early signs of such adverse effects. To evaluate the influence of overtime work on the cardiovascular system, we compared 24-hour blood pressure measurements among several groups of male white-collar workers. As a result, for those with normal blood pressure and those with mild hypertension, the 24-hour average blood pressure of the overtime groups was higher than that of the control groups; for those who periodically did overtime work, the 24-hour average blood pressure and heart rate during the busy period increased. These results indicate that the burden on the cardiovascular system of white-collar workers increases with overtime work. PMID:8899576

  6. Taking care of your back at home

    MedlinePlus

    Back strain treatment; Back pain - home care; Low back pain - home care; Lumbar pain - home care ... A common myth about back pain is that you need to rest and avoid activity for a long time. In fact, doctors do not recommend bed ...

  7. NATIONAL HOME AND HOSPICE CARE SURVEY (NHHCS)

    EPA Science Inventory

    The National Home and Hospice Care Survey is a continuing series of surveys of home and hospice care agencies in the United States. Information was collected about agencies that provide home and hospice care and about their current patients and discharges. The NHHCS is based on a...

  8. The entrepreneurial spirit and home care aides.

    PubMed

    Richman, F

    1998-04-01

    Emphasis in the home care industry is being placed on the development of private services in home care. Traditional management characteristics are necessary for this, but so are entrepreneurial ways of thinking--and those may come from all levels of an organization, even and especially home care aides. PMID:10179944

  9. Help is just a phone call away: after-hours support for palliative care patients wishing to die at home.

    PubMed

    Baird-Bower, Debbie; Roach, Julie; Andrews, Morven; Onslow, Fiona; Curnin, Emma

    2016-06-01

    The 24-hour support for palliative patients is the gold standard of health care in Australia. However, in the state of Tasmania after-hours telephone support was spatially fragmented and inequitable. In 2014, hospice@HOME, a pilot programme introduced in Tasmania in that year, implemented a state-wide after-hours palliative care support service--1800HOSPICE--offering 24-hour support, 7 days a week for palliative patients, caregivers and the public. Six months of after-hours call logs in combination with additional patient data, were analysed to evaluate the use and wider implications of a state-wide after-hours palliative care support number. Family and caregivers mainly used the after-hours support to request changes to support services (25.1%), report changes in patients' overall condition (23.6%) and request acute medical assistance (16.2%). Through the use of the after-hours services by all individuals involved in the care, end-of-life patients were able to reduce ambulance contact and emergency department admission, and thereby increase their likelihood of dying at home (for patients whose preference was to die at home). Overall, 24-hour palliative care telephone support was found to be a valuable tool for all individuals involved in the care of end-of-life patients. PMID:27349847

  10. IV treatment at home

    MedlinePlus

    ... 24 hours a day. If there is a problem with the IV, you can call your home health care agency for help. If the IV comes out of ... bleeding stops. Then call the home health care agency or the doctor right away.

  11. Chapter 4: 24-hour recall and diet record methods

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The two methods described in this chapter, the 24-hour dietary recall (24hdr) and the food record (FR) method, are the currently preferred methods of dietary intake assessment, and are based on foods and amounts actually consumed by an individual on one or more specific days. This minimizes some sou...

  12. A web-based care-requiring client and Home Helper mutual support system.

    PubMed

    Ogawa, Hidekuni; Yonezawa, Yoshiharu; Maki, Hiromichi; Hahn, Allen W; Caldwell, W Morton

    2005-01-01

    For the improved efficiency of home care of the elderly, a web-based system has been developed to enable faster communications between care-requiring clients, their Home Helper and the care manager. Changes to care items, such as cooking, bathing, washing, cleaning and shopping are usually requested by the elderly client over the telephone. However, the care central office often requires 24 hours to process and respond to such spoken requests. The system we have developed consists of Internet client computers with liquid crystal input tablets, wireless Internet Java enabled mobile phones and a central office server that yields almost instant communication. The care clients enter requests on the liquid crystal tablet at their home and then their computer sends these requests to the server at the Home Helper central office. The server automatically creates a new file of the requested items, and then immediately transfers them to the care manager and Home Helper's mobile phone. With this non-vocal and paperless system, the care-requiring clients, who can easily operate the liquid crystal tablet, can very quickly communicate their needed care change requests to their Home Helper. PMID:15850098

  13. [Hospital-based advanced home-care, models from Ekenäs, Finland].

    PubMed

    Wikström, U; Weibull, H; Klockars, M

    1998-12-01

    In 1995, advanced home treatment services were introduced at Västra Nyland district hospital in Finland. For selected patients the new services constitute an alternative where hospitalisation would otherwise be necessary. Some of the hospital bed resources were moved to the patients' homes together with a trained team with immediate responsibility for the patients and providing 24-hour care, backed up by access to hospital resources in terms of specialised knowledge and sophisticated technology. Two years' experience of 500 patients so treated showed their diseases to have represented the complete spectrum of specialists fields. The most common diagnoses were oncological and infectious diseases. Although preliminary assessment suggests advanced home care to be a cheaper alternative than hospitalised care, the preeminent advantage from the patients' point of view was improved quality of life. PMID:9894412

  14. FastStats: Home Health Care

    MedlinePlus

    ... Submit What's this? Submit Button NCHS Home Home Health Care Recommend on Facebook Tweet Share Compartir Data are ... Data Alzheimer’s disease Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over [ ...

  15. EURHOMAP: mapping professional home care in Europe

    PubMed Central

    Cabanas, Marta; Ondiviela, M. Àngels; Bolibar, Bonaventura; Morales, José Miguel; José Audera, Francisco; Taltavull, Joana Maria

    2009-01-01

    Introduction Not only is there no comparable information on home care available from the newest EU member states, but information from the other 15 is old. Furthermore, as European countries have implemented health care reforms over the past decade, updating is needed. Description of policy practice The EURHOMAP project (Mapping professional home care in Europe) aims to describe and compare the organisation and provision of home care (health and social) services through the gathering, analysing and disseminating of information on various aspects of home care services in 32 European countries. Discussion/Conclusions Data collection will be done firstly with vignettes, descriptions of cases of elderly or disabled people in need of care living at home, and secondly with a collection table including data and selected home care items. Both instruments will be handled by experts. Comparison of the two instruments will show the diversity of home care in Europe: different roles of home care in European health care systems, variations in financing and provision, links with other sectors of health care and social services, and type of patient needs and demands to which home care is responding.

  16. Palliative Home Care: A Designer's Perspective.

    PubMed

    Bhatnagar, Tigmanshu

    2015-01-01

    The purpose for this observational research was to understand how Can Support provides palliative care at home and analyze its strengths and weaknesses in various socioeconomic scenarios for future development. In the period of 2 weeks, patients and their caregivers were silently observed in their natural surroundings during home care visits in order to listen their problems, identify the pattern of questions for the home care team, their natural way of storytelling, organizational techniques for medicines and medical reports, care givers lives, patient journey, etc. Such observations have enabled the understanding of the phenomena of home palliative care and have led to the identification of certain influential variables of the practice. PMID:26009683

  17. Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design

    PubMed Central

    Brødsgaard, Anne; Zachariassen, Gitte; Clemensen, Jane

    2016-01-01

    Background For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. Objective To identify parental needs when wanting to provide neonatal home care supported by telemedicine. Methods The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Results Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a “bell cord” to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Conclusions Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using

  18. Home care safety markers: a scoping review.

    PubMed

    Macdonald, Marilyn; Lang, Ariella; Storch, Jan; Stevenson, Lynn; Donaldson, Susan; Barber, Tanya; Iaboni, Kristine

    2013-01-01

    Safety in home care is a new research frontier, and one in which demand for services continues to rise. A scoping review of the home care literature on chronic obstructive pulmonary disease and congestive heart failure was thus completed to identify safety markers that could serve to develop our understanding of safety in this sector. Results generated seven safety markers: (a) Home alone; (b) A fixed agenda in a foreign language; (c) Strangers in the home; (d) The butcher, the baker, the candlestick maker; (e) Medication mania; (f) Out of pocket: The cost of caring at home; and (g) My health for yours: Declining caregiver health. PMID:23679662

  19. Care homes crisis must be addressed urgently.

    PubMed

    Cole, Elaine

    2014-11-01

    The annual report on the state of health and social care in England from the Care Quality Commission makes for worrying reading. As well as safety concerns in 80 per cent of the hospitals that it inspected, the watchdog warns of a shortage of nurses in care homes - one in three vacancies is unfilled in some places and one in five care homes inspected had too few staff on duty to ensure patient safety and good quality care. PMID:25351045

  20. Oral health for adults in care homes.

    PubMed

    Berry, Lisa

    2016-08-01

    Essential facts It is estimated that more than 400,000 adults live in UK care homes, 80% of whom have dementia. More than half of older people in care homes have tooth decay compared with 40% of over 75s and 33% of over 85s who do not live in care homes. Care home residents are more likely to have fewer natural teeth, and those with teeth are less likely to have enough teeth to eat comfortably and socialise without embarrassment. PMID:27573950

  1. Breast milk intake: 12 hour versus 24 hour assessment.

    PubMed

    De Carvalho, M; Pittard, W

    1982-11-01

    Letter to the editor commenting on "Clinical and field studies of human lactation: methodological considerations," by Brown et al. The point is made that in test-weighing infants to estimate breast milk intake, culture related breastfeeding practices must be studied before a 12 hour test period is used to estimate intake for a complete 24 hour period. In western cultures milk intake between 7 am and 7 pm was found to differ significantly from intake between 7 pm and 7 am, whereas in a Bangladesh study milk intake during the 2 12 hour periods was comparable. PMID:7137079

  2. [Challenges Associated with Involvement of Small-Scale Pharmacies in Home Health Care].

    PubMed

    Oka, Toyoka; Takeda, Namihiro; Hamana, Tomoko; Hirohara, Masayoshi; Kushida, Kazuki

    2015-12-01

    As our society is progressing towards a composition wherein a significant portion is constituted by the elderly, a comprehensive home health care system is warranted. The provision of pharmacy services is a key factor in ensuring comprehensive home health care. Our pharmacy has been involved in home health care since its inception. This report is an attempt at evaluation of future prospects through identification and analysis of current operational issues. Our pharmacy is adequately equipped to accommodate home cared patients with significant medical dependency. However, being a small-scale business with few employees, coordinating shifts to ensure 24 hours operation in addition to providing home visits when required has been challenging. These place a substantial burden on the staff pharmacists. It is highly challenging for a single small-scale pharmacy to operate as a"self-contained pharmacy"that remains independent and still adequately serves their clients. Creating a collaborative pharmaceutical service team, consisting of several complementary small-scale pharmacies, provisionally called a "regional cooperative pharmacy,"could prove to be a more realistic alternative. In the coming decade, improving the implementation of home health care through regional level cooperation is necessary. This would require the collaboration various professionals, and the involvement of municipalities and professional organizations to ensure adequate regional support services. PMID:26809404

  3. Integrated working between residential care homes and primary care: a survey of care homes in England

    PubMed Central

    2012-01-01

    Background Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS) about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care) were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621) in England in 2009. Responses were analysed using quantitative and qualitative methods. Results The survey achieved an overall response rate of 15.8%. Most care homes (78.7%) worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs) had visited the care homes in the last six months (SD 5.11, median 14); a mean of .39 (SD.163) professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60%) managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low levels of respect for

  4. New horizons in care home medicine.

    PubMed

    Burns, Eileen; Nair, Sherena

    2014-01-01

    Care home medicine has been an under-researched area, but over the last decade there has been a substantial growth in publications. Most of these have focused on the 'geriatric giants' of falls, incontinence and mental health issues (especially dementia, behavioural disturbance and depression) as well as other key topics such as medication use and issues related to death and dying. Other areas of recent interest are around access to health services for care home residents, how such services may most effectively be developed and how the quality of life for residents can be enhanced. While many of the reported studies are small and not always well designed, evidence in several areas is emerging which begins to guide service developments. A common theme is that multi-disciplinary interventions are the most effective models of delivery. The role of care home staff as members of these teams is key to their effectiveness. Recent consensus guidelines around falls prevention in care homes synthesise the evidence and recommend multi-disciplinary interventions, and clarify the role of vitamin D and of exercise in certain populations in the care home. The benefits of pharmacist led medication reviews are beginning to emerge; although studies reviewed to date have not yet led to the 'holy grail' of hospital admission avoidance they point to benefits in reduction of drug burden. Effectiveness may be enhanced when working with GPs and care home nurses. Welcome evidence is emerging that in the UK the rate of prescription of anti-psychotics has fallen. This is clear evidence that changes in practice around care homes can be effected. The poor access to non-pharmacological therapies for care home residents with behavioural disturbance remains a significant gap in service. End-of-life care planning and delivery is an important part of care in care homes, and there is evidence that integrated pathways can improve care; however, the use of palliative care medications was limited

  5. [Formula creatinine clearance as a substitute for 24-hour creatine clearance in children with kidney transplantation].

    PubMed

    Aufricht, C; Balbisi, A; Gerdov, C; Müller, T; Lothaller, M A; Balzar, E

    1995-01-01

    Despite many theoretical advantages, formula-creatininclearance (Schwartz et al, Journal of Pediatrics 1976) has not found broad clinical acceptance in everyday pediatric patient care. In this study we report our results of long term observations (11.7 +/- 6.8 (1.7-24.8) months) of measured and computed creatininclearance in 27 children after renal transplantation (15 boys, 12 girls, mean age 14.5 +/- 4.2 (5.5-20) years) at the Kinderdialyse of the Universitäts-Kinderklinik of Vienna. We found a wide scattered correlation between the measured and computed creatininclearance values with a 90% confidence interval between -30% to +60% of the 24 hour creatininclearance. Formula creatininclearance (SD 17.8%) was markedly better reproducable than the 24 hour creatininclearancethe (SD 37.8%), the intraindividuell collecting error (36.1%) was almost twice the interindividuell "coefficient" error (20.27%). We therefore conclude that the 24 hour creatininclearance is by far not as accurate as the complexity of the procedure pretends and support broad clinical acceptance for the formula creatininclearance. PMID:7752601

  6. Recovery of amplitude integrated electroencephalographic background patterns within 24 hours of perinatal asphyxia

    PubMed Central

    van Rooij, L G M; Toet, M; Osredkar, D; van Huffelen, A C; Groenendaal, F; de Vries, L S

    2005-01-01

    Objective: To assess the time course of recovery of severely abnormal initial amplitude integrated electroencephalographic (aEEG) patterns (flat trace (FT), continuous low voltage (CLV), or burst suppression (BS)) in full term asphyxiated neonates, in relation to other neurophysiological and neuroimaging findings and neurodevelopmental outcome. Methods: A total of 190 aEEGs of full term infants were reviewed. The neonates were admitted within 6 hours of birth to the neonatal intensive care unit because of perinatal asphyxia, and aEEG recording was started immediately. In all, 160 infants were included; 65 of these had an initial FT or CLV pattern and 25 an initial BS pattern. Neurodevelopmental outcome was assessed using a full neurological examination and the Griffiths' mental developmental scale. Results: In the FT/CLV group, the background pattern recovered to continuous normal voltage within 24 hours in six of the 65 infants (9%). All six infants survived the neonatal period; one had a severe disability, and five were normal at follow up. In the BS group, the background pattern improved to normal voltage in 12 of the 25 infants (48%) within 24 hours. Of these infants, one died, five survived with moderate to severe disability, two with mild disability, and four were normal. The patients who did not recover within 24 hours either died in the neonatal period or survived with a severe disability. Conclusion: In this study there was a small group of infants who presented with a severely abnormal aEEG background pattern within six hours of birth, but who achieved recovery to a continuous normal background pattern within the first 24 hours. Sixty one percent of these infants survived without, or with a mild, disability. PMID:15846017

  7. Medication Information Flow in Home Care.

    PubMed

    Norri-Sederholm, Teija; Saranto, Kaija; Paakkonen, Heikki

    2016-01-01

    Critical success factors in medication care involve communication and information sharing. Knowing the information needs of each actor in medication process in home care, is the first step to ensure that the right type of information is available, when needed. The aim of the study was to describe the needed and delivered information in home care in order to perform medication care successfully. A total of 15 nurses from primary home care participated a workshop focusing on medication treatment. The qualitative data was collected by focus group technique. Data was analyzed according to content analysis. Three medication information themes were formulated: Client-related information, medication, and medication error. The critical medication information were generic drug information, validity of the list of medication and client's clinical status. As a conclusion findings, show the diversity of the medication information in home care. PMID:27332222

  8. Home Health Care: What It Is and What to Expect

    MedlinePlus

    ... care + Share widget - Select to show What’s home health care & what should I expect? What's home health care? Home health care is a wide range of ... listed. What should I expect from my home health care? Doctor’s orders are needed to start care. Once ...

  9. Is home health care a substitute for hospital care?

    PubMed

    Lichtenberg, Frank R

    2012-01-01

    A previous study used aggregate (region-level) data to investigate whether home health care serves as a substitute for inpatient hospital care and concluded that "there is no evidence that services provided at home replace hospital services." However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional heterogeneity. In this article, state-level employment data are used to reexamine whether home health care serves as a substitute for inpatient hospital care. This analysis is based on longitudinal (panel) data--observations on states in two time periods--which enable the reduction or elimination of biases that arise from use of cross-sectional data. This study finds that states that had higher home health care employment growth during the period 1998-2008 tended to have lower hospital employment growth, controlling for changes in population. Moreover, states that had higher home health care payroll growth tended to have lower hospital payroll growth. The estimates indicate that the reduction in hospital payroll associated with a $1,000 increase in home health payroll is not less than $1,542, and may be as high as $2,315. This study does not find a significant relationship between growth in utilization of home health care and growth in utilization of nursing and residential care facilities. An important reason why home health care may serve as a substitute for hospital care is that the availability of home health care may allow patients to be discharged from the hospital earlier. Hospital discharge data from the Healthcare Cost and Utilization Project are used to test the hypothesis that use of home health care reduces the length of hospital stays. Major Diagnostic Categories with larger increases in the fraction of patients discharged to home health care tended to have larger declines in mean length of stay (LOS). Between 1998 and 2008, mean LOS declined by 4.1%, from 4.78 to 4.59 days

  10. Supporting collaboration in multidisciplinary home care teams.

    PubMed

    Pinelle, David; Gutwin, Carl

    2002-01-01

    Collaboration is an important part of healthcare delivery. However, in home care, collaboration is difficult due to the mobility and schedule variability of the workers. In this paper, we investigate the difficulties inherent in home care collaboration. We present the results of a study carried out with home care clinicians in Saskatoon District Health, and identify five areas of collaboration that are difficult for home care workers: scheduling, information dissemination, information retrieval, short-term treatment coordination, and long-term treatment planning. We present recommendations for incorporating support for each of these areas into point-of-care clinical information systems that provide access to shared patient records. Finally, we discuss general design approaches for incorporating this type of support, including the need for workers to maintain awareness of the activities of others, and the need to integrate communication with the presentation of the health record. PMID:12463897

  11. Structural Predictors of Child Care Quality in Child Care Homes.

    ERIC Educational Resources Information Center

    Burchinal, Margaret; Howes, Carollee; Kontos, Susan

    2002-01-01

    Used data from a family child care study and a licensing study to identify dimensions best predicting global day care quality in over 300 child care homes. Found that caregiver training most consistently predicted global quality. Found no reliable association between care quality and child-caregiver ratio or age-weighted group size recommendations…

  12. Home Care Research: What Does It Tell Us?

    ERIC Educational Resources Information Center

    Chappell, Neena L.

    1994-01-01

    Assesses applied relevance of research on home care, reviewing literature on predictors of use of home care services, experience of receiving home care, and efficacy studies. Notes that efficacy studies have not concluded that home care is less costly or better for quality of life of older adults when compared with institutional care. (Author/NB)

  13. Making research integral to home care services.

    PubMed

    Lang, Ariella; Shamian, Judith; Goodwin, Sharon

    2015-09-01

    Home care is the fastest growing segment of the Canadian healthcare system, yet research on patient safety has been conducted predominantly in institutional settings. This is a case example of how Victorian Order of Nurses Canada, a national not-for-profit home and community care provider, embedded a nurse researcher to create an environment in which health services research flourished. This model strategically propelled important issues such as home care safety on to the national research and policy agendas and helped leverage change in multiple levels of the healthcare system. This is a call to action for building partnerships to have a researcher as an integral team member in organizations providing home care services. PMID:26135296

  14. Home Care Nursing Improves Cancer Symptom Management

    Cancer.gov

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  15. Home care compliance: how to protect yourself.

    PubMed

    Stine, C; Howarth, D

    1998-10-01

    Home care agencies are operating in a supercharged environment of distrust, thanks to recent regulatory and legislative changes. By establishing and closely following compliance programs, however, they will lower their risk and make improvements in overall agency operations. PMID:10186122

  16. Psychological Issues in Pediatric Home Care.

    ERIC Educational Resources Information Center

    Kohrman, Arthur F.

    The popularity of home care for chronically ill or technology-dependent children has moved professionals into unfamiliar settings. Factors responsible for the relatively sudden surge of effort to place children with complex needs at home include costs, individualism and autonomy, changing views of medicine and its institutions, limits of medical…

  17. Managing sleep and wakefulness in a 24-hour world

    PubMed Central

    Coveney, Catherine M

    2014-01-01

    This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi-structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24-hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work–social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self-regulate our sleeping patterns. PMID:23957268

  18. Cognitive Performance during a 24-Hour Cold Exposure Survival Simulation

    PubMed Central

    Hartley, Geoffrey L.; Zaharieva, Dessi; Basset, Fabien A.; Hynes, Zach

    2016-01-01

    Survivor of a ship ground in polar regions may have to wait more than five days before being rescued. Therefore, the purpose of this study was to explore cognitive performance during prolonged cold exposure. Core temperature (Tc) and cognitive test battery (CTB) performance data were collected from eight participants during 24 hours of cold exposure (7.5°C ambient air temperature). Participants (recruited from those who have regular occupational exposure to cold) were instructed that they could freely engage in minimal exercise that was perceived to maintaining a tolerable level of thermal comfort. Despite the active engagement, test conditions were sufficient to significantly decrease Tc after exposure and to eliminate the typical 0.5–1.0°C circadian rise and drop in core temperature throughout a 24 h cycle. Results showed minimal changes in CTB performance regardless of exposure time. Based on the results, it is recommended that survivors who are waiting for rescue should be encouraged to engage in mild physical activity, which could have the benefit of maintaining metabolic heat production, improve motivation, and act as a distractor from cold discomfort. This recommendation should be taken into consideration during future research and when considering guidelines for mandatory survival equipment regarding cognitive performance. PMID:27478839

  19. Cognitive Performance during a 24-Hour Cold Exposure Survival Simulation.

    PubMed

    Taber, Michael J; Hartley, Geoffrey L; McGarr, Gregory W; Zaharieva, Dessi; Basset, Fabien A; Hynes, Zach; Haman, Francois; Pinet, Bernard M; DuCharme, Michel B; Cheung, Stephen S

    2016-01-01

    Survivor of a ship ground in polar regions may have to wait more than five days before being rescued. Therefore, the purpose of this study was to explore cognitive performance during prolonged cold exposure. Core temperature (T c) and cognitive test battery (CTB) performance data were collected from eight participants during 24 hours of cold exposure (7.5°C ambient air temperature). Participants (recruited from those who have regular occupational exposure to cold) were instructed that they could freely engage in minimal exercise that was perceived to maintaining a tolerable level of thermal comfort. Despite the active engagement, test conditions were sufficient to significantly decrease T c after exposure and to eliminate the typical 0.5-1.0°C circadian rise and drop in core temperature throughout a 24 h cycle. Results showed minimal changes in CTB performance regardless of exposure time. Based on the results, it is recommended that survivors who are waiting for rescue should be encouraged to engage in mild physical activity, which could have the benefit of maintaining metabolic heat production, improve motivation, and act as a distractor from cold discomfort. This recommendation should be taken into consideration during future research and when considering guidelines for mandatory survival equipment regarding cognitive performance. PMID:27478839

  20. The Determinants of Care Home Closure

    PubMed Central

    Allan, Stephen; Forder, Julien

    2015-01-01

    This study investigates the causes of full closure of care homes in the English care home/nursing home market. We develop theoretical arguments about two causes for closure that are triggered by errors or external shocks: poor economic sustainability and regulatory action. Homes aiming to operate with lower quality in the market are argued for a number of reasons to be more susceptible to errors/shocks in setting quality, especially negative errors, leading to an empirical hypothesis that observed quality should negatively affect closure chance. In addition, given quality, homes facing relatively high levels of local competition should also have an increased chance of closure. We use a panel of care homes from 2008 and 2010 to examine factors affecting their closure status in subsequent years. We allow for the potential endogeneity of home quality and use multiple imputation to replace missing data. Results suggest that homes with comparatively higher quality and/or lower levels of competition have less chance of closure than other homes. We discuss that the results provide some support for the policy of regulators providing quality information to potential purchasers in the market. © 2015 The Authors. Health Economics published by John Wiley & Sons Ltd. PMID:25760588

  1. Teaching wound care in the home.

    PubMed

    Grupp, K; Albert, M

    1990-01-01

    A survey of Medicare-certified agencies in Alaska, Idaho, Montana, Oregon, and Washington identified wound care and teaching wound care as being among the highest ranked clinical problems related to earlier hospital discharges that have resulted from Medicare Diagnostic Related Groupings (DRGs). Home care nurses are treating increasingly complex wounds and are required to teach complex wound care skills to clients and caregivers. This paper provides guidelines and resources to home care nurses for teaching wound care to their elderly clients and caregivers. The process of developing and implementing a teaching plan is described through the use of the community health nursing process. Following the presentation of the process content, a sample teaching wound care plan and sample teaching handouts are presented with a list of available teaching resources about wound care. PMID:10108797

  2. Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias

    PubMed Central

    2014-01-01

    Background Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope. Methods Design: prospective, observational, cross-sectional study. Setting: Clinical Physiology, University Hospital. Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope. Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG® thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days. Main outcome measures: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II–III, sinus arrest (SA), wide complex tachycardia (WCT). Results 95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1–8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2–22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia

  3. Preparation and results of a 24-hour orbital flight.

    PubMed

    Titov, G S

    1963-01-01

    The space age presents man with unprecedented opportunities for discovery and for cooperative endeavors to benefit all mankind. My flight of August 6-7, 1961 was conducted for the purpose of determining whether man can stay and work effectively and whether all systems of the spaceship can operate successfully during a period of 24 hours in space. The flight of Vostok II represents an experimental step in a logical sequence which included the first earth orbiting flight of USSR citizen Yuri A. Gagarin. Preparation for the flight included the study of theoretical and applied subjects, testing in various kinds of apparatus which provide acceleration, heat and isolation experience, brief airborne weightless flights and parachute landings, in addition to extensive training in a real spacecraft having simulators for normal and emergency contingencies of space flight. The actual flight was therefore carried out with a sense of confidence and familiarity and with continuous close radio contact with ground centers from whom my fellow cosmonauts served as spokesmen. Sequential boosters totaling 600 000 kg thrust placed the 4731 kg spaceship into a perfect orbit varying in altitude from 178-246 km in a plane 64 degrees 58' inclined to the equator. The spaceship made 17 orbits around the earth landing 25 hours, 18 minutes after take-off. The cabin had full atmospheric pressure and a comfortable habitability which could be extended for 10 days. I was able to maneuver the spaceship and perform many other control functions, make observations and take pictures of the earth and its cloud cover, eat meals and sleep all with good efficiency. I experienced mild symptoms suggestive of seasickness which were aggravated by head turning, ameliorated by sleep and entirely relieved by resumption of g-loading during descent. Altogether analyses of the physical and structural performance of the spaceship and the continuously monitored physiological responses of the pilot indicate that all

  4. Comforts of Home: Home Care of the Terminally Ill

    PubMed Central

    Fraser, Jacqueline

    1990-01-01

    When a terminal illness is diagnosed, it is appropriate for the family physician to take a primary role in future management. Care goals change from being disease-focused and cure-directed to being person-focused and comfort-targeted. The patient and family comprise the unit of care. Care of the terminally ill in the home requires good planning, teamwork, excellent symptom management, and a commitment by the family physician to be available or provide alternate coverage. Death in the home should be an option for the patient and family whenever feasible. Caring for patients until death and supporting their families and friends are rewarding and positive parts of family practice. PMID:21233972

  5. Working conditions in home care: a survey of Washington state's home care workers.

    PubMed

    Hayashi, R; Gibson, J W; Weatherley, R A

    1994-01-01

    Home care services make it possible for millions of older Americans to continue living in the community. Such services may enhance the recipients' quality of life while providing essential respite to family caregivers. But while there has been increasing recognition of the burden borne by the predominantly female family caregivers, there has been less attention to the plight of the home care workforce. With the growth of the home care industry, the burden of care has to some extent shifted from one category of female caregivers to another. This paper, based on a survey of 16 agencies and 1,900 workers, examines the employment conditions of home care workers in Washington state. The study reveals a pattern of harsh working conditions, low wages, and few benefits. The findings raise questions about the ethics and efficacy of government policies that are based on the exploitation of home care workers. PMID:10134029

  6. Kansas Adult Care Home Aide Curriculum. Revised.

    ERIC Educational Resources Information Center

    Fornelli, Linda K.; Bartel, Myrna J.

    This curriculum guide is designed for use by instructors whose responsibility it is to prepare persons to provide basic direct care for residents living in adult care homes. Addressed in the individual units of part I (which contains information to be covered in the first 40 hours of training) are the following topics: working in an adult care…

  7. Reducing dehydration in residents of care homes.

    PubMed

    Hooper, Lee; Whitelock, Suzan; Bunn, Diane

    Dehydration can have serious consequences for older people and is a particular problem for residents of nursing and care homes. This article, the second in a two-part series, describes how a specialist care home for people with dementia in Great Yarmouth introduced high-quality hydration care to frail residents. By involving all staff and ensuring residents take a litre of fluid by the end of a relaxed and extended breakfast, staff have reduced anxiety and aggression and created a calmer and more sociable atmosphere. This has benefitted residents, visitors and staff, and is reflected in low levels of unplanned hospital admissions and paramedic call-outs. PMID:26492664

  8. Essential program components for perinatal home care.

    PubMed

    Goodwin, L

    1994-10-01

    Home care will continue to be a rapidly expanding area of health care. This growth will be evident in the perinatal nursing specialty. There are multiple models for delivery of perinatal home services. In each case, consideration needs to be given to licensing and other standards; to operational areas such as staffing, supplies, equipment, and reimbursement; and to quality issues, such as staff development, internal and external customer service, and a continuous quality improvement program. Successful marketing of the services requires recognition that the product is nursing care. PMID:7836991

  9. Speak Up: Help Prevent Errors in Your Care: Home Care

    MedlinePlus

    ... to see if they meet The Joint Commission’s quality standards. • Ask if the home care organization has taken ... rules that make sure that patient safety and quality standards are followed. P articipate in all decisions about ...

  10. They Are Called Nursing Homes for a Reason: RN Staffing in Long-Term Care Facilities.

    PubMed

    Harden, J Taylor; Burger, Sarah Greene

    2015-12-01

    According to the Centers for Medicare and Medicaid Services (CMS), the Consolidated Medicare and Medicaid regulations have not been systematically reviewed and updated since 1991. Existing regulations require that, with certain exceptions, an RN provide services in a facility for 8 consecutive hours per day, 7 days per week; licensed practical nurses (LPNs) 24 hours per day; and sufficient staff to meet residents' needs. The requirements to determine "sufficient" staff remain undefined by CMS. Several national organizations support RN staffing 24 hours per day each day of the week (24/7). These organizations provided evidence refuting CMS' position that it does not have sufficient information at this time to require a specific number of staff or hours of nursing care per resident. Consideration should be given to the Institute of Medicine recommendation affrming the need for and requiring the presence of at least one RN within every nursing home facility at all times. Currently, there is a bill in the House of Representatives that supports 24/7 RN coverage in nursing homes, which must become both bipartisan and bicameral to be passed. PMID:26594951

  11. A Focus on Literacy in Home Day Care.

    ERIC Educational Resources Information Center

    Cress, Susan W.

    Although about 15 percent of young children are cared for in a home day care setting, there is little information available on literacy experiences provided for children in home day care. This study examined literacy environments in home day care centers in St. Joseph County, Indiana. Sixty-one family day care providers responded to a mail survey…

  12. Home Inotropes and Other Palliative Care.

    PubMed

    Ginwalla, Mahazarin

    2016-07-01

    Heart failure is a leading case of morbidity and mortality worldwide, and patients with advanced heart failure have limited options without any available cure. These options mainly include cardiac transplantation or mechanical circulatory support device implantation. Chronic home inotropes are an option in these patients for a variety of indications. This report discusses the use of chronic home inotropes in palliated heart failure patients and reviews the role of palliative care management in end-stage heart failure. PMID:27371519

  13. Ownership Status and Home Health Care Performance

    PubMed Central

    Grabowski, David C.; Huskamp, Haiden A.; Stevenson, David G.; Keating, Nancy L.

    2009-01-01

    Few studies have analyzed for-profit and nonprofit differences in the home health care sector. Using data from the National Home and Hospice Care Survey, we found that patients in nonprofit agencies were more likely to be discharged within 30 days under Medicare cost-based payment compared to patients in for-profit agencies. However, this difference in length of enrollment did not translate into meaningful differences in discharge outcomes between nonprofit and for-profit patients, suggesting that – under a cost-based payment system – nonprofits may behave more efficiently relative to for-profits. These results highlight the importance of organizational and payment factors in the delivery of home health care services. PMID:19333838

  14. Comparative Costs of Home Care and Residential Care

    ERIC Educational Resources Information Center

    Chappell, Neena L.; Havens, Betty; Honorary, Dlitt; Hollander, Marcus J.; Miller, Jo Ann; McWilliam, Carol

    2004-01-01

    Purpose: This paper reports on Canadian research that examined the cost effectiveness of home care for seniors as a substitute for long-term institutional services. Design and Methods: Two Canadian cities were included in the research: Victoria, British Columbia, and Winnipeg, Manitoba. The research computes the costs of formal care and informal…

  15. Home Medical Care for Heart Failure.

    PubMed

    Yumino, Dai

    2016-01-01

    As heart failure progresses to the end stage, it becomes more difficult to maintain the same level of quality of life using the established therapy for the heart failure patients. We believe that an innovative home medical care for heart failure therapy that focuses on the individual's quality of daily living and early intervention is necessary. The roles of home medical care include: early discharge to home as opposed to long hospitalization; the prevention of re-hospitalization; the provision of good care; treatment of any exacerbations; and options available at the end of the patient's life at home. Being able to provide all of the above will allow heart failure patients to live at their home. Home medical care for heart failure requires collaborative teamwork among multiple institutions and medical professionals. Among this collaborative group, the role of pharmacists is critical. Since many of the elderly with heart failure are taking multiple medications, it is important to evaluate the compliance and to intervene for improvement. Pharmacists visiting the patient's home will be able to check the patient's living environment, to evaluate medication compliance, to reconsider the necessary medications for the specific patient, and to consult physicians. Pharmacists can also explain clearly to patients and their family members any changes in medical therapy, as the conditions for an end-stage heart failure patient may change drastically in a short time. By achieving all of the above, it may be possible to prevent re-hospitalization and to help maintain the quality of life for heart failure patients. PMID:27477731

  16. 77 FR 72738 - Contracts and Provider Agreements for State Home Nursing Home Care

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-06

    ... AFFAIRS 38 CFR Part 51 RIN 2900-AO57 Contracts and Provider Agreements for State Home Nursing Home Care... agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking is required to implement a change in law that revises how VA will pay for care provided to these veterans...

  17. Home care for brain tumor patients

    PubMed Central

    Pace, Andrea; Villani, Veronica; Di Pasquale, Antonella; Benincasa, Dario; Guariglia, Lara; Ieraci, Sonia; Focarelli, Silvia; Carapella, Carmine Maria; Pompili, Alfredo

    2014-01-01

    Background Brain tumor patients are quite different from other populations of cancer patients due to the complexity of supportive care needs, the trajectory of disease, the very short life expectancy, and resulting need for a specific palliative approach. Methods A pilot program of comprehensive palliative care for brain tumor patients was started in the Regina Elena National Cancer Institute of Rome in October 2000, supported by the Lazio Regional Health System. The aim of this model of assistance was to meet patient's needs for care in all stages of disease, support the families, and reduce the rehospitalization rate. The efficacy of the model of care was evaluated analyzing the place of death, caregiver satisfaction, rehospitalization rate, and the impact on costs to the health system. Results From October 2000 to December 2012, 848 patients affected by brain tumor were enrolled in a comprehensive program of neuro-oncological home care. Out of 529 patients who died, 323 (61%) were assisted at home until death, 117 (22.2%) died in hospital, and 89 (16.8%) died in hospice. A cost-effectiveness analysis demonstrated a significant reduction in hospital readmission rates in the last 2 months of life compared with the control group (16.7% vs 38%; P < .001). Conclusions Our findings concerning death at home, rehospitalization rate, quality of life, and satisfaction of patients and their relatives with the care received suggest that a neuro-oncologic palliative home-care program has a positive impact on the quality of care for brain tumor patients, particularly at the end of life. PMID:26034609

  18. Assessing home care agencies' readiness for telehealth.

    PubMed

    Demiris, George; Patrick, Timothy; Khatri, Naresh

    2003-01-01

    Home healthcare is facing a set of challenging new realities in the 21st century such as funding limitations and increased life expectancy. Many believe that the use of telehealth enabling patients at home to interact with nurses at the clinical site using videoconferencing technology, will be a cost-effective solution to providing quality care services. Many agencies have adopted or are planning on implementing a telehealth solution. Level of agencies' readiness can lead to a lower level of risk, and a more successful innovation outcome. We developed a framework for assessing home care agencies' readiness for telehealth consisting of 35 items. This instrument can be used as a decision support tool for agencies that are about to implement a telehealth system as well as a formative or summative evaluation tool for agencies already utilizing telehealth. PMID:14728330

  19. Sexuality and intimacy among care home residents.

    PubMed

    Simpson, Paul; Horne, Maria; Brown, Laura J E; Dickinson, Tommy; Wilson, Christine Brown

    Discussing sexuality and intimacy with older people can be problematic, so it is not uncommon that their needs go unrecognised. This article identifies barriers to addressing sexuality and intimacy needs, and outlines some simple strategies to raise awareness of them among older care home residents and staff, thereby facilitating a discussion to enable such needs to be met. PMID:27141720

  20. [Nursing care at home and secularism].

    PubMed

    Lecointre, Brigitte

    2015-12-01

    The question of secularism, long-time confined to schools and the relationships between the Church and State, is today being raised in the field of public health. Nurses are directly affected and are integrating this dimension of secularism into their care practices. A private practice nurse describes the effect these changes are having on her practice in patients' homes. PMID:26654502

  1. Home Care Service Diversification: A Pilot Investigation.

    ERIC Educational Resources Information Center

    Jette, Alan M.; And Others

    1981-01-01

    Describes a diversified approach to delivering home care to vulnerable older people. This pilot program, funded by the Massachusetts Department of Elder Affairs, attempted to reduce the demand for scarce homemaker services. Results suggest homecare diversification did not alter consumer satisfaction but increased manager time. (Author/JAC)

  2. Perinatal home care: one entrepreneur's experience.

    PubMed

    Eaton, D G

    1994-10-01

    Nurses have responded to the entrepreneurial movement by entering into various nontraditional roles and starting their own businesses. This article describes the author's experience in establishing a perinatal home-care business. The characteristics of women and nurse entrepreneurs are discussed, as are the components of a business plan and how to manage a business. PMID:7836999

  3. Managed care. An opportunity for home care agencies.

    PubMed

    Dee-Kelly, P A; Heller, S; Sibley, M

    1994-09-01

    It is clear, even in the future of health care reform, that home care is a growing component of the health care industry. For many years, fee for service was the model reimbursement method. Today we are in a changing health care system that requires a greater emphasis on home care cost containment. New methods of reimbursement are a part of the change. Progressive home care agencies see this as an opportunity to become leaders. This approach does not come without certain risks, however. In taking the risks, it is imperative to minimize the chances for problems, obstacles, and compromising the quality of patient care. It requires that the agency develop a strategy, set a course, and then devote the resources necessary to meet these challenges. Resources may mean investing in upgraded information systems, hiring clinical specialists to develop care plans and protocols, or developing in-house case management staff to allow the agency to monitor use and quality. One thing is clear--the old way of doing business, cost-based fee for service, has a limited life span, and agencies need to embrace these changes, not ignore them. PMID:8090642

  4. Lessons Learned from Home Visiting with Home-Based Child Care Providers

    ERIC Educational Resources Information Center

    McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana

    2011-01-01

    Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…

  5. Elimination of 24-hour continuous medical resident duty in Quebec

    PubMed Central

    Hamadani, Fadi; Deckelbaum, Dan; Shaheen, Mohammed; Sauvé, Alexandre; Dumitra, Sinziana; Ahmed, Najma; Latulippe, Jean-François; Balaa, Fady; Walsh, Mark; Fata, Paola

    2016-01-01

    Summary In 2012 Quebec limited continuous in-hospital duty to 16 consecutive hours for all residents regardless of postgraduate (PGY) level. The new restrictions in Quebec appeared to have a profound, negative effect on the quality of life of surgical residents at McGill University and a perceived detrimental effect on the delivery of surgical education and patient care. Here we discuss the results of a nationwide survey that we created and distributed to general surgery residents across Canada to capture and compare their perceptions of the changes to duty hour restrictions. PMID:26574704

  6. The Fresenius Medical Care home hemodialysis system.

    PubMed

    Schlaeper, Christian; Diaz-Buxo, Jose A

    2004-01-01

    The Fresenius Medical Care home dialysis system consists of a newly designed machine, a central monitoring system, a state-of-the-art reverse osmosis module, ultrapure water, and all the services associated with a successful implementation. The 2008K@home hemodialysis machine has the flexibility to accommodate the changing needs of the home hemodialysis patient and is well suited to deliver short daily or prolonged nocturnal dialysis using a broad range of dialysate flows and concentrates. The intuitive design, large graphic illustrations, and step-by-step tutorial make this equipment very user friendly. Patient safety is assured by the use of hydraulic systems with a long history of reliability, smart alarm algorithms, and advanced electronic monitoring. To further patient comfort with their safety at home, the 2008K@home is enabled to communicate with the newly designed iCare remote monitoring system. The Aquaboss Smart reverse osmosis (RO) system is compact, quiet, highly efficient, and offers an improved hygienic design. The RO module reduces water consumption by monitoring the water flow of the dialysis system and adjusting water production accordingly. The Diasafe Plus filter provides ultrapure water, known for its long-term benefits. This comprehensive approach includes planning, installation, technical and clinical support, and customer service. PMID:15043622

  7. 42 CFR 494.100 - Condition: Care at home.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at... part. (a) Standard: Training. The interdisciplinary team must oversee training of the home...

  8. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  9. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  10. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  11. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  12. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...

  13. 42 CFR 494.100 - Condition: Care at home.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at... part. (a) Standard: Training. The interdisciplinary team must oversee training of the home...

  14. 42 CFR 494.100 - Condition: Care at home.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at... part. (a) Standard: Training. The interdisciplinary team must oversee training of the home...

  15. 42 CFR 494.100 - Condition: Care at home.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at... part. (a) Standard: Training. The interdisciplinary team must oversee training of the home...

  16. 42 CFR 494.100 - Condition: Care at home.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at... part. (a) Standard: Training. The interdisciplinary team must oversee training of the home...

  17. Heart rate variability and arrhythmic patterns of 24-hour Holter electrocardiography among Nigerians with cardiovascular diseases

    PubMed Central

    Adebayo, Rasaaq Ayodele; Ikwu, Amanze Nkemjika; Balogun, Michael Olabode; Akintomide, Anthony Olubunmi; Ajayi, Olufemi Eyitayo; Adeyeye, Victor Oladeji; Mene-Afejuku, Tuoyo Omasan; Bamikole, Olaniyi James; Ogunyemi, Suraj Adefabi; Ajibare, Adeola Olubunmi; Oketona, Omolola Abiodun

    2015-01-01

    Background Facilities for Holter electrocardiography (ECG) monitoring in many Nigerian hospitals are limited. There are few published works in Nigeria on the use of 24-hour Holter ECG in cardiac arrhythmic evaluation of patients with cardiovascular diseases. Objective To study the clinical indications, arrhythmic pattern, and heart rate variability (HRV) among subjects referred for 24-hour Holter ECG at our Cardiac Care Unit. Methods Three-hundred and ten patients (134 males and 176 females) were studied consecutively over a 48-month period using Schiller type (MT-101) Holter ECG machine. Results Out of the 310 patients reviewed, 134 were males (43.2%) and 176 were females (56.8%). The commonest indication for Holter ECG was palpitation followed by syncope in 71 (23%) and 49 (15.8%) of subjects, respectively. Premature ventricular complex and premature atrial complex were the commonest types of arrhythmia in 51.5% and 15% subjects, respectively. Ventricular arrhythmia was more prevalent in dilated cardiomyopathy patients (85.7%). The HRV of subjects with palpitation, stroke, and diabetes mellitus with autonomic neuropathy, using standard deviation of normal to normal intervals average (milliseconds), were 107.32±49.61, 79.15±49.15, and 66.50±15.54, respectively. The HRV, using standard deviation of averages of normal to normal intervals average (milliseconds), of patients with palpitation, stroke, and diabetes mellitus with autonomic neuropathy were 77.39±62.34, 57.82±37.05, and 55.50±12.71, respectively. Conclusion Palpitation and syncope were the commonest indications for Holter ECG among our subjects. The commonest arrhythmic patterns were premature ventricular complex and premature atrial complex, with ventricular arrhythmia being more prevalent in dilated cardiomyopathy. There was a reduction in HRV in patients with stroke and diabetic autonomic neuropathy. PMID:26170685

  18. [Supply and demand in home health care].

    PubMed

    Braga, Patrícia Pinto; de Sena, Roseni Rosângela; Seixas, Clarissa Terenzi; de Castro, Edna Aparecida Barbosa; Andrade, Angélica Mônica; Silva, Yara Cardoso

    2016-03-01

    The changes in the demographic and epidemiologic profiles of the Brazilian population and the need to rethink the health care model have led many countries like Brazil to consider Home Care (HC) as a care strategy. However, there is a gap between the supply of HC services, the demand for care and the health needs manifested by the population. Thus, this article analyzes scientific output regarding the status of the relation between supply, demand and the needs related to home health care. This work is based on an integrative review of the literature in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health and Science (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) and Web of Science. Despite the fact that few articles refer to the issue in question, there is evidence indicating that health demands and needs are seldom taken into account either in a quantitative or qualitative approach when developing the organization of HC services. The analysis would indicate that there is a national and international deficit in the supply of HC services considering the demand for health care and needs currently prevailing. PMID:26960102

  19. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... affecting § 226.18, see the List of CFR Sections Affected, which appears in the Finding Aids section of the... 7 Agriculture 4 2013-01-01 2013-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing...

  20. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... affecting § 226.18, see the List of CFR Sections Affected, which appears in the Finding Aids section of the... 7 Agriculture 4 2012-01-01 2012-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing...

  1. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... affecting § 226.18, see the List of CFR Sections Affected, which appears in the Finding Aids section of the... 7 Agriculture 4 2014-01-01 2014-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing...

  2. A comparison between 24-hour and 2-hour urine collection for the determination of proteinuria.

    PubMed

    Somanathan, N; Farrell, T; Galimberti, A

    2003-07-01

    Proteinuria is one of the fundamental criteria for the diagnosis of pre-eclampsia with quantitative assessment based on the 24-hour urine protein estimation as the gold standard. This study was undertaken to determine whether a 2-hour protein estimation correlated with that of a formal 24-hour collection. Thirty women with proteinuric hypertension were recruited. There was significant correlation between the 2-hour and 24-hour urine protein levels (Pearson's correlation coefficient 0.76 (P 0.000). A positive 2-hour test was associated more closely with significant levels of 24-hour proteinuria than dipstick analysis alone. We conclude from this study that a random 2-hour sample could be used for the initial assessment of proteinuria and so avoid the delay associated with 24-hour quantification of urinary protein. PMID:12881076

  3. Reliability and Predictive Validity of Caloric Intake Measures from the 24-Hour Dietary Recalls of Homebound Older Adults

    PubMed Central

    Sun, Yanhui; Roth, David L.; Ritchie, Christine S.; Burgio, Kathryn L.; Locher, Julie L.

    2010-01-01

    24-hour dietary recalls are used frequently to study homebound older adults’ eating behaviors. However, the reliability and predictive validity of this method have not been established in this population. The purpose of this study is to examine whether homebound older adults provide reliable and valid measures of total caloric intake in 24-hour dietary recalls. 230 homebound older adults were interviewed in their homes using a questionnaire to assess eating behaviors and factors that could affect those behaviors. Participants completed three 24-hour dietary recalls at baseline and again at 6-month follow-up. Two sub-samples were identified for analyses. For participants who were not hospitalized during the 6-month interval and had their weight measured at both assessments (n = 52), sufficient test-retest reliability of caloric intake was observed (r = 0.59); but caloric intake deficiencies relative to estimated energy requirements did not predict actual weight loss (r = 0.08). When this sample was supplemented with 91 participants who experienced any adverse event (weight loss of 2.5% or more, hospitalization, institutionalization, or mortality) in the 6-month period (n = 143), adverse events were more likely to occur for those with insufficient caloric intake (odds ratio = 3.49, p = .009), and in White participants compared to African American participants (odds ratio = 3.13, p=0.016). Adequate test-retest reliability of the 24-hour dietary recall was demonstrated, but additional research with larger samples and longer follow-up intervals are needed to better evaluate the predictive validity of caloric intake measures for this population. PMID:20430140

  4. Recruiting Strategy and 24-Hour Biomonitoring of Paraquat in Agricultural Workers

    PubMed Central

    Park, Eun-Kee; Tagles, Hector Duarte; Gee, Shirley J.; Hammock, Bruce D.; Lee, Kiyoung; Schenker, Marc B.

    2010-01-01

    The objectives of this study were to recruit agricultural workers in Costa Rica to participate in a 24-hour urine collection for paraquat exposure assessment and to compare the 24-hour sampling to end-of-shift sampling. The authors recruited 187 handlers and 54 nonhandlers from coffee, banana, and palm oil plantations. The completeness of 24-hour urine samples collected (a total of 393 samples) was confirmed by questionnaire and urinary creatinine level. For a subset of 12 samples, the absorbed paraquat level was determined in 24-hours and end-of-shift spot urine samples. The participation rate for handlers was ~90%. The completeness of 24-hour urine collections was verified as the overall average of creatinine levels from 393 urines (1.11 ± 0.50 g/L). A total of 92.4% to 96.7% of urine samples were considered within the acceptable range of urinary creatinine, whereas 94.7% of the samples were described as “complete” from the questionnaire. Measured creatinine correlated well to predicted values (r = .327, p = .0024, 95% CI .12–.51). Detected paraquat levels in spot urine samples had a sensitivity of 96.9% at the high specificity of 100% compared to 24-hour urine samples as the gold standard. There was a significant (p < .0001) correlation between spot and 24-hour urine paraquat levels (r = .7825, 95% CI .61–.88). The recruiting strategy was successful in getting 24-hour urine samples from a farm worker population. Comparison between the paraquat levels in spot and 24-hour urine samples demonstrated that for this compound, end-of-shift spot urine samples would be an appropriate substitute for 24-hour collections. PMID:19064412

  5. Bellco Formula Domus Home Care System.

    PubMed

    Trewin, Elizabeth

    2004-01-01

    There are certain characteristics in a dialysis machine that would be desirable for use in home and limited care environments. These features relate to safety, ease of use, consideration of physical space, and reliability. The Bellco Formula Domus Home Care System was designed to meet all these requirements. Bellco's philosophy of patient treatment centers on global biocompatibility. This is evident in the design of the Formula Domus Home Care System. It has the smallest hydraulic fluid pathway of any dialysis machine on the market. Formula is capable of preparing ultrapure dialysate. The ultrafiltration measurement mechanism, the patented Coriolis flow meter, measures the mass of the dialysate, not the volume. For this reason it is the only dialysis machine that detects actual backfiltration, not just the theoretical possibility of it based on transmembrane pressure. The Coriolis flow meter also ensures that dialysate flow is a true single pass. The operator interface is a single window operating control. It is possible to select up to 14 different languages. There is an online help key to assist patients with troubleshooting. Programmable start-up and shutdown times save time for the patient. Formula is the only dialysis machine to offer a backup battery feature. Formula is capable of communicating with any software available. The focus on global biocompatibility ensures the best quality dialysis treatments for a population of patients who will likely remain on dialysis for a longer period of time than conventional dialysis patients. PMID:15043621

  6. The Impact of Certificate-of-Need Laws on Nursing Home and Home Health Care Expenditures

    PubMed Central

    Rahman, Momotazur; Galarraga, Omar; Zinn, Jacqueline S.; Grabowski, David C.; Mor, Vincent

    2016-01-01

    Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes. PMID:26223431

  7. Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.

    PubMed Central

    Oktay, J S; Volland, P J

    1987-01-01

    This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population. PMID:3674248

  8. Expanded Medical Home Model Works for Children in Foster Care

    ERIC Educational Resources Information Center

    Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

    2012-01-01

    The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

  9. Severe community-acquired pneumonia: timely management measures in the first 24 hours.

    PubMed

    Phua, Jason; Dean, Nathan C; Guo, Qi; Kuan, Win Sen; Lim, Hui Fang; Lim, Tow Keang

    2016-01-01

    Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools. The bundles include early guideline-concordant antibiotics including macrolides, early haemodynamic support (lactate measurement, intravenous fluids, and vasopressors), and early respiratory support (high-flow nasal cannulae, lung-protective ventilation, prone positioning, and neuromuscular blockade for acute respiratory distress syndrome).While the proposed interventions appear straightforward, multiple barriers to their implementation exist. To successfully decrease mortality for severe CAP, early and close collaboration between emergency medicine and respiratory and critical care medicine teams is required. We propose a workflow incorporating these interventions. PMID:27567896

  10. Nurses take center stage in private duty home care.

    PubMed

    Brackett, Nicole

    2013-06-01

    The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care. PMID:24069792

  11. Home and Community Care Sector Accountability

    PubMed Central

    Gray, Carolyn Steele; Berta, Whitney; Deber, Raisa B.; Lum, Janet

    2014-01-01

    This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. PMID:25305389

  12. Home and community care sector accountability.

    PubMed

    Steele Gray, Carolyn; Berta, Whitney; Deber, Raisa B; Lum, Janet

    2014-09-01

    This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. PMID:25305389

  13. Nurses in independent care homes: issues, challenges and potential.

    PubMed

    Morris-Thompson, Trish; Marks-Maran, Diane

    Many registered nurses in the UK work in the social care sector in independent care homes and nursing homes. This article explores the challenges related to providing nursing care for adults in care homes, issues arising for nurses and nursing in the social care sector, and providing a career pathway for nurses in the social care sector. Steps need to be taken to ensure that cooperation, collaboration and leadership in nursing in the social care sector is recognised and that appropriate representation of nurses in social care takes place at national level. PMID:26203504

  14. A Survey of Home Delivery and Newborn Care Practices among Women in a Suburban Area of Western Nigeria

    PubMed Central

    Adelaja, Lamina Mustafa

    2011-01-01

    Context. Information about reasons for delivering at home and newborn care practices in suburban areas of Western Nigeria is lacking, and such information will be useful for policy makers. Objectives. To describe the home delivery and newborn care practices and to assess the reasons for delivering at home. Study Design, Setting, and Subjects. A cross-sectional survey was carried out in the immunization clinics of Sagamu local government, Western part of Nigeria during January and February 2008. Two trained health workers administered a semistructured questionnaire to the mothers who had delivered at home. Main Outcome Measures. Planned or unplanned home delivery, reasons for delivering at home, the details of events that took place at home from the onset of labour pains till delivery and after birth till initiation of breast-feeding, attendance at delivery, cleanliness and hygiene practices during delivery, thermal control, and infant feeding. Results. A total of 300 mothers were interviewed. Planned home deliveries were 200 (66.7%) and 100 (33.3%) were unplanned. Only 13.4% of deliveries had a skilled birth attendant present, and 47 (15.7%) mothers gave birth alone. Only 51 (16.2%) women had used a clean home delivery surface. Majority (98.2%) of the newborns were given a bath soon after birth. Initiation rates of breast-feeding were 65.3% within one hour and 95.7% within 24 hours. Conclusion. High-risk home delivery and newborn care practices are common in semiurban population also. Community-based interventions are required to improve the number of families coming to health facilities and engaging a skilled attendant and hygiene during delivery. PMID:21804945

  15. Blending Key Ingredients to Assure Quality in Home Health Care.

    ERIC Educational Resources Information Center

    Griffith, Deloris G.

    1986-01-01

    Careful staff selection, training, and review are among the methods the author recommends to home care agencies striving to provide top-notch services. Discusses measuring the quality of care employees are providing, accreditation, and the benefits of accreditation. (CT)

  16. Social Workers in Home Care: The Israeli Case

    ERIC Educational Resources Information Center

    Ayalon, Liat; Baum, Nehami

    2010-01-01

    In Israel, the government partially supports personal home care services (grooming, feeding, assistance with transfers) as a means to maintain frail individuals in their home environment for as long as possible. Social workers capture a prominent position in these arrangements as initiators and supervisors of personal home care services. This…

  17. Home Based Care: Direction for the 80s.

    ERIC Educational Resources Information Center

    Bryce, Marvin E.

    Home based family centered (HBFC) service programs have been developed as alternatives to out-of-home placement. These programs have reported relatively high service success rates at costs signficantly lower than foster home and institutional care while, at the same time, avoiding the social and psychological risks of out-of-home placement.…

  18. Digital skills training in care homes: achievement.

    PubMed

    Wild, Deidre; Kydd, Angela

    2016-05-27

    This article describes digital skills training (DST) for staff and later, residents, as part of a programme of culture change in a large care home with nursing in Glasgow. It presents the successes and challenges arising from DST from the perspectives of the two volunteer information technology (IT) champions (Thomas Sloan and John Thomson), who were also staff members. Using their written reports, questionnaires and subsequent conversations, the IT champions recall the challenges and gains for staff and residents as a result of their initial training. This is supplemented by a follow-up on IT activities in the 18 months after the introduction period. PMID:27231084

  19. Palliative Home Care: A Designer’s Perspective

    PubMed Central

    Bhatnagar, Tigmanshu

    2015-01-01

    The purpose for this observational research was to understand how Can Support provides palliative care at home and analyze its strengths and weaknesses in various socioeconomic scenarios for future development. In the period of 2 weeks, patients and their caregivers were silently observed in their natural surroundings during home care visits in order to listen their problems, identify the pattern of questions for the home care team, their natural way of storytelling, organizational techniques for medicines and medical reports, care givers lives, patient journey, etc. Such observations have enabled the understanding of the phenomena of home palliative care and have led to the identification of certain influential variables of the practice. PMID:26009683

  20. Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey

    PubMed Central

    Sreeramareddy, Chandrashekhar T; Joshi, Hari S; Sreekumaran, Binu V; Giri, Sabitri; Chuni, Neena

    2006-01-01

    Background About 98% of newborn deaths occur in developing countries, where most newborns deaths occur at home. In Nepal, approximately, 90% of deliveries take place at home. Information about reasons for delivering at home and newborn care practices in urban areas of Nepal is lacking and such information will be useful for policy makers. Methods A cross-sectional survey was carried out in the immunisation clinics of Pokhara city, western Nepal during January and February, 2006. Two trained health workers administered a semi-structured questionnaire to the mothers who had delivered at home. Results A total of 240 mothers were interviewed. Planned home deliveries were 140 (58.3%) and 100 (41.7%) were unplanned. Only 6.2% of deliveries had a skilled birth attendant present and 38 (15.8%) mothers gave birth alone. Only 46 (16.2%) women had used a clean home delivery kit and only 92 (38.3%) birth attendants had washed their hands. The umbilical cord was cut after expulsion of placenta in 154 (64.2%) deliveries and cord was cut using a new/boiled blade in 217 (90.4%) deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1%) deliveries. Birth place was heated throughout the delivery in 88 (64.2%) deliveries. Only 100 (45.8%) newborns were wrapped within 10 minutes and 233 (97.1%) were wrapped within 30 minutes. Majority (93.8%) of the newborns were given a bath soon after birth. Mustard oil massage of the newborns was a common practice (144, 60%). Sixteen (10.8%) mothers did not feed colostrum to their babies. Prelacteal feeds were given to 37(15.2%) newborns. Initiation rates of breast-feeding were 57.9% within one hour and 85.4% within 24 hours. Main reasons cited for delivering at home were 'preference' (25.7%), 'ease and convenience' (21.4%) for planned deliveries while 'precipitate labor' (51%), 'lack of transportation' (18%) and 'lack of escort' during labor (11%) were cited for the unplanned ones. Conclusion High-risk home delivery and newborn care

  1. Ocean tide loading effects on 24 hour GPS height estimates and resulting time series

    NASA Astrophysics Data System (ADS)

    Penna, N. T.; Stewart, M. P.

    2003-04-01

    GPS data from continuously operating GPS receivers are usually made available on a daily basis in 24 hour data files, so it is convenient for the user to adopt 24 hour data processing sessions. Time series are often then formed from the discrete 24 hour solutions, used for such applications as crustal deformation monitoring or high quality coordinate determination. When heights are estimated, ocean tide loading is a systematic error source that must be considered. Since the principal ocean tide loading effects have periods close to 12 and 24 hours respectively, it has been suggested from previous works that if models for ocean tide loading are not applied when processing GPS data as 24 hour sessions, at worst a small increase in the variance of the height time series will result. This paper further investigates the effects of ocean tide loading on 24 hour GPS height estimates and resulting time series, by considering a year of both simulated and real data from sites in Australia, at which the ocean tide loading effects differ substantially. The effect of each of the individual constituents is also considered. The role of the tropospheric delay mitigation strategy is addressed, regarding the effect on the height estimates when ocean tide loading effects are modelled or ignored.

  2. [Hospital care in the home after a laryngectomy].

    PubMed

    Beudaert, Maggy; Houzé, Séverine; Piésyk, Véronique; Bonnissent, Véronique

    2013-01-01

    Hospital care in the home offers patients suffering from larynx cancer and their family the possibility of returning home in optimal conditions of comfort and security. A multidisciplinary team takes over the patient's care from the hospital staff and draws up the personalised care project. PMID:24245400

  3. Evaluating Home Day Care Mothers' Work with Young Children.

    ERIC Educational Resources Information Center

    Seattle Community Coll., Washington.

    This checklist was developed to determine the skills of day care home mothers before and after training as observed by a day care home educator. Areas evaluated are: Professional Attitude; Parent Relationships; Nutrition; Health and Safety; Baby Care; Preparing the Teaching Environment; Guidance; Teaching Techniques, Language and Literature; Art;…

  4. Caffeine does not entrain the circadian clock but improves daytime alertness in blind patients with non-24-hour rhythms

    PubMed Central

    St. Hilaire, Melissa A.; Lockley, Steven W.

    2015-01-01

    Objective/Background Totally blind individuals are highly likely to suffer from Non-24-Hour Sleep-Wake Disorder due to a failure of light to reset the circadian pacemaker in the suprachiasmatic nuclei. In this outpatient case series, we investigated whether daily caffeine administration could entrain the circadian pacemaker in non-entrained blind patients to alleviate symptoms of non-24-hour sleep–wake disorder. Patients/Methods Three totally blind males (63.0 ± 7.5 years old) were studied at home over ~4 months. Urinary 6-sulphatoxymelatonin (aMT6s) rhythms were measured for 48 h every 1–2 weeks. Participants completed daily sleep–wake logs, and rated their alertness and mood using nine-point scales every ~2–4 h while awake on urine sampling days. Caffeine capsules (150 mg per os) were self-administered daily at 10 a.m. for approximately one circadian beat cycle based on each participant's endogenous circadian period τ and compared to placebo (n = 2) or no treatment (n = 1) in a single-masked manner. Results Non-24-h aMT6s rhythms were confirmed in all three participants (τ range = 24.32–24.57 h). Daily administration of 150 mg caffeine did not entrain the circadian clock. Caffeine treatment significantly improved daytime alertness at adverse circadian phases (p < 0.0001) but did not decrease the occurrence of daytime naps compared with placebo. Conclusions Although caffeine was able to improve daytime alertness acutely and may therefore provide temporary symptomatic relief, the inability of caffeine to correct the underlying circadian disorder means that an entraining agent is required to treat Non-24-Hour Sleep–Wake Disorder in the blind appropriately. PMID:25891543

  5. 24-hour central blood pressure and intermediate cardiovascular phenotypes in untreated subjects

    PubMed Central

    Bednarek, Agnieszka; Jankowski, Piotr; Olszanecka, Agnieszka; Windak, Adam; Kawecka-Jaszcz, Kalina; Czarnecka, Danuta

    2014-01-01

    Background: Recently, 24-hour monitoring of central systolic blood pressure (SBP) has become available. However, the relation between end-organ damage and the 24-hour central SBP profile and variability has not so far been analyzed. Therefore, the aim of this cross-sectional study was to evaluate the relation between 24-hour central SBP, 24-hour central SBP profile as well as central SBP short-term variability and parameters of cardiac and vascular intermediate phenotypes. Methods: The study group consisted of 50 patients with newly diagnosed, untreated hypertension (age 40.4 ± 11.5 years, 35 men) and 50 normotensive subjects (age 38.3 ± 12.0 years, 35 men). Applanation tonometry of the radial artery and the “n-point forward moving average” method were used to determine 24-hour central SBP. Each study participant underwent echocardiography and carotid ultrasonography. Results: 24-hour, daytime, and nighttime central SBP was related to left ventricle end-diastole diameter (p < 0.05), left ventricular mass index (p < 0.001), relative wall thickness (p < 0.05), E/E’ ratio (p < 0.01), and left atrium volume (p < 0.01). The nocturnal central SBP fall was not related to any of the mentioned parameters, whereas parameters of short-term variability were related to IMT in hypertensives only (p < 0.05). Conclusions: The present study showed that 24-hour central SBP is related to intermediate cardiac phenotypes as assessed by echocardiography whereas short-term central SBP variability is mainly related to vascular phenotype as determined by IMT. PMID:25628959

  6. The Relationship Between 24-Hour Symptoms and COPD Exacerbations and Healthcare Resource Use: Results from an Observational Study (ASSESS).

    PubMed

    Miravitlles, Marc; Worth, Heinrich; Soler-Cataluña, Juan José; Price, David; De Benedetto, Fernando; Roche, Nicolas; Godtfredsen, Nina S; van der Molen, Thys; Löfdahl, Claes-Göran; Padullés, Laura; Ribera, Anna

    2016-10-01

    This observational study assessed the relationship between nighttime, early-morning and daytime chronic obstructive pulmonary disease (COPD) symptoms and exacerbations and healthcare resource use. COPD symptoms were assessed at baseline in patients with stable COPD using a standardised questionnaire during routine clinical visits. Information was recorded on exacerbations and healthcare resource use during the year before baseline and during a 6-month follow-up period. The main objective of the analysis was to determine the predictive nature of current symptoms for future exacerbations and healthcare resource use. 727 patients were eligible (65.8% male, mean age: 67.2 years, % predicted forced expiratory volume in 1 second: 52.8%); 698 patients (96.0%) provided information after 6 months. Symptoms in any part of the day were associated with a prior history of exacerbations (all p < 0.05) and nighttime and early-morning symptoms were associated with the frequency of primary care visits in the year before baseline (both p < 0.01). During follow-up, patients with baseline symptoms during any part of the 24-hour day had more exacerbations than patients with no symptoms in each period (all p < 0.05); there was also an association between 24-hour symptoms and the frequency of primary care visits (all p ≤ 0.01). Although there was a significant association between early-morning and daytime symptoms and exacerbations during follow-up (both p < 0.01), significance was not maintained when adjusted for potential confounders. Prior exacerbations were most strongly associated with future risk of exacerbation. The results suggest 24-hour COPD symptoms do not independently predict future exacerbation risk. PMID:26983349

  7. Culture change in care homes: a literature review.

    PubMed

    Wild, Deirdre; Kydd, Angela

    2016-08-01

    This article is the first of a two-part series that explores a programme of culture change in care homes. A UK care home company sought the authors' expertise to design and facilitate an independent programme of learning to encourage and support staff in two of its homes to become the architects of their own quality improvement. The article reviews the literature that was an essential information base for the authors in their dual roles as designers of the learning programme and facilitators of its delivery to participant staff. The literature is necessarily broad in reflecting the nature and context of care homes, residents' needs and wants from care, and the particular challenges that might be faced by care home staff and managers when making quality improvements. In the second article, the reality of running the programme in the two homes is described. PMID:27573965

  8. Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

    PubMed

    Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

    2014-01-01

    A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template. PMID:23938358

  9. Insights about serum sodium behavior after 24 hours of continuous renal replacement therapy

    PubMed Central

    Romano, Thiago Gomes; Martins, Cassia Pimenta Barufi; Mendes, Pedro Vitale; Besen, Bruno Adler Maccagnan Pinheiro; Zampieri, Fernando Godinho; Park, Marcelo

    2016-01-01

    Objective The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation. Methods Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations. Results In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values. Conclusions Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose - formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible. PMID:27410407

  10. [Supervising student nurses in the provision of home care].

    PubMed

    Talon-Chrétien, Marie-Claire; Prigent, Alexane; Thirion, Lucille

    2016-01-01

    The private practice nurse may be required to supervise a student during their provision of care to patients in their home. These situations can be mutually rewarding and open the way for discussion around the quality of care. PMID:27393989

  11. Family Perceptions of Geriatric Foster Family and Nursing Home Care.

    ERIC Educational Resources Information Center

    Braun, Kathryn L.; Rose, Charles L.

    1987-01-01

    Relatives (N=62) of matched pairs of patients in geriatric foster homes and nursing homes rated care provided to their relatives. Significantly more foster family patients had positive pre-placement attitudes than did nursing home patients. Upon follow-up, relatives of foster patients reported seeing more patient improvement, satisfaction,…

  12. Webcasting in home and hospice care services: virtual communication in home care.

    PubMed

    Smith-Stoner, Marilyn

    2011-06-01

    The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy. PMID:21633224

  13. The Road Ahead to Continuous 24-Hour Intraocular Pressure Monitoring in Glaucoma

    PubMed Central

    Mansouri, Kaweh

    2014-01-01

    Intraocular pressure (IOP) is the only treatable risk factor for glaucoma. Yet, current glaucoma management usually relies on single IOP measurements during clinic hours despite the fact that IOP is a dynamic parameter with individual rhythms. Single IOP measurements underpin all major clinical guidelines on treatment of glaucoma. Other potentially informative parameters, such as IOP fluctuations and peak IOP, have been neglected, and effects of IOP-lowering interventions on such measures are largely unknown. The search for continuous 24-hour IOP monitoring started over 50 years ago, but only recent technological advances have provided clinician-researchers with devices for continuous IOP monitoring. Herein, we discuss innovative approaches with permanent and temporary devices for 24-hour IOP monitoring, such as a contact lens sensor. Despite being in their infancy, these devices may soon enable clinicians to use 24-hour IOP data to improve glaucoma management and reduce the glaucoma-related burden of disease. PMID:25279129

  14. Microtensile bond strength of resin-resin interfaces after 24-hour and 2-month soaking.

    PubMed

    Leavitt, Curry; Boberick, Kenneth G; Winkler, Sheldon

    2007-01-01

    Evaluate the bond strengths of denture base-repair materials to minimize recurrent failure rate. Use microtensile bond strength (muTBS) testing to evaluate the interfacial bonding strength of 6 commercial denture repair materials after 24-hour and 12-month soaking. Blocks of poly(methyl metacrylate) (PMMA) and Triad were fabricated, fractured, and repaired. Twenty bars (1 x 1 x 30 mm) per group were sectioned from each block parallel to the long axis and approximately 90 degrees to the resin-resin repair interface and stored before muTBS testing in a servo-hydraulic tensile-testing machine. Intact PMMA and Triad bars that had been soaked for 24 hours and 12 months were tested for reference. The 24-hour repair strengths for PMMA ranged from 52% to 84% of original strength. Soaking for 12 months resulted in a 20% decrease in strength for the PMMA control. The 12-month repair strengths for PMMA ranged from 43% to 74% of the 12-month soaked material strength. Triad repair tested 35% of original strength after soaking for 24 hours. Permabond (cyanoacrylate) to PMMA tested 47% of original strength after 24 hours of soaking and 26% of the 12-month soaked material strength. Permabond to Triad tested 30% of original strength after 24 hours of soaking. Permabond and Triad showed a 100% adhesive mode of failure. All other materials tested exhibited either an adhesive mode of failure at the denture base-repair-material interface or a complex cohesive failure within the repair-material interface. The muTBS approach can be used to analyze the resin-resin interface of repaired acrylics. The relatively small standard deviations make the muTBS approach attractive. In this study, muTBS was used to evaluate the repair strength of 6 denture repair materials enabling clinicians to make clinical judgments regarding the strongest repair bond available. PMID:17987865

  15. A Measure of Palliative Care in Nursing Homes

    PubMed Central

    Thompson, Sarah; Bott, Marjorie; Boyle, Diane; Gajewski, Byron; Tilden, Virginia P.

    2010-01-01

    Context Efforts to improve care for nursing home residents stand to be enhanced by measures to assess the degree to which staff provide palliative care. As the incidence of death in nursing homes increases with the aging population, the gap in measurement must be addressed. To that end, we report the development and psychometric testing of a nursing home palliative care survey. Objectives The purpose of this study was to evaluate the psychometric properties of the Palliative Care Survey for use in nursing homes. Methods Psychometric evaluation of the instrument was completed in two phases. Phase 1 focused on individual item analyses and subsequent revision or deletion of items, and Phase 2 evaluated evidence for reliability and validity. Phase 1 included 26 nursing homes and staff (n = 717) and Phase 2 included 85 nursing homes and staff (n = 2779). Data were analyzed using item-total correlations, Cronbach’s alpha, confirmatory factor analysis, and analysis of variance (ANOVA). Results Support was obtained for a 51-item Palliative Care Survey (PCS) made up of two constructs Palliative Care Practice and Palliative Care Knowledge. Conclusion The PCS measures the extent to which nursing home staff engage in palliative care practices and have knowledge consistent with good end-of-life care. Both practice and knowledge are an essential foundation to providing good end-of-life care to nursing home residents. Efforts to improve care for the dying in nursing homes have been slowed by an absence of measurement tools that capture care processes; a gap, which the Palliative Care Survey reported here, helps fill. PMID:20797836

  16. US-Hungarian partnership: strengthening home care's stand.

    PubMed

    Hutchison, F

    1997-10-01

    A partnership established between a US home care provider and a hospital in Hungary dedicated itself to reducing the length of hospital stays by strengthening home care in Vac, Hungary. With other similar ventures, the accomplishments of the partnership can be disseminated throughout other parts of Hungary and central and eastern Europe. PMID:10173928

  17. Assessment of Anxiety in Older Home Care Recipients

    ERIC Educational Resources Information Center

    Diefenbach, Gretchen J.; Tolin, David F.; Meunier, Suzanne A.; Gilliam, Christina M.

    2009-01-01

    Purpose: This study determined the psychometric properties of a variety of anxiety measures administered to older adults receiving home care services. Design and Methods: Data were collected from 66 adults aged 65 years and older who were receiving home care services. Participants completed self-report and clinician-rated measures of anxiety and…

  18. Learning Opportunities for Nurses Working within Home Care

    ERIC Educational Resources Information Center

    Lundgren, Solveig

    2011-01-01

    Purpose: The purpose of this study is to explore home care nurses' experience of learning in a multicultural environment. Design/methodology/approach: The study was based on qualitative research design. Data were collected through repeated interviews with registered home care nurses working in a multicultural area. The data were analyzed through a…

  19. Indicators of Home Care Use in Urban and Rural Settings

    ERIC Educational Resources Information Center

    Mitchell, Lori A.; Strain, Laurel A.; Blandford, Audrey A.

    2007-01-01

    This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were…

  20. Regional Variation in Home Care Use in Manitoba

    ERIC Educational Resources Information Center

    Peterson, Sandra; Shapiro, Evelyn; Roos, Noralou P.

    2005-01-01

    Previous studies report geographic variation in the use of home care services. In the province of Manitoba, home care is a core service that Manitoba's twelve regional health authorities (RHAs) are obligated to deliver. Manitoba's RHAs range from remote northern and rural southern regions to a major city, resulting in different challenges for…

  1. Relationship between home care service use and changes in the care needs level of Japanese elderly

    PubMed Central

    2009-01-01

    Background With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels. Methods The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician. Results In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based

  2. The innovative use of Six Sigma in home care.

    PubMed

    Elberfeld, Adrienne; Bennis, Sandra; Ritzius, Jeannie; Yhlen, David

    2007-01-01

    The Prospective Payment System had significant impact on home healthcare agencies throughout the nation. Virtua Home Care, located in Southern New Jersey, realized the need for process improvement in order to remain viable. Six Sigma was introduced to the agency and the Define, Measure, Analyze, Improve, and Control processes were initiated to achieve sustainable results, and within 9 months, Virtua Home Care improved regulatory compliance, experienced a deficiency-free survey, and recognized a 1.2 million dollars financial gain. PMID:17218866

  3. Home apnea monitoring. A systems approach to the family's home care needs.

    PubMed

    Ridgell, N H

    1993-12-01

    Parents who bring home an infant requiring constant home apnea monitoring often face a stressful situation with their child's medical difficulties and their own financial concerns. The home care nurse must be aware of the difficulties facing these families to offer the necessary support and education. PMID:10130220

  4. A clinician-driven home care delivery system.

    PubMed

    August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R

    1993-12-01

    The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal. PMID:8242586

  5. Client involvement in home care practice: a relational sociological perspective.

    PubMed

    Glasdam, Stinne; Henriksen, Nina; Kjær, Lone; Praestegaard, Jeanette

    2013-12-01

    'Client involvement' has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how 'client involvement' is practised in home-care services. The aim of this article is to analyse 'client involvement' in practise seen from the positions of healthcare professionals, an elderly person and his relative in a home-care setting. A sociologically inspired single case study was conducted, consisting of three weeks of observations and interviews. The study has a focus on the relational aspects of home care and the structural, political and administrative frames that rule home- care practice. Client involvement is shown within four constructed analytical categories: 'Structural conditions of providing and receiving home care'; 'Client involvement inside the home: performing a professional task and living an everyday life'; 'Client involvement outside the home: liberal business and mutual goal setting'; and 'Converting a home to a working place: refurnishing a life'. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which involvement of the client in public home-care practice remains limited. PMID:23217061

  6. Total parenteral nutrition (TPN) at home: prototype high-tech home care nursing.

    PubMed

    Davis, J H

    1996-01-01

    Current economic and demographic trends in the United States indicate the demand for complex treatments, such as infusion therapies at home, will continue to escalate. In light of the increasingly acute and autonomous nature of home health practice, examination of home care nursing process affecting patient care outcomes is crucial. This study explored the cognitive, technical, and interpersonal components included in total parenteral nutrition (TPN) home care nursing. The purpose of this study was to evaluate psychometrically the Schmele Instrument to Measure the Process of Nursing Practice in Home Health (SIMP-H) so that it may be used to examine high-tech home care nursing process. Home visits must be observed to identify the specific cognitive, technical, and interpersonal components included in high-tech home care nursing that are important for patient care outcomes. This study captured high-tech home care nursing process on videotape, which provided a medium for evaluating interobserver reliability for the SIMP-H. Results revealed an interobserver reliability coefficient of .72. PMID:9025400

  7. Older Women Doing Home Care: Exploitation or Ideal Job?

    PubMed Central

    Butler, Sandra S.

    2013-01-01

    The increased need for both personal assistance workers and meaningful employment opportunities for older workers results in growing numbers of older home care aides. This study examined lifetime financial security and perceived advantages of older age in this field through interviews with 31 older home care aides. Study participants experienced high levels of financial insecurity and perceived older workers as particularly well suited to the home care job. The consequences of this low-wage, low-status work are explored along with implications for social workers to advocate for improved conditions for these workers providing essential care to frail elders. PMID:23600600

  8. Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

    ERIC Educational Resources Information Center

    Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.

    2011-01-01

    Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…

  9. Implementing digital skills training in care homes: a literature review.

    PubMed

    Wild, Deidre; Kydd, Angela; Szczepura, Ala

    2016-05-01

    This article is the first of a two-part series that informs and describes digital skills training using a dedicated console computer provided for staff and residents in a care home setting. This was part of a programme of culture change in a large care home with nursing in Glasgow, Scotland. The literature review shows that over the past decade there has been a gradual increase in the use of digital technology by staff and older people in community settings including care homes. Policy from the European Commission presents a persuasive argument for the advancement of technology-enabled care to counter the future impact of an increased number of people of advanced age on finite health and social care resources. The psychosocial and environmental issues that inhibit or enhance the acquisition of digital skills in care homes are considered and include the identification of exemplar schemes and the support involved. PMID:27125940

  10. Housing choices and care home design for people with dementia.

    PubMed

    Hadjri, Karim; Rooney, Cliona; Faith, Verity

    2015-01-01

    This article reviews the current state of housing for people with dementia by exploring housing choices available to this group, and identifying potential issues with design of care homes. Older people who wish to age in place are faced with the challenge of adapting their domestic environment to ensure independence, accessibility, and social connectivity. This is even more challenging for people with dementia who continue to live at home, given the risks of self-harm and getting lost. More imaginative and inclusive forms of collective housing are needed. For people with dementia, a move to a new environment is often a stressful experience that causes shock, withdrawal, and anger. Hence, more research is needed to develop more fitting long-term housing options for people with dementia. This article presents a brief review on housing choices and housing design for people with dementia. Interviews with managers of 22 care homes were conducted to explore housing choices and design issues. Results show that the main housing choices available to people with dementia offer different levels of care. The choice of care homes relates to the atmosphere of a home as some occupants favor a homely or relaxing environment and others prefer dynamic settings. A combination of appropriate level of care, a good atmosphere, and design quality within the care home are elements that lead to a more enabling environment. Design of a successful caring environment also requires appropriate care and a positive therapeutic and domestic-looking environment. PMID:25929473

  11. The Three-Continent, 24-Hour Help Desk: An Academic First?

    ERIC Educational Resources Information Center

    Sykes, Jean

    2002-01-01

    Describes Follow the Sun, a computer help-desk service that takes advantage of time differences around the world to permit four universities (University of Colorado Boulder, Australia's Macquarie and Newcastle universities, and the London School of Economics) to share services and provide 24-hour support to users. (EV)

  12. Oropharyngeal 24-Hour pH Monitoring in Children With Airway-Related Problems

    PubMed Central

    Mesallam, Tamer A.

    2016-01-01

    Objectives Diagnosis and clinical presentation of pediatric laryngopharyngeal reflux (LPR) is still controversial. The aims of this work were to study the possibility of performing 24-hour oropharyngeal pH monitoring for children in the outpatient clinic setup and to explore the results of this test in correlation to airway-related problems. Methods In this descriptive qualitative study, 26 children suffering from airway-related problems were included. Oropharyngeal 24-hour pH monitoring was performed for all subjects in the outpatient clinic setting. The distribution of airway diagnoses among the study group was studied versus the results of the pH monitoring. Results There were 16 males and 10 females participated in the study with a mean age of 6.88 (SD, ±5.77) years. Thirty-five percent of the patients were under the age of 3 years (range, 11 months to 3 years). Eight-five percent of the patients tolerated the pH probe insertion and completed 24-hour of pH recording. Laryngomalacia and subglottic stenosis (SGS) were more frequently reported in the positive LPR patients (77%). Conclusion Oropharyngeal 24-hour pH monitoring can be conducted for children in the outpatient setup even in young age children below 3 years old. Among the positive LPR group, SGS and laryngomalacia were the most commonly reported airway findings. PMID:27090271

  13. Assessing dietary intake in childhood cancer survivors: Food frequency questionnaire versus 24-hour diet recalls

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cancer diagnosis and treatment may influence dietary intake. The validity of using self-reported methods to quantify dietary intake has not been evaluated in childhood cancer survivors. We validated total energy intake (EI) reported from Food Frequency Questionnaire (FFQ) and repeated 24-hour diet r...

  14. 24-Hour Access: Responding to Students' Need for Late Library Hours at the University of Denver

    ERIC Educational Resources Information Center

    Sewell, Bethany B.

    2013-01-01

    The University of Denver's Penrose Library saw a substantial increase in use as a result of several new and enhanced services over a six-year period. In turn, longer operating hours and increased staffing for a 24-hours-a-day, five-days-a-week (24 x 5) operating schedule was funded. This case study analyzes student need for longer library hours…

  15. Mood-Dependent Cognitive Change in a Man with Bipolar Disorder Who Cycles Every 24 Hours

    ERIC Educational Resources Information Center

    Lam, Dominic; Mansell, Warren

    2008-01-01

    A case study of a bipolar patient whose mood changes every 24 hours is described to illustrate the changes in cognitive processing and content during different phases of bipolar disorder. The participant completed a battery of questionnaires and tasks on 4 separate occasions: twice when depressed and twice when manic. Depression tended to be…

  16. Dementia Home Care Resources: How Are We Managing?

    PubMed Central

    Ward-Griffin, Catherine; Hall, Jodi; DeForge, Ryan; St-Amant, Oona; McWilliam, Carol; Oudshoorn, Abram; Forbes, Dorothy; Klosek, Marita

    2012-01-01

    With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future. PMID:22132332

  17. 78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-31

    ... AFFAIRS Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes): Comment Request AGENCY: Veterans Health... day health care facilities are providing high quality services to Veterans in State homes....

  18. Caring for Young Children in the Home.

    ERIC Educational Resources Information Center

    Birckmayer, Jennifer; And Others

    Group leaders of 10- to 13-year-olds may use this program guide to help the preteens interact with young children through six discussion meetings and five visits with a preschool child at home. Discussion topics concern (1) the family environment of young children, (2) children's play; (3) children's play areas at home, (4) safety at home, (5)…

  19. [Choice of Expiration for Cancer Patients under Home Medical Care - Palliative Care Unit or Home].

    PubMed

    Okino, Takashi; Okagaki, Tetsuya; Nakamura, Hiromi; Okino, Akie

    2015-12-01

    Kohka Public Hospital(KPH)was rebuilt at a new place in April 2013. The Palliative Care Unit(PCU)was newly constructed during renovation. We examined the will and outcome of cancer patients, especially on expiration. A 123 patients died in 2014: 27 died at the PCU, and the remaining 7 at home. Of 27 patients, 20 were willing to die at the PCU, and one patient visited the hospital after judgment by the Visiting Nurse Center. Other 6 patients were admitted finally after their families experienced fatigue. Six of seven patients who died at home, showed a strong will to stay at home. We think that patients' will drives the clinical course, especially in their end-stage. In this context, the majority of the patients decided their terminal place based on their will. On the contrary, there were several cases whose requests were not fulfilled. To overcome the problem, we should discuss cancer patients' will to make a choice regarding death at the end-stage of their lives and the place of expiration in advance. We including the staff of social care and regional medical resources, should co-operate and share information on these patients to solve the problems. PMID:26809413

  20. [Home care for the chronically ill: a self-care health system].

    PubMed

    Silva, Leticia Robles

    2004-01-01

    This article focuses on home care for chronically ill adults and seniors. According to our thesis, home care should be understood as a self-care system, and its aim is to guarantee the individual's social and bodily survival. Home care consists of three areas, related to illness, the home, and to life history. Caregiving, usually under women's responsibility, is present throughout the history of the illness and the health-seeking process. The article analyzes these issues in light of the ageing process, the epidemiological changes occurring worldwide, and the urgency to incorporate this analysis into the heath care research agenda. PMID:15073644

  1. Day Care Cost Analysis: A Manual of Instructions.

    ERIC Educational Resources Information Center

    McClellan, Keith; And Others

    This manual is designed to provide guidelines for the analysis of the costs of operating day care centers and not day care homes. Day care is defined as a broad term applied to a variety of programs that shelter preschool and school age children on something less than a 24-hour basis. The guidelines set forth by this manual aim to permit the…

  2. Integrating new graduate nurses in home health care.

    PubMed

    Meadows, Carl A

    2009-10-01

    In 2005, the home health nursing sector of a large Canadian health authority was on its way toward changing a hiring prerequisite of acute care (medical or surgical) experience for entry to practice into home care nursing. At that time, home healthcare services in Canada and the United States were generally requiring acute care experience as prerequisites for working in home health. However, much of the research beginning as early as early 2000 challenged this perspective and universities and colleges offering baccalaureate degrees in nursing began including home health content in their curricula. The findings from research add to the ongoing critique of this acute care requirement and support the concept that acute care and home care are different practice areas with distinct competencies. This article discusses the contextual background that influenced the undertaking of our research, the relevant research literature, our research findings, model for integration, and evaluation of our pilot and lessons learned. The successes seen as a result of New Graduate integration are now being utilized by other home care nursing offices as a result of this work. PMID:19820662

  3. A programme to reduce acquired pressure ulcers in care homes.

    PubMed

    Thompson, Trish Morris; Marks-Maran, Di

    Prevention of pressure ulcers is a major health concern, especially for older people. Much of the literature related to prevention of pressure ulcers focuses on hospital-acquired pressure ulcers. There is less literature related to prevention of pressure ulcers in care homes. This article presents a review of the literature related to prevention of pressure ulcers in care homes and an ambitious project undertaken by one care home provider to raise awareness of pressure ulcers, provide training in prevention and monitor and evaluate pressure ulcers in over 200 care home across the UK. Known as MI SKIN, the project involves ongoing training to all levels of care staff, a robust system of monitoring pressure ulcers and a mechanism to investigate and learn from any incident of pressure ulcer using root cause analysis. PMID:26110989

  4. [Utility of Smartphone in Home Care Medicine - First Trial].

    PubMed

    Takeshige, Toshiyuki; Hirano, Chiho; Nakagawa, Midori; Yoshioka, Rentaro

    2015-12-01

    The use of video calls for home care can reduce anxiety and offer patients peace of mind. The most suitable terminals at facilities to support home care have been iPad Air and iPhone with FaceTime software. However, usage has been limited to specific terminals. In order to eliminate the need for special terminals and software, we have developed a program that has been customized to meet the needs of facilities using Web Real Time Communication(WebRTC)in cooperation with the University of Aizu. With this software, video calls can accommodate the large number of home care patients. PMID:26809398

  5. Child Nutrition Programs: Child and Adult Care Food Program. Family Day Care Home Handbook.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Education, Oklahoma City.

    This handbook details requirements for family day care homes in Oklahoma for providing child nutrition through the Child and Adult Care Food Program. The handbook includes contact information for state consultants. The basic responsibilities for sponsors of family day care home child nutrition programs are outlined, and the sponsoring organization…

  6. Paediatric palliative home care in areas of Germany with low population density and long distances: a questionnaire survey with general paediatricians

    PubMed Central

    2012-01-01

    Background In 2007, the patient’s right to specialised palliative home care became law in Germany. However, childhood palliative care in territorial states with low patient numbers and long distances requires adapted models to ensure an area-wide maintenance. Actually, general paediatricians are the basic care providers for children and adolescents. They also provide home care. The aim of this study was to improve the knowledge about general paediatrician’s involvement in and contribution to palliative care in children. Findings To evaluate the current status of palliative home care provided by general paediatricians and their cooperation with other paediatric palliative care providers, a questionnaire survey was disseminated to general paediatricians in Lower Saxony, a German federal state with nearly eight million inhabitants and a predominantly rural infrastructure. Data analysis was descriptive. One hundred forty one of 157 included general paediatricians completed the questionnaire (response rate: 89.8%). A total of 792 children and adolescents suffering from life-limiting conditions were cared for by these general paediatricians in 2008. Severe cerebral palsy was the most prevalent diagnosis. Eighty-nine per cent of the general paediatricians stated that they had professional experience with paediatric palliative care. Collaboration of general paediatricians and other palliative care providers was stated as not well developed. The support by a specialised team including 24-hour on-call duty and the intensification of educational programs were emphasised. Conclusions The current regional infrastructure of palliative home care in Lower Saxony can benefit from the establishment of a coordinated network of palliative home care providers. PMID:22967691

  7. Providing home care services in a for-profit environment.

    PubMed

    Shamansky, S L

    1988-06-01

    It is no surprise that politics and ideology will determine the future of home health and long-term care. Those same forces will also dictate whether home care services will become more or less dependent upon federal support. At the moment the prospects are not promising. Over the last several years our national reimbursement policies have pointed toward more and more stringent use of Medicare home health care benefits, despite the assumptions (and the data) that prospective payment systems might legitimately increase their use. The implementation of tight cost limits, consolidation to ten regional fiscal intermediaries, and increased claim denials have signaled home care agencies that cost containment is the aim of the present conservative administration. Private insurance companies, however, have begun to examine the prospects for long-term care and home care policies. Presently, most home care benefits are available through employment-based policies, which, of course, are nearly useless to the elderly, the major users of home care services. But what if businesses provided more comprehensive health care policies so that their employees could have better protection in the case of long-term illnesses? What if the giant corporation such as IBM, Xerox, General Electric, General Motors, and so forth, established programs to underwrite the cost of long-term care? What if private insurance companies attempted to spread the risks among thousands of policy holders so that long-term care insurance premiums were affordable to most older Americans? Rather than new sources of funding, it is more reasonable to expect that the financing of home care services will be reshaped by innovative reimbursement strategies. The future will probably bring prospective, resource-sensitive, or capitated schemes. There are no easy remedies. We must secure the participation of all sectors of our country--both public and private--in a cooperative endeavor. And at the same time we are struggling

  8. Medicaid Home Care Services and Survival in New York City

    ERIC Educational Resources Information Center

    Albert, Steven M.; Simone, Bridget; Brassard, Andrea; Stern, Yaakov; Mayeux, Richard

    2005-01-01

    Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid…

  9. Child Care: Volume II. Vocational Home Economics Education. Revised.

    ERIC Educational Resources Information Center

    Benson, Ann; Kates, Donna

    Intended for use in a four-semester occupational child care program for 11th- or 12th-grade and adult students, this curriculum guide provides instructional materials covering basic information and skills for operating a child care center or a family day care home. It includes 4 sections and 23 instructional units. Each unit of instruction…

  10. Seasonal changes of 24-hour intraocular pressure rhythm in healthy Shanghai population

    PubMed Central

    Cheng, Jingyi; Xiao, Ming; Xu, Huan; Fang, Shaobin; Chen, Xu; Kong, Xiangmei; Sun, Xinghuai

    2016-01-01

    Abstract The aim of the present study was to investigate and compare the 24-hour intraocular pressure (IOP) rhythms in winter and summer in the healthy population of Shanghai, China. This is a cross-sectional study in which 24-hour IOP measurements were taken for all eligible healthy volunteers in winter and summer, respectively, and the temperature, hours of sunlight (sunlight time), and circulatory parameters, including heart rate, systolic blood pressure, and diastolic blood pressure, were also recorded. The 24-hour IOP curves and IOP parameters (mean, peak, trough, and fluctuation of IOP together with the diurnal-to-nocturnal IOP change) in winter and summer were obtained and compared. The magnitude of IOP changes from summer to winter was also calculated. A total of 29 participants (58 eyes), 14 (48.28%) male and 15 (51.72%) female, aged 43.66 ± 12.20 (19–61) years, were considered eligible for this study. Generally, IOP decreased progressively before noon, increased notably in the nocturnal period, and peaked at 12:00 am in winter and at 2:00 am in summer. The pattern of 24-hour IOP in winter and summer was significantly different (P = 0.002). The average IOPs from 4:00 pm to 8:00 am, except for 6:00 am, were significantly higher in winter (P < 0.05). However, no significant differences were shown after adjusting for temperature and/or sunlight time. From summer to winter, the extent of IOP increase was mostly around 0 to 3 mm Hg, and the IOPs increased more significantly in the nocturnal period than in the diurnal period (P = 0.05). The 24-hour IOP rhythms were different in winter and summer, with higher IOP level in winter. Temperature and sunlight time, which are independent of heart rate and blood pressure, affected the 24-hour IOP rhythms in healthy people in Shanghai, China. Further investigations are expected for the rhythm of some endogenous substance secretion and the inner mechanism of regulation of IOP. PMID:27495076

  11. Seasonal changes of 24-hour intraocular pressure rhythm in healthy Shanghai population.

    PubMed

    Cheng, Jingyi; Xiao, Ming; Xu, Huan; Fang, Shaobin; Chen, Xu; Kong, Xiangmei; Sun, Xinghuai

    2016-08-01

    The aim of the present study was to investigate and compare the 24-hour intraocular pressure (IOP) rhythms in winter and summer in the healthy population of Shanghai, China.This is a cross-sectional study in which 24-hour IOP measurements were taken for all eligible healthy volunteers in winter and summer, respectively, and the temperature, hours of sunlight (sunlight time), and circulatory parameters, including heart rate, systolic blood pressure, and diastolic blood pressure, were also recorded. The 24-hour IOP curves and IOP parameters (mean, peak, trough, and fluctuation of IOP together with the diurnal-to-nocturnal IOP change) in winter and summer were obtained and compared. The magnitude of IOP changes from summer to winter was also calculated.A total of 29 participants (58 eyes), 14 (48.28%) male and 15 (51.72%) female, aged 43.66 ± 12.20 (19-61) years, were considered eligible for this study. Generally, IOP decreased progressively before noon, increased notably in the nocturnal period, and peaked at 12:00 AM in winter and at 2:00 AM in summer. The pattern of 24-hour IOP in winter and summer was significantly different (P = 0.002). The average IOPs from 4:00 PM to 8:00 AM, except for 6:00 AM, were significantly higher in winter (P < 0.05). However, no significant differences were shown after adjusting for temperature and/or sunlight time. From summer to winter, the extent of IOP increase was mostly around 0 to 3 mm Hg, and the IOPs increased more significantly in the nocturnal period than in the diurnal period (P = 0.05).The 24-hour IOP rhythms were different in winter and summer, with higher IOP level in winter. Temperature and sunlight time, which are independent of heart rate and blood pressure, affected the 24-hour IOP rhythms in healthy people in Shanghai, China. Further investigations are expected for the rhythm of some endogenous substance secretion and the inner mechanism of regulation of IOP. PMID:27495076

  12. The Future of Home Health project: developing the framework for health care at home.

    PubMed

    Lee, Teresa; Schiller, Jennifer

    2015-02-01

    In addition to providing high-quality care to vulnerable patient populations, home healthcare offers the least costly option for patients and the healthcare system, particularly in postacute care. As the baby boom generation ages, policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. The Alliance for Home Health Quality and Innovation seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. This article describes the initiative and invites readers to provide comments and suggestions. PMID:25654456

  13. [Relations with emergency medical care and primary care doctor, home health care].

    PubMed

    Azuma, Kazunari; Ohta, Shoichi

    2016-02-01

    Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society. PMID:26915240

  14. Home Care Technology Through an Ability Expectation Lens

    PubMed Central

    2014-01-01

    Home care is on the rise, and its delivery is increasingly reliant on an expanding variety of health technologies ranging from computers to telephone “health apps” to social robots. These technologies are most often predicated on expectations that people in their homes (1) can actively interact with these technologies and (2) are willing to submit to the action of the technology in their home. Our purpose is to use an “ability expectations” lens to bring together, and provide some synthesis of, the types of utility and disadvantages that can arise for people with disabilities in relation to home care technology development and use. We searched the academic databases Scopus, Web of Science, EBSCO ALL, IEEE Xplore, and Compendex to collect articles that had the term “home care technology” in the abstract or as a topic (in the case of Web of Science). We also used our background knowledge and related academic literature pertaining to self-diagnosis, health monitoring, companionship, health information gathering, and care. We examined background articles and articles collected through our home care technology search in terms of ability expectations assumed in the presentation of home care technologies, or discussed in relation to home care technologies. While advances in health care support are made possible through emerging technologies, we urge critical examination of such technologies in terms of implications for the rights and dignity of people with diverse abilities. Specifically, we see potential for technologies to result in new forms of exclusion and powerlessness. Ableism influences choices made by funders, policy makers, and the public in the development and use of home health technologies and impacts how people with disabilities are served and how useful health support technologies will be for them. We urge continued critical examination of technology development and use according to ability expectations, and we recommend increasing incorporation

  15. Home care technology through an ability expectation lens.

    PubMed

    Wolbring, Gregor; Lashewicz, Bonnie

    2014-01-01

    Home care is on the rise, and its delivery is increasingly reliant on an expanding variety of health technologies ranging from computers to telephone "health apps" to social robots. These technologies are most often predicated on expectations that people in their homes (1) can actively interact with these technologies and (2) are willing to submit to the action of the technology in their home. Our purpose is to use an "ability expectations" lens to bring together, and provide some synthesis of, the types of utility and disadvantages that can arise for people with disabilities in relation to home care technology development and use. We searched the academic databases Scopus, Web of Science, EBSCO ALL, IEEE Xplore, and Compendex to collect articles that had the term "home care technology" in the abstract or as a topic (in the case of Web of Science). We also used our background knowledge and related academic literature pertaining to self-diagnosis, health monitoring, companionship, health information gathering, and care. We examined background articles and articles collected through our home care technology search in terms of ability expectations assumed in the presentation of home care technologies, or discussed in relation to home care technologies. While advances in health care support are made possible through emerging technologies, we urge critical examination of such technologies in terms of implications for the rights and dignity of people with diverse abilities. Specifically, we see potential for technologies to result in new forms of exclusion and powerlessness. Ableism influences choices made by funders, policy makers, and the public in the development and use of home health technologies and impacts how people with disabilities are served and how useful health support technologies will be for them. We urge continued critical examination of technology development and use according to ability expectations, and we recommend increasing incorporation of

  16. Care on demand in nursing homes: a queueing theoretic approach.

    PubMed

    van Eeden, Karin; Moeke, Dennis; Bekker, René

    2016-09-01

    Nursing homes face ever-tightening healthcare budgets and are searching for ways to increase the efficiency of their healthcare processes without losing sight of the needs of their residents. Optimizing the allocation of care workers plays a key role in this search as care workers are responsible for the daily care of the residents and account for a significant proportion of the total labor expenses. In practice, the lack of reliable data makes it difficult for nursing home managers to make informed staffing decisions. The focus of this study lies on the 'care on demand' process in a Belgian nursing home. Based on the analysis of real-life 'call button' data, a queueing model is presented which can be used by nursing home managers to determine the number of care workers required to meet a specific service level. Based on numerical experiments an 80/10 service level is proposed for this nursing home, meaning that at least 80 percent of the clients should receive care within 10 minutes after a call button request. To the best of our knowledge, this is the first attempt to develop a quantitative model for the 'care on demand' process in a nursing home. PMID:25542224

  17. Information Persistence Services Designed to Support Home Care

    PubMed Central

    Queirós, Alexandra; Augusto, Filipe; Rodríguez, Yosvany Llerena; Cardoso, Carlos; Grade, José Miguel; Quintas, João

    2015-01-01

    Background Due to the challenges faced by health and social care systems, in particular those related to actual demographic trends, home care emerges as a potentially cost-effective solution to answer the needs of citizens, and to allow the reallocation of resources to alternatives to hospitalization or institutionalization. Objective Home care services require cooperation between different actors, including health and social caregivers, care receivers, and their informal caregivers (eg, relatives or friends), across time, space, and organizational boundaries. Therefore, it is foreseeable that eHealth services can contribute to their improvement. The aim of this study is to evaluate information persistence services based on the Reference Information Model (RIM) of the Health Level Seven (HL7) version 3 to support formal caregivers, both health and social care providers, and informal caregivers in the context of home care services. Methods A pilot study was set up involving two Portuguese institutions that provide home care services for the elderly. Defining of information requirements was performed according to a comprehensive process. This included a review of the literature, observations of work activities, interviews with caregivers, care receivers and their relatives, analysis of paper documentation related to care receivers’ histories, health conditions and care plans, and brainstorming groups involving specialized professionals. Following this, information objects were implemented and validated. Results The methodological approach, as well as the information persistence services, proved to be robust and adequate to specify, implement, and validate different types of information objects related to home care services for the elderly. This study also reinforces the application of the RIM of the HL7 version 3 beyond the strict scope of health care, allowing the persistence of not only health care information, but also information related to social assistance

  18. Understanding nursing home worker conceptualizations about good care.

    PubMed

    Chung, Gawon

    2013-04-01

    This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were conducted. Data were analyzed using a grounded theory approach, and the results revealed that direct care workers equated good care, such as resident cleanliness, comfort, and happiness as a desirable outcome of care activities. Good care also meant affectionate, respectful, and patient attitudes of direct care workers toward residents in care delivery processes. Nursing home workers internalized the perspectives of residents and other professionals about what constitutes good care, and then drew their own conclusions about how to balance, combine, and compromise those diverse demands. It is important to communicate accurate and consistent messages about what comprises good nursing home care to nursing home workers and build a working environment where workers' conceptualizations about good care can be executed without organizational barriers. PMID:22936538

  19. [24-hour blood pressure measurement in normal pregnancy in hypertensive pregnant patients].

    PubMed

    Rath, W; Schrader, J; Guhlke, U; Buhr-Schinner, H; Haupt, A; Kramer, A; Kuhn, W

    1990-08-01

    Noninvasive 24-hour ambulatory blood pressure monitoring was performed in 17 normotensive and 19 preeclamptic pregnant women. The normotensive women showed a significant nightly decline in their systolic and diastolic blood pressure. In contrast, the preeclamptic women demonstrated either an attenuated circadian rhythm or no circadian rhythm at all. This result was even more pronounced in patients with severe hypertension, some of whom had a nocturnal increase in blood pressure in spite of being treated with antihypertensive drugs in an evening dose. The lack of nocturnal blood pressure decrease was also found 24 hours post partum. In summary, these results suggest that preeclamptic women are endangered by hypertensive emergencies mostly during the night. Therefore blood pressure controls should be extended into the night, and antihypertensive drugs should also be given in a sufficient evening dose. PMID:2214601

  20. Evaluation of Home Health Care Devices: Remote Usability Assessment

    PubMed Central

    2015-01-01

    Background An increasing amount of health care is now performed in a home setting, away from the hospital. While there is growing anecdotal evidence about the difficulty patients and caregivers have using increasingly complex health care devices in the home, there has been little systematic scientific study to quantify the global nature of home health care device usability in the field. Research has tended to focus on a handful of devices, making it difficult to gain a broad view of the usability of home-care devices in general. Objective The objective of this paper is to describe a remote usability assessment method using the System Usability Scale (SUS), and to report on the usability of a broad range of health care devices using this metric. Methods A total of 271 participants selected and rated up to 10 home health care devices of their choice using the SUS, which scores usability from 0 (unusable) to 100 (highly usable). Participants rated a total of 455 devices in their own home without an experimenter present. Results Usability scores ranged from 98 (oxygen masks) to 59 (home hormone test kits). An analysis conducted on devices that had at least 10 ratings showed that the effect of device on SUS scores was significant (P<.001), and that the usability of these devices was on the low end when compared with other commonly used items in the home, such as microwave ovens and telephones. Conclusions A large database of usability scores for home health care devices collected using this remote methodology would be beneficial for physicians, patients, and their caregivers. PMID:27025664

  1. Controversial issues in home health care: a roundtable discussion.

    PubMed

    McAllister, J C; Black, B L; Griffin, R E; Smith, J E

    1986-04-01

    Controversial issues in home health care (HHC) were discussed by a panel of four individuals involved in or knowledgeable about HHC. The panel addressed the following issues: reluctance of health professionals to participate in home care, challenges in providing HHC services, assigning responsibility for HHC services, reimbursement considerations in joint-venture arrangements, assuming fiscal responsibility for unreimbursed care, selecting HHC providers, defining patient rights, selecting drug products for home-care patients, competing with community pharmacists, circumvention of pharmacist input in preparation of solutions for home infusion, and the future of HHC. Hospital pharmacists who plan to become involved or are already involved in providing HHC services should become familiar with these controversial issues. PMID:3706341

  2. Circadian Polymorphisms in Night Owls, in Bipolars, and in Non-24-Hour Sleep Cycles

    PubMed Central

    Klimecki, Walter T.; Nievergelt, Caroline M.; Rex, Katharine M.; Murray, Sarah S.; Shekhtman, Tatyana; Tranah, Gregory J.; Loving, Richard T.; Lee, Heon-Jeong; Rhee, Min Kyu; Shadan, Farhad F.; Poceta, J. Steven; Jamil, Shazia M.; Kline, Lawrence E.; Kelsoe, John R.

    2014-01-01

    People called night owls habitually have late bedtimes and late times of arising, sometimes suffering a heritable circadian disturbance called delayed sleep phase syndrome (DSPS). Those with DSPS, those with more severe progressively-late non-24-hour sleep-wake cycles, and those with bipolar disorder may share genetic tendencies for slowed or delayed circadian cycles. We searched for polymorphisms associated with DSPS in a case-control study of DSPS research participants and a separate study of Sleep Center patients undergoing polysomnography. In 45 participants, we resequenced portions of 15 circadian genes to identify unknown polymorphisms that might be associated with DSPS, non-24-hour rhythms, or bipolar comorbidities. We then genotyped single nucleotide polymorphisms (SNPs) in both larger samples, using Illumina Golden Gate assays. Associations of SNPs with the DSPS phenotype and with the morningness-eveningness parametric phenotype were computed for both samples, then combined for meta-analyses. Delayed sleep and "eveningness" were inversely associated with loci in circadian genes NFIL3 (rs2482705) and RORC (rs3828057). A group of haplotypes overlapping BHLHE40 was associated with non-24-hour sleep-wake cycles, and less robustly, with delayed sleep and bipolar disorder (e.g., rs34883305, rs34870629, rs74439275, and rs3750275 were associated with n=37, p=4.58E-09, Bonferroni p=2.95E-06). Bright light and melatonin can palliate circadian disorders, and genetics may clarify the underlying circadian photoperiodic mechanisms. After further replication and identification of the causal polymorphisms, these findings may point to future treatments for DSPS, non-24-hour rhythms, and possibly bipolar disorder or depression. PMID:25395965

  3. Mechanical properties of direct and indirect composites after storage for 24 hours and 10 months

    PubMed Central

    Alves, Paula Barbosa; Brandt, William Cunha; Neves, Ana Christina Claro; Cunha, Leonardo Gonçalves; Silva-Concilio, Lais Regiane

    2013-01-01

    Objective: The objective of this study was to evaluate the diametral tensile strength (DTS) and Knoop hardness (KH) of direct (Filtek Z350-3M/ESPE and Charisma-Heraeus Kulzer) and indirect composites (Sinfony-3M/ESPE and Signum-Heraeus Kulzer) kept in storage for two periods of time, 24 hours and 10 months, in distilled water. Methods: Twenty-five specimens of each material were prepared. DTS (n=10) was tested using a universal testing machine (Versat, model 2000) at a crosshead speed of 1.0 mm/min. KH (n=5) was measured using Knoop micro-hardness (HMV-2000; 50 gf for 15 s). All tests were performed 24 hours after polymerization and after 10 months of storage in distilled water at 37°C. The data were statistically analyzed using Kolmogorov-Smirnov, ANOVA and t-Student (P=.05). Results: Filtek Z350, Sinfony, and Signum showed higher DTS values than Charisma after 24 hours. After storage, Sinfony and Signum showed higher DTS values because the storage did not influence the DTS values of the indirect composites. Filtek Z350 showed higher KH values after 24 hours and after storage than other composites; the storage influenced the KH of all composites except Sinfony. Conclusion: Storage for 10 months did not influence the properties of the indirect composite Sinfony. In general, the indirect composites showed higher DTS values than direct composites, especially after 10 months storage. The direct composite Filtek Z350 obtained the highest KH values regardless of storage. PMID:23407869

  4. Analogue step-by-step DC component eliminator for 24-hour PPG signal monitoring.

    PubMed

    Pilt, Kristjan; Meigas, Kalju; Lass, Jaanus; Rosmann, Mart; Kaik, Jüri

    2007-01-01

    For applications where PPG signal AC component needs to be measured without disturbances in its shape and recorded digitally with high digitalization accuracy, the step-by-step DC component eliminator is developed. This paper describes step-by-step DC component eliminator, which is utilized with analogue comparator and operational amplifier. It allows to record PPG signal without disturbances in its shape in 24-hours PPG signal monitoring system. The experiments with PPG signal have been carried out. PMID:18002130

  5. Federal Home Visiting under the Affordable Care Act

    ERIC Educational Resources Information Center

    Strader, Kathleen; Counts, Jacqueline; Filene, Jill

    2013-01-01

    The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is part of The Patient Protection and Affordable Care Act and provides $1.5 billion over 5 years to states, territories, and tribes with the goal of delivering evidence-based home visiting services as part of a high-quality, comprehensive early childhood system that promotes…

  6. Patients' Anticipation of Stress in Nursing Home Care.

    ERIC Educational Resources Information Center

    Stein, Shayna; And Others

    1985-01-01

    Examined anticipation of stresses in 223 patients recently admitted to nursing homes, who completed the stresses in Institutional Care Scale (SIC). Factor analysis revealed five factors significantly related to psychological and physical variables. Suggests using SIC for admission screening in nursing homes. Appendix contains the SIC. (NRB)

  7. Home care workers: injury prevention through risk factor reduction.

    PubMed

    Jarrell, R B

    1997-01-01

    Home health care professionals work in a nonstandard and unpredictable environment for which few controls are available. The professional must cope with a residence's existing access, cleanliness, facilities, and other occupants (including pets), among other factors, and these vary between homes. This chapter suggests interventions that can reduce risks to employees, patients, and family members. PMID:9353822

  8. Measuring End-of-Life Care Processes in Nursing Homes

    ERIC Educational Resources Information Center

    Temkin-Greener, Helena; Zheng, Nan; Norton, Sally A.; Quill, Timothy; Ladwig, Susan; Veazie, Peter

    2009-01-01

    Purpose: The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them. Design and Methods: A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities.…

  9. 24-hour-restraint stress induces long-term depressive-like phenotypes in mice.

    PubMed

    Chu, Xixia; Zhou, Ying; Hu, Zhiqiang; Lou, Jingyu; Song, Wei; Li, Jing; Liang, Xiao; Chen, Chen; Wang, Shuai; Yang, Beimeng; Chen, Lei; Zhang, Xu; Song, Jinjing; Dong, Yujie; Chen, Shiqing; He, Lin; Xie, Qingguo; Chen, Xiaoping; Li, Weidong

    2016-01-01

    There is an increasing risk of mental disorders, such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and depression among survivors who were trapped in rubble during earthquake. Such long-term impaction of a single acute restraint stress has not been extensively explored. In this study, we subjected mice to 24-hour-restraint to simulate the trapping episode, and investigated the acute (2 days after the restraint) and long-term (35 days after the restraint) impacts. Surprisingly, we found that the mice displayed depression-like behaviors, decreased glucose uptake in brain and reduced adult hippocampal neurogenesis 35 days after the restraint. Differential expression profiling based on microarrays suggested that genes and pathways related to depression and other mental disorders were differentially expressed in both PFC and hippocampus. Furthermore, the depression-like phenotypes induced by 24-hour-restraint could be reversed by fluoxetine, a type of antidepressant drug. These findings demonstrated that a single severe stressful event could produce long-term depressive-like phenotypes. Moreover, the 24-hour-restraint stress mice could also be used for further studies on mood disorders. PMID:27609090

  10. 24-hour-restraint stress induces long-term depressive-like phenotypes in mice

    PubMed Central

    Zhou, Ying; Hu, Zhiqiang; Lou, Jingyu; Song, Wei; Li, Jing; Liang, Xiao; Chen, Chen; Wang, Shuai; Yang, Beimeng; Chen, Lei; Zhang, Xu; Song, Jinjing; Dong, Yujie; Chen, Shiqing; He, Lin; Xie, Qingguo; Chen, Xiaoping; Li, Weidong

    2016-01-01

    There is an increasing risk of mental disorders, such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and depression among survivors who were trapped in rubble during earthquake. Such long-term impaction of a single acute restraint stress has not been extensively explored. In this study, we subjected mice to 24-hour-restraint to simulate the trapping episode, and investigated the acute (2 days after the restraint) and long-term (35 days after the restraint) impacts. Surprisingly, we found that the mice displayed depression-like behaviors, decreased glucose uptake in brain and reduced adult hippocampal neurogenesis 35 days after the restraint. Differential expression profiling based on microarrays suggested that genes and pathways related to depression and other mental disorders were differentially expressed in both PFC and hippocampus. Furthermore, the depression-like phenotypes induced by 24-hour-restraint could be reversed by fluoxetine, a type of antidepressant drug. These findings demonstrated that a single severe stressful event could produce long-term depressive-like phenotypes. Moreover, the 24-hour-restraint stress mice could also be used for further studies on mood disorders. PMID:27609090

  11. A New Method to Make 24-Hour Urine Collection More Convenient: A Validity Study

    PubMed Central

    2014-01-01

    Background and Objectives. This study proposes a novel urine collection device that can divide each urine collection into 20 parts and store and cool just one part. The aim of the current study is to compare measured biomarkers from the proposed urine collection device to those of conventional 24-hour sampling method. We also hypothesized that the new method would significantly increase patients' adherence to the timed urine collection. Methods. Two 24-hour urine samples with the conventional method and with the new automated urine collection device that uses just one-twentieth of each void were obtained from 40 healthy volunteers. Urine parameters including volume, creatinine, and protein levels were compared between the two methods and the agreement of two measurements for each subject was reported through Bland-Altman plots. Results. Our results confirmed that for all three variables, there is a positive correlation (P < 0.001) between the two measurements and high degree of agreement could be seen in Bland-Altman plots. Moreover, more subjects reported the new method as “more convenient” for 24-hour urine collection. Conclusions. Our results clearly indicate that a fixed proportion of each void may significantly reduce the urine volume in timed collections and this, in turn, may increase subjects' adherence to this difficult sampling. PMID:24963405

  12. Phase II trial of cyclophosphamide, leucovorin, 5-fluorouracil 24-hour infusion and tamoxifen in pancreatic cancer.

    PubMed

    Eckel, F; Lersch, C; Lippl, F; Assmann, G; Schulte-Frohlinde, E

    2000-09-01

    Leucovorin modulates the cytotoxic effects of 5-fluorouracil (5-FU) in the treatment of cancer. 24-hour infusion of 5-FU has been shown to enhance antitumor activity in colorectal cancer compared to bolus infusion. According to experimental data cyclophosphamide and tamoxifen may enhance the effectiveness of leucovorin and 5-FU. A phase II trial was initiated to evaluate the effect of a combination of low-dose cyclophosphamide (C), leucovorin (L), 5-FU (F) and tamoxifen (T) (CLFT) in advanced pancreatic cancer. Fifty patients were treated monthly with 300 mg/m2 cyclophosphamide and weekly with 500 mg/m2 leucovorin followed by a 24-hour infusion of 2000 mg/m2 5-FU and tamoxifen 20 mg bid. Three patients had a partial response (6%), two a minor response (4%) and 32 (64%) no change of disease. The median survival time was 8.5 months for all patients, the median time to progression of disease was 4.6 months and the 1-year survival rate was 28%. CLFT was fairly well tolerated. These data suggest that biochemical modulation of 24-hour infusional 5-FU with leucovorin together with cyclophosphamide and tamoxifen has some positive effects in the treatment of pancreatic cancer. PMID:11144522

  13. Impact of diet on 24-hour intragastric pH profile in healthy horses.

    PubMed

    Damkel, Cornelia; Snyder, Alice; Uhlig, Albrecht; Coenen, Manfred; Schusser, Gerald Fritz

    2015-01-01

    An electrode incorporated into a polyethylene hose was introduced under endoscopic control into the stomach of six fasting adult horses for long-lasting pH measurements. The intragastric pH was recorded every four seconds for a period of 24 hours. The Warmblood horses were assigned randomly to receive hay ad libitum (H group); 1.5 kg hay/100 kg BW/day and 1 kg concentrate/100 kg BW/ day (C group) or protocol C plus 75 g pectin-lecithin supplement/100 kg BW/day (P group). The horses were adapted to each diet for 14 days. The 24-hour median pH value for protocol H (2.69) was significantly lower compared to protocol C (3.35) and P (3.44) (p < 0.05). The horses in protocol P had a significant higher percentage (40.1 %) of 24-hour intragastric pH values ≥ 4 than in protocol C (36.2 %) or in protocol H (25.3 %) (p < 0.05). PMID:26591378

  14. Quality of life for chronic psychiatric illnesses and home care

    PubMed Central

    Molu, Nesibe Gunay; Ozkan, Birgul; Icel, Sema

    2016-01-01

    Nowadays, mental illnesses are gradually increasing and so does chronic psychiatric patients. As a result of this increase, chronic psychiatric disorders lead the burden of patients and their families. To reduce the burden of mental illnesses on individuals and their families, treatment and care are given including psychosocial, physiological and medical support and social services. To begin with, home care enables both the patient and his or her family to stay at their own houses and not to be bothered with residents or long-term, institutional-based nursing homes. In addition, the home care providers deliver services to the patient’s at their own house. The other advantages of taking care at home is that it eases financial issues in terms of reducing the cost, reduces the patient’s symptoms and improve the individual’s quality of life (QoL). In addition to these, home care also minimizes the burden on outpatient services and provides help for the patient and the family in order to solve their problems and give support. Home care services help patients to get their freedom back and enhance the quality of their lives. Thus, it is necessary to procure and implement these services and supply both the patient and his or her family a high-quality life. Sources of data/ study selection: Literature review was done by using the keywords “home care, patient with chronic mental illness, quality of life, home care nursing” from the sources including PsychINFO, PsychARTICLES, MEDLINE, PubMED, EBSCOHOST and The COCHRANE LIBRARY in the time period of 2005- 2015. PMID:27182272

  15. Geographic Concentration Of Home-Based Medical Care Providers.

    PubMed

    Yao, Nengliang; Ritchie, Christine; Camacho, Fabian; Leff, Bruce

    2016-08-01

    The United States faces a shortage of providers who care for homebound patients. About 5,000 primary care providers made 1.7 million home visits to Medicare fee-for-service beneficiaries in 2013, accounting for 70 percent of all home-based medical visits. Nine percent of these providers performed 44 percent of visits. However, most homebound people live more than thirty miles from a high-volume provider. PMID:27503964

  16. [Precarity, vulnerability, anticipating end-of-life care at home].

    PubMed

    Bonneval, Camille

    2016-02-01

    Many patients want to end their life at home. Care teams adapt to these wishes and organise a form of treatment which blends safety of care and the respect of the expectations of the patients and family members. When factors of precarity increase the vulnerability inherent to the end of life, caregivers anticipate and support as best as they can the difficulties encountered as testified by a hospital at home team in Dax. PMID:26861082

  17. Variations in levels of care between nursing home patients in a public health care system

    PubMed Central

    2014-01-01

    Background Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. Methods The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. Results There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. Conclusion In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients’ own needs, but also on the needs of all the other residents

  18. Home-based care, technology, and the maintenance of selves.

    PubMed

    Parks, Jennifer A

    2015-06-01

    In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons (especially older persons) to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing care for persons at home, but they also have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann's notion of "holding" persons' identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this "holding" work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be "held" in place. PMID:25787720

  19. Factors Associated With High Sodium Intake Based on Estimated 24-Hour Urinary Sodium Excretion

    PubMed Central

    Hong, Jae Won; Noh, Jung Hyun; Kim, Dong-Jun

    2016-01-01

    Abstract Although reducing dietary salt consumption is the most cost-effective strategy for preventing progression of cardiovascular and renal disease, policy-based approaches to monitor sodium intake accurately and the understanding factors associated with excessive sodium intake for the improvement of public health are lacking. We investigated factors associated with high sodium intake based on the estimated 24-hour urinary sodium excretion, using data from the 2009 to 2011 Korea National Health and Nutrition Examination Survey (KNHANES). Among 21,199 adults (≥19 years of age) who participated in the 2009 to 2011 KNHANES, 18,000 participants (weighted n = 33,969,783) who completed urinary sodium and creatinine evaluations were analyzed in this study. The 24-hour urinary sodium excretion was estimated using Tanaka equation. The mean estimated 24-hour urinary sodium excretion level was 4349 (4286–4413) mg per day. Only 18.5% (weighted n = 6,298,481/3,396,973, unweighted n = 2898/18,000) of the study participants consumed less the 2000 mg sodium per day. Female gender (P < 0.001), older age (P < 0.001), total energy intake ≥50 percentile (P < 0.005), and obesity (P < 0.001) were associated with high sodium intake, even after adjusting for potential confounders. Senior high school/college graduation in education and managers/professionals in occupation were associated with lower sodium intake (P < 0.001). According to hypertension management status, those who had hypertension without medication consumed more sodium than those who were normotensive. However, those who receiving treatment for hypertension consumed less sodium than those who were normotensive (P < 0.001). The number of family members, household income, and alcohol drinking did not affect 24-hour urinary sodium excretion. The logistic regression analysis for the highest estimated 24-hour urinary sodium excretion quartile (>6033 mg/day) using the

  20. The ABCs of DME: a home care durable medical equipment/home oxygen program.

    PubMed

    Fry, L M; Rice, M J

    1992-01-01

    With the evolution of high-tech healthcare in the home setting, patients and families now need to learn the skills to perform the tasks that previously were done in hospital settings by health professionals. Numerous private and federally funded home health organizations are offering services to this patient population. The mission of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is to improve the quality of care provided to the public (JCAHO, 1991b). In 1988, the commission implemented standards for the accreditation of home care and began to survey home care providers (JCAHO, 1988). Standards governing the provision of durable medical equipment are included in the JCAHO Accreditation Manual for Home Care (1991a). The article describes an effective collaborative approach used to develop a comprehensive durable medical equipment/home oxygen (DME/home O2) program at the Department of Veterans Affairs Medical Center (DVAMC), now called the Veterans Health Administration Medical Center, in East Orange, NJ. Project management principles were used by the quality management (QM) staff to develop and implement the DME/home O2 program successfully. PMID:10119891

  1. 78 FR 76193 - Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction... Retaining Nurses at State Homes).'' SUPPLEMENTARY INFORMATION: Title: Care Coordination Home...

  2. 77 FR 45719 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... Diem for Adult Day Care of Veterans in State Homes): Comment Request AGENCY: Veterans Health... day health care facilities are providing high quality services to Veterans in State homes. DATES... nursing home and adult day health services care to Veterans. VA requires facilities providing nursing...

  3. Workforce development and models of care in home hemodialysis.

    PubMed

    Mitra, Sandip; Cress, Cheryl; Goovaerts, Tony

    2015-04-01

    Creating and maintaining a successful home hemodialysis (HD) program is highly dependent on the workforce model and quality of staff. We describe the minimum staff required to start a home HD program (e.g., a clinical champion and lead nurse) and detail what additional workforce (e.g., renal technician, dietitian, psychologist, and others) may be necessary as the program evolves and expands. The goal of the program and allied staff should be to provide a seamless patient journey, a process that requires consideration of a patient recruitment strategy, a patient training pathway, thoughtful initiation of home HD, and development of support systems for routine care and emergencies at home. This module describes how care models are implemented at centers of excellence in various locations around the world, highlights the importance of an integrated care pathway, and describes workforce challenges that programs may encounter. PMID:25925823

  4. Component analysis of productivity in home care RNs.

    PubMed

    Benefield, L E

    1996-08-01

    The purpose of this study was to develop a productivity measurement method applicable to home health care registered nurses (RNs) by identifying and quantifying the areas of knowledge and ability that define productive nursing practice in home health care. A descriptive, correlational design using qualitative and quantitative methods of data collection and analysis identified 35 knowledge and ability variables that grouped into seven dimensions: Client/Family Management, Practice Management, Knowledge/Skill Maintenance, Communication, Nursing Process, Written Documentation, and Home Health Care Knowledge. There were no significant differences in productivity variables among four major types of agencies. Among agencies considered preeminent, intellectual skills appeared to be of greater importance to productive practice than direct-care skills. The seven productivity dimensions that emerged from this study show promise in providing 1) a theoretical basis for understanding the knowledge and abilities associated with RN productivity in the home health setting, 2) a description of nurse inputs in a home health services productivity model, and 3) a reality-based measurement tool that has utility in managing RN productivity in home health care. PMID:8828384

  5. Parenteral inotropic therapy in the home: an update for home care and hospice.

    PubMed

    Lyons, Margaret G; Carey, Lawrence

    2013-04-01

    This article provides an evidence-based overview of heart failure (HF), including its pathogenesis, staging, assessment, prognosis, and treatment with intravenous inotropic medications in the home. Inotropic infusions in the home setting require advanced care planning, symptom management, and knowledge about ambulatory pumps and devices. These medications can be safely used throughout the continuum of care as pediatric/adult bridges from transplant to hospice care. Nurses who recognize advanced HF symptomatology and use prognostic/risk-stratification models will be better prepared to facilitate this advanced care planning, thus supporting optimal treatment outcomes. The ultimate goal of care for heart failure therapy in the home is to integrate pharmacotherapeutic knowledge of treatment advances with comfort measures and to provide them to patients concurrently and in a seamless process. PMID:23549250

  6. The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.

    PubMed

    Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John

    2016-04-01

    People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. PMID:27037378

  7. Correlates of Home Health Care Services Use among the Elderly.

    ERIC Educational Resources Information Center

    Starrett, Richard A.; And Others

    The use of health and social services is influenced by economic, community, geographic, organizational, societal, and environmental factors. A study was conducted to examine predisposing, enabling, and need-for-care factors related to the use of home health care services by a stratified random sample of 400 older adults. Predisposing factors…

  8. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.18 Day...-related expenses must complete documentation requested by their sponsor as described in § 226.16(k) prior... those children for whom the sponsoring organization or day care home possess documentation of the...

  9. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.18 Day...-related expenses must complete documentation requested by their sponsor as described in § 226.16(k) prior... those children for whom the sponsoring organization or day care home possess documentation of the...

  10. The Coach Is in: Improving Nutritional Care in Nursing Homes

    ERIC Educational Resources Information Center

    Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.

    2012-01-01

    Purpose: This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff…

  11. Autism-Specific Primary Care Medical Home Intervention

    ERIC Educational Resources Information Center

    Golnik, Allison; Scal, Peter; Wey, Andrew; Gaillard, Philippe

    2012-01-01

    Forty-six subjects received primary medical care within an autism-specific medical home intervention (www.autismmedicalhome.com) and 157 controls received standard primary medical care. Subjects and controls had autism spectrum disorder diagnoses. Thirty-four subjects (74%) and 62 controls (40%) completed pre and post surveys. Controlling for…

  12. A Children's Standpoint: Needs in Out-of-Home Care

    ERIC Educational Resources Information Center

    Mason, Jan

    2008-01-01

    This article discusses research reported in "The Needs of Children in Care" ( Mason and Gibson, 2004) in which children participated in defining their needs in out-of-home care. In this study a central research presumption was that children are knowledgeable about their own needs. The methods used to facilitate the involvement in the project of…

  13. Understanding Nursing Home Worker Conceptualizations about Good Care

    ERIC Educational Resources Information Center

    Chung, Gawon

    2013-01-01

    This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were…

  14. Low Income Family Day Care Home Demonstration. Final Report.

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Washington, DC.

    A 1-year demonstration project was conducted by the United States Department of Agriculture's Food and Nutrition Service (FNS) to help remove or reduce barriers to the participation of low-income family day care homes in the Child and Adult Care Food Program (CACFP). FNS funded six grantees to conduct a demonstration of three different strategies.…

  15. Home Economics Education Guide for Occupational Child Care.

    ERIC Educational Resources Information Center

    Dewald, Margaret R.

    Designed to assist home economics teachers in providing a training program to prepare high school students for jobs in the child care field, this curriculum guide contains a two-year course of study in occupational child care. In the first year, the following nine topics are outlined: (1) an orientation to the philosophies and overview of careers…

  16. An Evaluation of Home-Based Respite Care.

    ERIC Educational Resources Information Center

    Upshur, Carole C.

    1982-01-01

    Findings of an evaluation of a pilot home-based respite care program designed to serve 35 severely mentally retarded and disabled persons were reported. Results indicated that respite care services had never been previously received by 51.8% of the families. (Author/SB)

  17. A patient classification system for emergency events in home care.

    PubMed

    Sienkiewicz, Josephine; Wilkinson, Ginny; Cubbage, Betsy

    2007-06-01

    The purpose of this article is to describe the development of a uniform classification system that provides a way for home care agencies to classify patient priority needs for evacuation, transport, supportive care, and use of staffing resources in an emergency/disaster situation/bioterroristic event. PMID:17556919

  18. Who's the boss? Ethical conflicts in home care.

    PubMed

    Young, A; Pignatello, C H; Taylor, M B

    1988-12-01

    In 1987 a committee of the Home Health Assembly of New Jersey began a study of ethical issues in home care situations where the autonomy of the elderly patient is at risk. The study was based on four case histories describing actual situations of elderly patients, their families, and the professional practice of nursing and social work in the home. To determine concerns of home health agency administrators and their staffs, the committee did surveys, held round-table discussions, and conducted telephone interviews. As a result, it identified four key ethical concerns: 1. Maintaining agency solvency without denying care to patients who lack adequate financial resources. 2. Responding to the conflicting needs of patients and families. 3. Practicing healthcare in situations where patients may be abused or neglected. 4. Addressing decisions about candor and treatment in the care of the terminally ill. The committee identified five characteristics unique to the home care setting that create challenging situations which are rare in other healthcare settings: 1. Strongly asserted autonomy. 2. Limited definition of communal values. 3. Patient isolation. 4. Patient dependency on family care givers. 5. Inadequate long-term care policies. PMID:10290837

  19. Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review

    ERIC Educational Resources Information Center

    Dellefield, Mary Ellen

    2006-01-01

    Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…

  20. Care Instability in Nursing Homes; A Qualitative Study

    PubMed Central

    Rahimi, Majid; Fadayevatan, Reza; Abedi, Heidar Ali

    2016-01-01

    Background: The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Objectives: This study was performed to assess the caring conditions in nursing homes. Patients and Methods: This study was conducted with a qualitative approach using conventional qualitative content analysis. The study was conducted on 23 Iranian participants including 14 elders and 9 caregivers. Data was collected with unstructured interviews and continued to the point of data saturation. Analysis of data was performed continually and concurrently with data collection through a comparative method. Results: Three themes emerged from 595 open codes including care as unpleasant task, sustained care and insufficient resources. Ten subthemes indicated participants’ experiences and understanding of caring conditions in a nursing home. Conclusions: The prevailing given care was the routine one with a focus on physical aspects, although there was some psychological care given to the older people. The findings of this research are guidelines for managers and care planners in nursing homes who should pay attention to physical and psychological care needs of older people. In addition, it is important to pay close attention to the needs of caregivers and provision of instructions for treatment, supervision and education of caregivers and medical students to provide a better care. PMID:27186382

  1. Nurse Delegation in Home Care: Research Guiding Policy Change.

    PubMed

    Young, Heather M; Farnham, Jennifer; Reinhard, Susan C

    2016-09-01

    The current study evaluated nurse delegation in home care, a pilot program introduced in 2007 in New Jersey to promote home care options for consumers needing assistance with medical/nursing tasks. Findings on readiness for the program, barriers and facilitating factors, experience with the program, and recommendations are summarized and presented. Methods included surveys and interviews with participants in nurse delegation, observations of planning and implementation meetings, and review meeting minutes. Major findings were no negative outcomes for consumers, improvements in quality of life and quality of care for consumers, high readiness and increasing satisfaction with experience in delegation, perception of nurse delegation in home care as a valued option, and the challenges of ensuring adequate staffing. Subsequent changes in regulation in New Jersey are underway, translating this research into policy. [Journal of Gerontological Nursing, 42(9), 7-15.]. PMID:27571400

  2. [eLearning service for home palliative care].

    PubMed

    Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu

    2008-12-01

    In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids. PMID:20443298

  3. Battling AIDS through home care in Uganda and Zambia.

    PubMed

    1992-10-01

    Innovative home care programs, providing a variety of services to persons with HIV infection and their families and reflecting different health, political, cultural, social, and philosophical concepts, have been developed in Africa, starting in 1987. In 1989 the World Health Organization (WHO) Global Programme on AIDS conducted a descriptive study of some of these programs. It is hoped that these experiences will assist planners and health care providers in their decision making and thereby benefit persons with HIV infection and their families. The lessons learned about the context, backgrounds, structure, process, and outcome of the six selected home care programs can be used and adapted by policymakers and program planners in their own settings when deciding on "their" model of home care. PMID:10121240

  4. 77 FR 65310 - Additional Air Quality Designations for the 2006 24-Hour Fine Particle National Ambient Air...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... the 2006 24-hour Fine Particle (PM 2.5 ) National Ambient Air Quality Standards,'' 74 FR 58688... Federal Regulations DC District of Columbia EO Executive Order EPA Environmental Protection Agency FR... EPA finalized designations for the 2006 24-hour PM 2.5 NAAQS (74 FR 58688, November 13, 2009), the...

  5. 40 CFR 52.1990 - Interstate Transport for the 2006 24-hour PM2.5 NAAQS.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 4 2014-07-01 2014-07-01 false Interstate Transport for the 2006 24-hour PM2.5 NAAQS. 52.1990 Section 52.1990 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 52.1990 Interstate Transport for the 2006 24-hour PM2.5 NAAQS. (a) EPA approves the portion of...

  6. 40 CFR 52.1990 - Interstate Transport for the 2006 24-hour PM2.5 NAAQS.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 4 2013-07-01 2013-07-01 false Interstate Transport for the 2006 24-hour PM2.5 NAAQS. 52.1990 Section 52.1990 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 52.1990 Interstate Transport for the 2006 24-hour PM2.5 NAAQS. (a) EPA approves the portion of...

  7. 40 CFR 52.1990 - Interstate Transport for the 2006 24-hour PM2.5 NAAQS.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 4 2012-07-01 2012-07-01 false Interstate Transport for the 2006 24-hour PM2.5 NAAQS. 52.1990 Section 52.1990 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 52.1990 Interstate Transport for the 2006 24-hour PM2.5 NAAQS. (a) EPA approves the portion of...

  8. Tasimelteon for the treatment of non-24-hour sleep-wake disorder.

    PubMed

    Neubauer, D N

    2015-01-01

    Tasimelteon (Hetlioz®), a melatonin receptor agonist, is the first, and, at the time of the publication, the only drug to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of non-24-hour sleep-wake disorder (non-24). This circadian rhythm disorder occurs most commonly in blind individuals without light perception, and it results from their inability to entrain to the 24-hour photoperiod, although the indication does not specify a particular patient population. Non-24 is characterized by a persistent cycle of nighttime insomnia and daytime sleepiness, alternating with asymptomatic periods depending on an individual's degree of circadian rhythm synchronization with the photoperiod at any particular time. Phase II clinical trials in healthy individuals confirmed the circadian phase-shifting potential of tasimelteon. Phase III trials in totally blind subjects diagnosed with non-24 demonstrated the efficacy of tasimelteon in reducing both nighttime wakefulness and daytime napping. Physiologic monitoring revealed that tasimelteon resulted in a higher proportion of individuals becoming entrained to the 24-hour cycle compared with placebo. Safety assessments indicated that tasimelteon is well tolerated, with the most common adverse events being headache, alanine aminotransferase elevation, nightmares or unusual dreams, and upper respiratory or urinary tract infections. Tasimelteon is available as a capsule in a single 20-mg dose and it must be obtained through Vanda Pharmaceutical's HetliozSolutions program with dispensing through a specialty pharmacy. Safety studies in blind individuals diagnosed with non-24 are ongoing and a future clinical trial with Smith-Magenis syndrome patients is planned. PMID:25685859

  9. 24-Hour Measurement of Gastric pH in Rural South Africa

    PubMed Central

    Sammon, Alastair M.; Ndebia, Eugene J.; Umapathy, Ekambaram; Iputo, Jehu E.

    2015-01-01

    Background. Previous studies have established norms of 24-hour gastric pH profiles for western countries. This study was designed to establish the pattern for a rural African population with a high incidence of oesophageal cancer. Methods. After lower oesophageal manometry a probe was placed 10 cm distal to the lower oesophageal sphincter. We carried out 24-hour ambulatory monitoring of gastric pH on 59 healthy subjects. This was satisfactorily completed on 26 female and 18 male (age 21–64, median 35) subjects in the Transkei region of South Africa. Results. The mean 24 hour gastric pH was 2.84 and the mean night-time pH was 3.7. 40 volunteers recorded a night-time pH reaching over 4. 33 volunteers recorded a night-time pH over 7. Night-time alkalinisation was present for 136.4 minutes (25th centile 22.8, 75th centile 208.1) at pH4 or over, and 79.3 (2.5, 122.7) minutes at pH7 or over. Episodes of rapid alkaline rise were 17 (10, 47). 21.1% of these occurred while supine. 35 of 36 tested subjects were positive for H. pylori IgG. Conclusion. Gastric alkalinisation is common in Transkei, at a higher pH than that reported in other studies, and is sustained longer. Nighttime alkalinisation is frequent. This suggests a high level of duodenogastric reflux. PMID:25861260

  10. Bioenergetical and Cardiac Adaptations of Pilots to a 24-Hour Team Kart Race.

    PubMed

    Durand, Sylvain; Ripamonti, Michael; Rahmani, Abderrahmane; Beaune, Bruno

    2015-11-01

    This study aimed to evaluate energy expenditure (EE) and heart rate (HR) response in kart pilots to successive driving bouts during a 24-hour team race. Eight adult male pilots (22.8 ± 4.1 years) participated to a team 24-hour speedway kart race in Le Mans (France). They alternatively piloted a 390 cm kart. Each relay was 45 minutes long and each pilot performed 4 relays. For each pilot, mean speeds were calculated from lap-to-lap duration recordings using a telemetric infrared timing device. Heart rate values were recorded continuously on 5-second intervals using a portable cardiometric device. Total energy expenditure (EET) and physical activity ratio (PAR) were determined by accelerometry. To pilot a kart during 45 minutes at a mean speed around 62 km·h induces a 300-kcal EET, corresponding to a 5.6-Mets PAR. This effort is responsive for a 73 b·min increase in HR, from 84.1 ± 7.6 to 157.4 ± 11.0 b·min (82% maximal heart rate intensity). However, during this relay period, HR values seemed independent to mean speed performance and bioenergetical values. Thus, in the context of the 24-hour team race, the variability in effort made during each relay and relay succession did not alter bioenergetical adaptation of pilots to kart driving. The high EE and HR values would be better explained by both emotional stress and environmental constraints such as speedway configuration and vibrations. The way how these factors specifically influence bioenergetical demand, and their relative importance, has to be specified to optimize training procedure and recommendations. PMID:25029011

  11. Evaluation of Intradermal and Subcutaneous Infusion Set Performance Under 24-Hour Basal and Bolus Conditions

    PubMed Central

    McVey, Elaine; Keith, Steven; Herr, Joshua K.; Sutter, Diane; Pettis, Ronald J.

    2015-01-01

    Background: This study sought to assess the function and delivery reliability of intradermal (ID) infusion sets used with commercial insulin pumps. Method: Healthy subjects (n = 43) were randomized to either ID or subcutaneous (SC) arms, and received basal/bolus placebo delivery for 24 hours. Subjects received 4 of 8 infusion set combinations (ID: microneedle design A or B, with 2 pump brands [Animas or MiniMed]; SC: Teflon Quickset or steel Rapid-D, Animas pump only, with or without overtaping) and were evaluated for pump occlusion alarms, fluid leakage, pain, and tissue tolerability. A novel algorithm was developed to determine flow consistency based on fluid pressure, and the duration and occurrence rate for periods of unalarmed but interrupted flow (“silent occlusions’”) were compared. Results: ID delivery was successfully maintained over the 24-hour infusion period. The number of silent occlusions was lower for ID microneedle cannula design B than A (P < .01) and lower for Rapid-D SC device compared to Quick-set (P = .03). There was no significant difference in the number of occlusion alarms between the ID and SC devices with the Animas pump. However, the pumps tested with ID devices had significantly different alarm rates (MiniMed 29.5%, Animas 0%, P < .001). Leakage and tissue tolerability were comparable across devices. Conclusion: The ID infusion set reliably delivered diluent for an extended 24-hour period in healthy subjects and was well tolerated. Silent occlusion flow interruptions could be detected in both ID and SC infusion sets using a proprietary algorithm. This algorithm is a promising method for quantitatively evaluating infusion set flow performance. PMID:26319228

  12. Implementation of a 24-Hour Pharmacy Service with Prospective Medication Review in the Emergency Department

    PubMed Central

    Yee, Linda; Claudio-Saez, Maria; Halim, Qazi; Marshall, Lewis; Hayes-Quinn, Mary

    2015-01-01

    Background: It is reported that more than 128 million patients are seen in emergency departments (EDs) annually. Patient overcrowding had been associated with an increased occurrence of medication errors. Purpose: Due to increased patient volume and the need for improved patient safety, a 24-hour pharmacy service was established for our institution’s ED. The purpose of the study is to quantify and demonstrate the impact of a 24-hour pharmacy service in an urban ED. Methods: This was a retrospective descriptive study conducted at a regional level 1 trauma center. The study period occurred between December 2012 and July 2013. The following variables were quantified and analyzed: number of medication orders reviewed, number of intravenous medications compounded, and number of clinical interventions that were recommended by the ED pharmacy team (EDPT) and accepted by ED clinicians. Results: A total of 3,779 medication orders were reviewed by the EDPT. Of these orders, 3,482 (92%) were prospectively reviewed. A total of 3,068 (81.2%) and 711 (18.8%) orders were reviewed for the adult and pediatric ED, respectively. During the study period, the EDPT procured 549 intravenous admixtures and conducted 642 clinical interventions. Most of the interventions involved providing drug information for physicians and nurses (45.9%), adjusting drug dosages (21.1%), and recommending antimicrobial therapy (15.1%). Conclusion: The implementation of a 24-hour pharmacy service at our institution was an innovative practice that increased the role of pharmacists in the ED. The EDPT conducted prospective medication review, procured intravenous admixtures from a sterile environment, and provided therapeutic recommendations for the ED interdisciplinary team. PMID:25717209

  13. Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief

    PubMed Central

    Schaeffer, Jack; Donnenfeld, Eric

    2016-01-01

    Background: Allergic conjunctivitis (AC) is a common ocular inflammatory manifestation of allergen exposure in sensitized individuals. Signs and symptoms of AC can decrease quality of life, interfere with productivity, and lead to considerable economic burden. Consistent suppression of conjunctival inflammation is necessary for managing AC, but currently available medications require frequent administration and exhibit limited duration of action. Methods: In this review, we summarized AC pathogenesis, diagnosis, and current treatment options as well as their limitations. Findings from the literature were discussed in the context of the unmet need for a once-daily medication with sustained 24-hour effectiveness. Results: Topical pharmacologic treatments are the most common approach for managing extant AC; however, most available medications require multiple daily instillations. Dual-acting antihistamine-mast cell stabilizing agents are currently considered first-line therapeutics for AC because they provide acute relief of signs and symptoms and block persistent inflammation to promote regression of AC. Recent studies of a newly-developed, higher-concentration formulation of a dual-acting antihistamine-mast cell stabilizer have demonstrated that this formulation provides a 24-hour duration of action with once-daily dosing. Conclusions: Dual-acting AC medications exhibit a high degree of overall effectiveness and are well tolerated for chronic use. A newly available once-daily medication that manages signs and symptoms of AC for a full 24 hours may be considered a treatment of choice for patients experiencing seasonal or perennial AC. ClinicalTrials.gov NCT01743027 and NCT01479374 PMID:27466061

  14. Comparison of observation level versus 24-hour average atmospheric loading corrections in VLBI analysis

    NASA Astrophysics Data System (ADS)

    MacMillan, D. S.; van Dam, T. M.

    2009-04-01

    Variations in the horizontal distribution of atmospheric mass induce displacements of the Earth's surface. Theoretical estimates of the amplitude of the surface displacement indicate that the predicted surface displacement is often large enough to be detected by current geodetic techniques. In fact, the effects of atmospheric pressure loading have been detected in Global Positioning System (GPS) coordinate time series [van Dam et al., 1994; Dong et al., 2002; Scherneck et al., 2003; Zerbini et al., 2004] and very long baseline interferometery (VLBI) coordinates [Rabble and Schuh, 1986; Manabe et al., 1991; van Dam and Herring, 1994; Schuh et al., 2003; MacMillan and Gipson, 1994; and Petrov and Boy, 2004]. Some of these studies applied the atmospheric displacement at the observation level and in other studies, the predicted atmospheric and observed geodetic surface displacements have been averaged over 24 hours. A direct comparison of observation level and 24 hour corrections has not been carried out for VLBI to determine if one or the other approach is superior. In this presentation, we address the following questions: 1) Is it better to correct geodetic data at the observation level rather than applying corrections averaged over 24 hours to estimated geodetic coordinates a posteriori? 2) At the sub-daily periods, the atmospheric mass signal is composed of two components: a tidal component and a non-tidal component. If observation level corrections reduce the scatter of VLBI data more than a posteriori correction, is it sufficient to only model the atmospheric tides or must the entire atmospheric load signal be incorporated into the corrections? 3) When solutions from different geodetic techniques (or analysis centers within a technique) are combined (e.g., for ITRF2008), not all solutions may have applied atmospheric loading corrections. Are any systematic effects on the estimated TRF introduced when atmospheric loading is applied?

  15. Spiritual caring: end of life in a nursing home.

    PubMed

    Touhy, Theris A; Brown, Cynthia; Smith, Carol J

    2005-09-01

    The purpose of this qualitative study was to explore spiritual care for dying nursing home residents from the perspectives of registered nurses, practical nurses, certified nursing assistants, advanced practice nurses, and physicians. Five major themes emerged: honoring the person's dignity, intimate knowing in the nursing home environment, wishing we could do more, personal knowing of self as caregiver, and struggling with end-of-life treatment decisions. Spiritual caring was described within the context of deep personal relationships, holistic care, and support for residents. Spiritual care responses and similarities and differences in the experiences of participants are presented. Education and research about how to assist residents and families as they struggle with difficult end-of-life decisions, adequate time and staff to provide the kind of care they "wished they could," and development of models that honor the close connection and attachment of staff to residents could enhance end-of-life care in this setting. PMID:16190010

  16. Pulse wave velocity 24-hour monitoring with one-site measurements by oscillometry

    PubMed Central

    Posokhov, Igor N

    2013-01-01

    This review describes issues for the estimation of pulse wave velocity (PWV) under ambulatory conditions using oscillometric systems. The difference between the principles of measuring the PWV by the standard method and by oscillometry is shown, and information on device validation studies is summarized. It was concluded that currently oscillometry is a method that is very convenient to use in the 24-hour monitoring of the PWV, is relatively accurate, and is reasonably comfortable for the patient. Several indices with the same principles as those in the analysis of blood pressure in ambulatory monitoring of blood pressure, namely the assessment of load, variability, and circadian rhythm, are proposed. PMID:23549868

  17. [Program for early detection of illness level in foals during the first 24 hours of life].

    PubMed

    Bostedt, H; Hospes, R; Herfen, K

    1997-11-01

    Basing on exact investigations of normal behaviour and abnormalities in newborn and up to 24 hours old foals a program for evaluation, comprehending exogeniously judgable criteria, was developed. It aims at a quick recognition of aberrations in behaviour. The program includes a score, which allows early diagnosis of even subtile abnormalities. As a result, a veterinary surgeon should be consulted if the score exposes a critical situation, so that therapy can be started in time. Furthermore informations about investigations on blood-glucose- and immunoglobulin-G-concentration in relation to neonatal foal diseases are given. PMID:9451764

  18. Assessing Dietary Intake in Childhood Cancer Survivors: Food Frequency Questionnaire Versus 24-Hour Diet Recalls.

    PubMed

    Zhang, Fang Fang; Roberts, Susan B; Must, Aviva; Wong, William W; Gilhooly, Cheryl H; Kelly, Michael J; Parsons, Susan K; Saltzman, Edward

    2015-10-01

    Cancer diagnosis and treatment may influence dietary intake. The validity of using self-reported methods to quantify dietary intake has not been evaluated in childhood cancer survivors. We validated total energy intake (EI) reported from Food Frequency Questionnaire (FFQ) and repeated 24-hour diet recalls (24HRs) against total energy expenditure (TEE) measured using the doubly labeled water method in 16 childhood cancer survivors. Dietary underreporting, assessed by (EI-TEE)/TEE × 100%, was 22% for FFQ and 1% for repeated 24HRs. FFQ significantly underestimates dietary intake and should not be used to assess the absolute intake of foods and nutrients in childhood cancer survivors. PMID:25883059

  19. [Home care for the high-risk newborn infant].

    PubMed

    Puddu, M

    2010-06-01

    With increased survival of extremely low birth weigh (ELBW) and very ill infants, a lot of them are discharged with unresolved medical issues that complicate their subsequent care. Infants born preterm with low birth weight who require neonatal intensive care experience a much higher rate of hospital readmission and death during the first year after birth compared with healthy term infants. Despite initial hospital care which is one of the most expensive of all kind of hospitalization, home care services are sometimes still sparse though the high risk of this group for failure to thrive, respiratory problems, developmental delays, parenting problems. In addition, societal and economic forces have come to bear on the timing and process of discharge and home care. Moreover it takes time for the family of a high-risk infant to prepare to care for their infant in a home setting and to obtain the necessary support services and mobilize community resources. Careful preparation for discharge, good follow-up and medical home after discharge may reduce these risks. PMID:21090070

  20. MDS Coordinator Relationships and Nursing Home Care Processes

    PubMed Central

    Piven, Mary L.; Bailey, Donald; Ammarell, Natalie; Corazzini, Kirsten; Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Anderson, Ruth A.

    2006-01-01

    The purpose of this study was to describe how Minimum Data Set (MDS) Coordinators' relationship patterns influence nursing home care processes. The MDS Coordinator potentially interacts with staff across the nursing home to coordinate care processes of resident assessment and care planning. We know little about how MDS Coordinators enact this role or to what extent they may influence particular care processes beyond paper compliance. Guided by complexity science and using two nursing home case studies as examples (pseudonyms Sweet Dell and Safe Harbor), we describe MDS Coordinators' relationship patterns by assessing the extent to which they used and fostered the relationship parameters of good connections, new information flow, and cognitive diversity in their work. Sweet Dell MDS Coordinators fostered new information flow, good connections, and cognitive diversity, which positively influenced assessment and care planning. In contrast, Safe Harbor MDS Coordinators did little to foster good connections, information flow, or cognitive diversity with little influence on care processes. This study revealed that MDS Coordinators are an important new source of capacity for the nursing home industry to improve quality of care. Findings suggest ways to enhance this capacity. PMID:16585806

  1. Home Care and Health Reform: Changes in Home Care Utilization in One Canadian Province, 1990-2000

    ERIC Educational Resources Information Center

    Penning, Margaret J.; Brackley, Moyra E.; Allan, Diane E.

    2006-01-01

    Purpose: This study examines population-based trends in home care service utilization, alone and in conjunction with hospitalizations, during a period of health reform in Canada. It focuses on the extent to which observed trends suggest enhanced community-based care relative to three competing hypotheses: cost-cutting, medicalization, and…

  2. Considerations in establishing fees for home-care pharmaceutical services.

    PubMed

    Mirtallo, J M

    1989-07-01

    The activities of home-care pharmacists are highlighted, and factors that should be considered in establishing a reimbursement schedule are described. Pharmacists are important members of the home health-care team. Responsibilities of the pharmacist include assisting in the development of a therapeutic plan, reviewing and monitoring drug therapy, and ensuring that appropriate and correctly prepared medications are available to the patient. The degree of pharmaceutical service depends on the therapy prescribed. The traditional type of third-party reimbursement--cost of drug plus dispensing fee--is often inadequate and can discourage pharmacists from becoming involved in home health care or from providing services of optimal quality. An appropriate reimbursement schedule should take into account the variety of pharmaceutical services provided to home-care patients and should give special consideration to activities, such as discontinuation of unneeded drug therapy, that lower medical costs. Whether pharmacists are able to provide high-quality home health-care services may depend on how adequately they are reimbursed. PMID:2672803

  3. [Rapid Delivery of Pharmaceutical Drugs in Home Medical Care].

    PubMed

    Kawamata, Michiko; Hirohara, Masayoshi; Kushida, Kazuki

    2015-12-01

    The population of individuals over age 65 has grown in recent years, leading to a revision of the way medical care is provided, including an increased use of home care services, for example. Medicines are delivered to home care patients in accordance with a specific schedule and based on prescriptions written by home care doctors. Although this system functions perfectly well when the patient's condition is stable, a rapidly worsening condition may lead to changes or additions to the list of prescriptions. Moreover, in addition to specialized check-ups by home care doctors, patients may also visit ophthalmologists, orthopedic specialists, or dermatologists on an outpatient basis. In such cases, the provision of drugs often does not follow a regular schedule and may require special delivery to the patients' homes. These types of alterations to medications often happen suddenly and may require drug delivery outside the pharmacies' normal hours of operation, thus imposing a great burden on them. This report aims to describe the realities faced by pharmacies as they attempt to accommodate these sudden demands for drug delivery. PMID:26809401

  4. Roles of Nurses in Home Medical Care.

    PubMed

    Tomiyama, Miyuki

    2016-01-01

    Some patients of advanced age with heart failure (HF) require repeated hospital care. In an aging society, the importance of medical and social care support systems for patients with HF further increases. In Onomichi-city, a comprehensive community care system has been in place since its introduction in 1997. The system is called "Onomichi Type". This is an interprofessional care system in which a variety of healthcare professionals, with common basic knowledge of disease prevention, treatment and welfare, collaborate with other care professionals. These professionals gain shared knowledge in regard to care management, and fulfill their respective roles at Care Conferences held during a patient's hospital stay. Elderly patients also often have multiple comorbidities and take a lot of medicines. Some patients might forget to take their medicine, whereas others might take an overdose. Thus, sharing a patient's complete medical information with pharmacists is also necessary. We began to collaborate with pharmacists in hospitals and at pharmacies in 2014. The pharmacist plays a great role in providing comprehensive community medical care. PMID:27477730

  5. The Application of a Contact Lens Sensor in Detecting 24-Hour Intraocular Pressure-Related Patterns

    PubMed Central

    2016-01-01

    Glaucoma is one of the leading causes of blindness worldwide. Recent studies suggest that intraocular pressure (IOP) fluctuations, peaks, and rhythm are important factors in disease advancement. Yet, current glaucoma management remains hinged on single IOP measurements during clinic hours. To overcome this limitation, 24-hour IOP monitoring devices have been employed and include self-tonometry, permanent IOP, and temporary IOP monitoring. This review discusses each IOP measuring strategy and focuses on the recently FDA-approved contact lens sensor (CLS). The CLS records IOP-related ocular patterns for 24 hours continuously. Using the CLS, IOP-related parameters have been found to be associated with the rate of visual field progression in primary open-angle glaucoma, disease progression in primary angle-closure glaucoma, and various clinical variables in ocular hypertension. The CLS has been used to quantify blink rate and limbal strain and measure the circadian rhythm in a variety of disease states including normal-tension glaucoma and thyroid eye disease. The effects of various IOP-lowering interventions were also characterized using the CLS. CLS provides a unique, safe, and well-tolerated way to study IOP-related patterns in a wide range of disease states. IOP-related patterns may help identify patients most at risk for disease progression and assist with the development of tailored treatments. PMID:27525110

  6. Comparison of 3 different anesthetic techniques on 24-hour recovery after otologic surgical procedures.

    PubMed

    Jellish, W S; Leonetti, J P; Fahey, K; Fury, P

    1999-03-01

    Intravenous propofol anesthesia is better than inhalational anesthesia for otologic surgery, but cost and intraoperative movement make this technique prohibitive. This study compares a propofol sandwich anesthetic with a total propofol or inhalational anesthetic for otologic surgery to determine which produces the best perioperative conditions and least expense. One hundred twenty patients undergoing ear surgery were randomly chosen to receive an anesthetic with either isoflurane (INHAL), total propofol (TPROP), or propofol used in conjunction with isoflurane (PSAND). Postoperative wakeup and the incidence and severity of nausea, vomiting, and pain were compared among groups. Antiemetic administration and discharge times from recovery and the hospital were also compared. The groups were similar, but anesthesia times were longer in the INHAL group. Emergence from anesthesia after PSAND or TPROP was more rapid than after INHAL. Recovery during the next 24 hours was associated with less nausea and vomiting with PSAND than with INHAL. The cost of the PSAND anesthetic was similar to that of INHAL, and both were less than TPROP. PSAND anesthesia may be similar to TPROP and better than INHAL for otologic procedures. PSAND was less expensive than TPROP and produced a similar recovery profile and antiemetic effect in the 24-hour period after surgery. PMID:10064647

  7. Regional Neurodegeneration and Gliosis Are Amplified by Mild Traumatic Brain Injury Repeated at 24-Hour Intervals

    PubMed Central

    Bolton, Amanda Nicholle; Saatman, Kathryn Eileen

    2014-01-01

    Most traumatic brain injuries (TBIs) that occur every year are classified as ‘mild’. Individuals involved in high-risk activities may sustain multiple mild TBIs. We evaluated the acute physiological and histopathological consequences of mild TBI in a mouse model, comparing sham injury, single impact, or 5 impacts at a 24- or 48-hour inter-injury interval. A single closed skull impact resulted in bilateral gliosis in the hippocampus and entorhinal cortex that was proportional to impact depth. Midline impact, at a depth just above the threshold to induce transient unconsciousness, produced occasional axonal injury and degenerating neurons accompanied by astrogliosis in the entorhinal cortex and cerebellum. Mild TBI repeated every 24 hours resulted in bilateral hemorrhagic lesions in the entorhinal cortex along with significantly increased neurodegeneration and microglial activation despite diminished durations of apnea and unconsciousness with subsequent impacts. Astrogliosis and diffusely distributed axonal injury were also observed bilaterally in the cerebellum and the brainstem. When the interval between mild TBIs was increased to 48 hours, the pathological consequences were comparable to a single TBI. Together, these data suggest that in mice the brain remains at increased risk for damage for 24 hours after mild TBI despite reduced acute physiological responses to subsequent mild impacts. PMID:25232942

  8. Physician-pharmacist co-management and 24-hour blood pressure control.

    PubMed

    Chen, Ziqian; Ernst, Michael E; Ardery, Gail; Xu, Yinghui; Carter, Barry L

    2013-05-01

    The objectives of this study were to compare indices of 24-hour blood pressure (BP) following a physician-pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications. This was a secondary analysis of a prospective, cluster-randomized clinical trial conducted in 6 family medicine clinics randomized to co-managed (n=3 clinics, 176 patients) or control (n=3 clinics, 198 patients) groups. Mean ambulatory systolic BP (SBP) was significantly lower in the co-managed vs the control group: daytime BP 122.8 mm Hg vs 134.4 mm Hg (P<.001); nighttime SBP 114.8 mm Hg vs 123.7 mm Hg (P<.001); and 24-hour SBP 120.4 mm Hg vs 131.8 mm Hg (P<.001), respectively. Significantly more drug changes were made in the co-managed than in the control group (2.7 vs 1.1 changes per patient, P<.001), and there was greater diuretic use in co-managed patients (79.6% vs 62.6%, P<.001). Ambulatory BPs were significantly lower for the patients who had a diuretic added during the first month compared with those who never had a diuretic added (P<.01). Physician-pharmacist co-management significantly improved ambulatory BP compared with the control group. Antihypertensive drug therapy was intensified much more for patients in the co-managed group. PMID:23614849

  9. Sleep in healthy elderly subjects: a 24-hour ambulatory polysomnographic study.

    PubMed

    Gigli, G L; Placidi, F; Diomedi, M; Maschio, M; Silvestri, G; Scalise, A; Marciani, M G

    1996-04-01

    It is still debated whether the deterioration of the sleep pattern, frequently reported by elderly subjects, is due only to aging per se. Other factors associated with aging or modifications of biological rhythms could also be involved. Elderly subjects frequently complain of daytime sleepiness, but it is not clear whether this actually represents a return to a polyphasic structure of sleep, or only a consequence of a disturbed night sleep. Ten healthy, independent and active elderly subjects (age > 72 years) were elevated by means of 24-hour ambulatory polysomnography. Findings of nocturnal sleep were compared with sleep of the same group in the 24-hour period and with sleep of young healthy controls. We observed a fragmentation of nocturnal sleep, but a fairly good representation of stages and a preservation of cyclicity. Except for three cases, with early or late times of sleep onset and wake-up, sleep disruption did not seem to be related to modification of circadian rhythms. Only three subjects presented undesired daytime naps, whereas the others either did not show daytime sleep at all, or were used to having their siesta after lunch since their young adulthood. In normal aging, daytime sleep does not constitute a social problem. Ambulatory polysomnography is a valid alternative to laboratory recordings in the identification of daytime sleep. PMID:8734563

  10. Deviation of innate circadian period from 24 hours reduces longevity in mice

    PubMed Central

    Libert, Sergiy; Bonkowski, Michael S.; Pointer, Kelli; Pletcher, Scott D.; Guarente, Leonard

    2012-01-01

    Summary The variation of individual lifespans, even in highly inbred cohorts of animals and under strictly controlled environmental conditions, is substantial and not well understood. This variation in part could be due to epigenetic variation, which later affects the animal’s physiology and ultimately longevity. Identification of the physiological properties that impact health and lifespan is crucial for longevity research and the development of anti-aging therapies. Here we measured individual circadian and metabolic characteristics in a cohort of inbred F1 hybrid mice and correlated these parameters to their lifespans. We found that mice with innate circadian periods close to 24 hours (revealed during 30 days of housing in total darkness) enjoyed nearly 20% longer lifespans than their littermates, which had shorter or longer innate circadian periods. These findings show that maintenance of a 24 hour intrinsic circadian period is a positive predictor of longevity. Our data suggest that circadian period may be used to predict individual longevity and that processes that control innate circadian period affect aging. PMID:22702406

  11. The Application of a Contact Lens Sensor in Detecting 24-Hour Intraocular Pressure-Related Patterns.

    PubMed

    Xu, Sarah C; Gauthier, Angela C; Liu, Ji

    2016-01-01

    Glaucoma is one of the leading causes of blindness worldwide. Recent studies suggest that intraocular pressure (IOP) fluctuations, peaks, and rhythm are important factors in disease advancement. Yet, current glaucoma management remains hinged on single IOP measurements during clinic hours. To overcome this limitation, 24-hour IOP monitoring devices have been employed and include self-tonometry, permanent IOP, and temporary IOP monitoring. This review discusses each IOP measuring strategy and focuses on the recently FDA-approved contact lens sensor (CLS). The CLS records IOP-related ocular patterns for 24 hours continuously. Using the CLS, IOP-related parameters have been found to be associated with the rate of visual field progression in primary open-angle glaucoma, disease progression in primary angle-closure glaucoma, and various clinical variables in ocular hypertension. The CLS has been used to quantify blink rate and limbal strain and measure the circadian rhythm in a variety of disease states including normal-tension glaucoma and thyroid eye disease. The effects of various IOP-lowering interventions were also characterized using the CLS. CLS provides a unique, safe, and well-tolerated way to study IOP-related patterns in a wide range of disease states. IOP-related patterns may help identify patients most at risk for disease progression and assist with the development of tailored treatments. PMID:27525110

  12. A Compute Perspective: Delivering Decision Support Products in 24 Hours from the Airborne Snow Observatory

    NASA Astrophysics Data System (ADS)

    Ramirez, P.; Mattmann, C. A.; Painter, T. H.; Seidel, F. C.; Trangsrud, A.; Hart, A. F.; Goodale, C. E.; Boardman, J. W.; Heneghan, C.; Verma, R.; Khudikyan, S.; Boustani, M.; Zimdars, P. A.; Horn, J.; Neely, S.

    2013-12-01

    The JPL Airborne Snow Observatory (ASO) must process 100s of GB of raw data to 100s of Terabytes of derived data in 24 hour Near Real Time (NRT) latency in a geographically distributed mobile compute and data-intensive processing setting. ASO provides meaningful information to water resource managers in the Western US letting them know how much water to maintain; or release, and what the prospectus of the current snow season is in the Sierra Nevadas. Providing decision support products processed from airborne data in a 24 hour timeframe is an emergent field and required the team to develop a novel solution as this process is typically done over months. We've constructed a system that combines Apache OODT; with Apache Tika; with the Interactive Data Analysis (IDL)/ENVI programming environment to rapidly and unobtrusively generate, distribute and archive ASO data as soon as the plane lands near Mammoth Lakes, CA. Our system is flexible, underwent several redeployments and reconfigurations, and delivered this critical information to stakeholders during the recent "Snow On" campaign March 2013 - June 2013. This talk will take you through a day in the life of the compute team from data acquisition, delivery, processing, and dissemination. Within this context, we will discuss the architecture of ASO; the open source software we used; the data we stored; and how it was delivered to its users. Moreover we will discuss the logistics, system engineering, and staffing that went into the developing, deployment, and operation of the mobile compute system.

  13. [Compassionate care and the nursing home's charter].

    PubMed

    Poivet, Valérie

    2016-01-01

    The creation of a nursing home for dependent elderly people, disabled people or those with dementia provided an opportunity to reflect on the institute's charter. The main objective was to create a place in which residents and professionals feel good. An inter-professional collaborative approach focusing on the needs and aptitudes of the residents favoured the creation of an ideal climate. Thanks to the commitment of all concerned, the objectives have been achieved. PMID:27173631

  14. The meaning of receiving help from home nursing care.

    PubMed

    Moe, Aud; Hellzen, Ove; Enmarker, Ingela

    2013-11-01

    The aim of this study was to illuminate the meaning of receiving help from home nursing care for the chronically ill, elderly persons living in their homes. The study was carried out in Norway. Data were collected by narrative interviews and analysed by phenomenological hermeneutic interpretations. Receiving help from home nursing care sometimes meant 'Being ill and dependent on help'. Other times it meant 'Being at the mercy of help'. It could also mean 'Feeling inferior as a human being'. Sometimes help was given by nurses who were respectful and proficient at caring for an elderly person, while at other times nurses seemed to be incompetent and worked with a paternalistic attitude without respect for privacy. Receiving help also meant elderly persons wanted to be regarded and approached as equal human beings, supported in the courage to meet challenges in life. PMID:23625732

  15. What pediatric home care offers the nurse.

    PubMed

    Peirson, G S

    1993-01-01

    Pammy had never been home in her 16 months of life. She'd never been in a car seat, seen her sister go off to school, or sat outside in her stroller. Today was the first day of a new life. While her Dad finished putting the crib together and the respiratory therapist arrived with the missing ventilator connector, her mother and her nurse Judy were accompanying her in the ambulance home. Soon her tube-feeding bag was hanging on a hook next to the "Welcome Home, Pammy" sign that a neighbor had made on his computer, and her four-year-old brother was building a runway under the nurse's feet. The back-up ventilator filled a quarter of the small living room, and the tubing, suction catheters, vent parts, formula, and water bottles filled the closet in Pammy's room--large enough because Mom and Dad had moved out of the master bedroom. Judy had helped Pam's mother set up the room a week ago and already had a sense of her concerns, the four-year-old's busyness, and the irregular schedule that the father worked. This would be an enjoyable, but challenging experience. PMID:8295516

  16. Administration of care to older patients in transition from hospital to home care services: home nursing leaders’ experiences

    PubMed Central

    Dale, Bjørg; Hvalvik, Sigrun

    2013-01-01

    Background Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. Methods A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach. Results Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture. Conclusion To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the

  17. Prediction of Advisability of Returning Home Using the Home Care Score.

    PubMed

    Matsugi, Akiyoshi; Tani, Keisuke; Tamaru, Yoshiki; Yoshioka, Nami; Yamashita, Akira; Mori, Nobuhiko; Oku, Kosuke; Ikeda, Masashi; Nagano, Kiyoshi

    2015-01-01

    Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care. PMID:26491568

  18. Prediction of Advisability of Returning Home Using the Home Care Score

    PubMed Central

    Matsugi, Akiyoshi; Tani, Keisuke; Tamaru, Yoshiki; Yoshioka, Nami; Yamashita, Akira; Mori, Nobuhiko; Oku, Kosuke; Ikeda, Masashi; Nagano, Kiyoshi

    2015-01-01

    Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care. PMID:26491568

  19. SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

    PubMed

    Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

    2016-01-01

    The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction. PMID:26938182

  20. Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

    ERIC Educational Resources Information Center

    Davitt, Joan K.

    2014-01-01

    Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

  1. [Scale development of job stress for home care nurses].

    PubMed

    Hong, Jeong-Sook; Lee, Ga-Eon

    2004-10-01

    The purpose of this study was to develop a job stress scale for hospital-based home care nurses in Korea. The process was construction of the conceptual framework, development of the preliminary items, verification of the content validity, item analysis and test of the reliability. The preliminary items were based on literature review and in-depth interviews with home care nurses. As a result, eight categories and sixty items were selected. These were reviewed by seven specialists for content validity and finally fifty one items were chosen. Data was collected from 180 home care nurses who were engaged in 87 hospitals from August to September 2003. The result of item analysis one was excepted. The final item count was 50. Categories were as follows: overload work (8 items), lack of specialized knowledge and technique (5 items), ethical dilemma (4 items), role conflict (5 items), interpersonal relationships (6 items), visiting home environment (9 items), driving conditions (4 items) and lack of administrative support (9 items), The reliability of the scale by Cronbach's alpha was .948 and the domain's reliability ranged from .649 to .841. The result of this study could be used to measure the job stress of home care nurses. However, for further validity and reliability, repeated studies will be necessary. PMID:15613845

  2. Acute respiratory distress induced by repeated saline lavage provides stable experimental conditions for 24 hours in pigs.

    PubMed

    Muellenbach, Ralf M; Kredel, Markus; Zollhoefer, Bernd; Bernd, Zollhoefer; Johannes, Amelie; Kuestermann, Julian; Schuster, Frank; Schwemmer, Ulrich; Wurmb, Thomas; Wunder, Christian; Roewer, Norbert; Brederlau, Jörg

    2009-04-01

    Surfactant depletion is most often used to study acute respiratory failure in animal models. Because model stability is often criticized, the authors tested the following hypotheses: Repeated pulmonary lavage with normal saline provides stable experimental conditions for 24 hours with a PaO2/FiO2 ratio < 300 mm Hg. Lung injury was induced by bilateral pulmonary lavages in 8 female pigs (51.5 +/- 4.8 kg). The animals were ventilated for 24 hours (PEEP: 5 cm H2O; tidal volume: 6 mL/kg; respiratory rate: 30/min). After 24 hours the animals were euthanized. For histopathology slides from all pulmonary lobes were obtained. Supernatant of the bronchoalveolar fluid collected before induction of acute respiratory distress syndrome (ARDS) and after 24 hours was analyzed. A total of 19 +/- 6 lavages were needed to induce ARDS. PaO2/FiO2 ratio and pulmonary shunt fraction remained significantly deteriorated compared to baseline values after 24 hours (P < .01). Slight to moderate histopathologic changes were detected. Significant increases of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 were observed after 24 hours (P < .01). The presented surfactant depletion-based lung injury model was associated with increased pulmonary inflammation and fulfilled the criteria of acute ling injury (ALI) for 24 hours. PMID:19337905

  3. Troubling gifts of care: vulnerable persons and threatening exchanges in Chicago's home care industry.

    PubMed

    Buch, Elana D

    2014-12-01

    By tracing the transformations of troubling exchanges in paid home care, this article examines how differently positioned individuals strive to build caring relations within potentially restrictive regimes of care. In paid home care in Chicago, older adults and their workers regularly participate in exchanges of money, time, and material goods. These gifts play a crucial role in building good care relationships that sustain participants' moral personhood. Amid widespread concern about vulnerable elders, home care agencies compete in a crowded marketplace by prohibiting these exchanges, even as they depend on them to strengthen relationships. Supervisors thus exercise discretion, sometimes reclassifying gift exchanges as punishable thefts. In this context, the commodification of care did not lead to the actual elimination of gift relations, but rather transformed gift relations into a suspicious and troublesome source of value. PMID:25331658

  4. Troubling Gifts of Care: Vulnerable Persons and Threatening Exchanges in Chicago’s Home Care Industry

    PubMed Central

    Buch, Elana

    2015-01-01

    By tracing the transformations of troubling exchanges in paid home care, this article examines how differently positioned individuals strive to build caring relations within potentially restrictive regimes of care. In paid home care in Chicago, older adults and their workers regularly participate in exchanges of money, time, and material goods. These gifts play a crucial role in building good care relationships that sustain participants’ moral personhood. Amid widespread concern about vulnerable elders, home care agencies compete in a crowded marketplace by prohibiting these exchanges, even as they depend on them to strengthen relationships. Supervisors thus exercise discretion, sometimes reclassifying gift exchanges as punishable thefts. In this context, the commodification of care did not lead to the actual elimination of gift relations, but rather transformed gift relations into a suspicious and troublesome source of value. PMID:25331658

  5. Association between Sleep Duration and 24-Hour Urine Free Cortisol in the MrOS Sleep Study

    PubMed Central

    Rao, Madhu N.; Blackwell, Terri; Redline, Susan; Punjabi, Naresh M.; Barrett-Connor, Elizabeth; Neylan, Thomas C.; Stone, Katie L.

    2013-01-01

    Context Short sleep duration is associated with adverse health outcomes, but the mechanisms involved are unknown. It has been postulated that short sleep duration may elevate cortisol levels, but studies have had conflicting results. It is unclear whether these differing findings may be due to methodological issues, such as assessment of sleep duration. Specifically, objective versus subjective methods of measuring habitual sleep duration may account for the conflicting results found in epidemiological studies. Objective Our goal was to determine whether habitual sleep duration, measured objectively (by actigraphy) and subjectively (by self-report), was associated with 24-hour urine free cortisol (UFC), a measure of integrated cortisol secretion. Our secondary goal was to determine whether slow wave sleep (SWS, determined by polysomnography) was associated with 24-hour UFC. Design/Setting Cross sectional study of community dwelling older men. Patients/Participants 325 men (mean age = 76.6 years, SD = 5.5) from the Portland site of the MrOS Sleep Study, who underwent 24-hour urine collection, polysomnography, actigraphy and sleep questionnaire. Primary Outcome 24-hour UFC. Results In this study of community dwelling older men, self-reported sleep duration was inversely related to 24-hour UFC levels. Participants reporting <5 hours of habitual sleep had an adjusted mean 24-hour UFC of 29.8 ug, compared to 28.0 ug in participants reporting >5 to <8 hours of sleep 25.5 ug in those reporting >8 hours of habitual sleep. However, sleep duration determined by actigraphy was not associated with 24-hour UFC in either univariable or multivariable regression models. SWS was not associated with 24-hour UFC. Conclusion Objectively measured (i.e., actigraphic) sleep duration is not associated with 24-hour UFC in these community dwelling older men. This finding, together with prior studies, suggests that elevated levels of integrated cortisol secretion is not the

  6. Occupational health of home care aides: results of the safe home care survey

    PubMed Central

    Quinn, Margaret M; Markkanen, Pia K; Galligan, Catherine J; Sama, Susan R; Kriebel, David; Gore, Rebecca J; Brouillette, Natalie M; Okyere, Daniel; Sun, Chuan; Punnett, Laura; Laramie, Angela K; Davis, Letitia

    2016-01-01

    Objectives In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. Methods HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides’ OSH experiences. Results The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence. Conclusions The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting. PMID:26209318

  7. Longitudinal Changes in the Amount of Informal Care among Publicly Paid Home Care Recipients

    ERIC Educational Resources Information Center

    Li, Lydia W.

    2005-01-01

    Purpose: This study examined how the amount of informal care received by disabled elders changes when they are receiving publicly paid home care, and whether formal service use, disability, caregiving arrangements, and demographic characteristics of older adults predict changes in the amount of informal care. Design and Methods: Hierarchical…

  8. At-home options. Enhancing care for AIDS patients.

    PubMed

    Sibley, M R

    1993-05-01

    Mark is a 45-year-old man with advanced AIDS. His care partner, Gary, has a full-time job in the design industry. A home care aide visits Mark five days a week for 10 hours at a time to provide personal care while Gary is at work. A visiting nurse sees Mark weekly and has taught Gary how to prepare Mark's ganciclovir infusion. Every six weeks Mark meets with a nutritionist, who evaluates his dietary status and advises Gary on purchasing high-calorie foods for Mark. In May Gary must attend a conference out of town and he is worried:who will care for Mark for those three days? Gary calls the At Home Options (AHOP) nurse and explains the situation. She arranges for nighttime nursing coverage for those three days, and ensures that Mark's home care aide can stay for the weekend. Gary is able to attend his conference and concentrate on his work, secure in the knowledge that Mark will be well cared for and that scheduled respite care, although not a benefit with traditional insurance, is covered through the AHOP program. PMID:10125243

  9. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  10. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  11. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  12. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  13. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... increase the total number of state home nursing home and domiciliary beds in that state beyond the...

  14. [Conceptualizations on care for persons with dementia in nursing homes].

    PubMed

    Rodríguez-Martín, Beatriz; Martínez-Andrés, María; Notario-Pacheco, Blanca; Martínez-Vizcaíno, Vicente

    2016-01-01

    Despite the importance of family perceptions when analyzing care for the elderly in nursing homes, little is said about this aspect. This study aims to identify preferences and areas for improvement in care for persons with dementia, as perceived by families. A qualitative study was performed, based on Grounded Theory, combining two data collection techniques (participant observation and in-depth interviews) in a theoretical sample of institutionalized persons with dementia. The ideal model of care for persons with dementia, as perceived by participants, was based on specialized and individualized care and family participation in the care provided. Areas for improvement included aspects pertaining to specialized training in geriatrics, human relations, and the culture of institutional work. Faced with the current trend towards technification of care, families are now demanding personalized, small-scale care in which they form an active part of the team. PMID:27074217

  15. Designing the future: care closer to home.

    PubMed

    2014-03-01

    According to its architects, Maber, the Corby Urgent Care Centre is "the first of its kind, providing a combination of primary and emergency care facilities in a community-focused building that patients and staff agree is friendly, welcoming, and 'unlike a hospital'." Since it opened in February 2013, the Centre has almost doubled its visitor targets, and helped take NHS Corby CCG into the top 10 per cent of performers in England for (lower) A&E attendance. The architects report. PMID:24697092

  16. Pattern of 24 hour intragastric acidity in active duodenal ulcer disease and in healthy controls.

    PubMed Central

    Merki, H S; Fimmel, C J; Walt, R P; Harre, K; Röhmel, J; Witzel, L

    1988-01-01

    Twenty four hour intragastric acidity was measured by continuous recording using intragastric combined glass electrodes in 46 duodenal ulcer patients within 48 hours of endoscopic confirmation of active ulceration. Acidity during predefined time periods was compared with that measured in 40 healthy controls without gastrointestinal disease: it was significantly higher in duodenal ulcer patients at all times, but 25% of ulcer patients had median 24 hour acidity within the interquartile range of the normal group. During the evening (18,00 to 22,00 h) ulcer patients had considerable acidity with a median of 39.8 (63.1-31.6) mmol/l (interquartile range) compared with 5.6 (22.3-0.4) mmol/l of controls. It is suggested that antisecretory treatment be directed to decrease this period of unbuffered acidity, as well as during the night, which is presently considered of prime importance. PMID:3209116

  17. The Effects of 24-hour Sleep Deprivation on the Exploration-Exploitation Trade-off

    PubMed Central

    Glass, Brian D.; Maddox, W. Todd; Bowen, Christopher; Savarie, Zachary R.; Matthews, Michael D.; Markman, Arthur B.; Schnyer, David M.

    2010-01-01

    Sleep deprivation has a complex set of neurological effects that go beyond a mere slowing of mental processes. While cognitive and perceptual impairments in sleep deprived individuals are widespread, some abilities remain intact. In an effort to characterize these effects, some have suggested an impairment of complex decision making ability despite intact ability to follow simple rules. To examine this trade-off, 24-hour total sleep deprived individuals performed two versions of a resource acquisition foraging task, one in which exploration is optimal (to succeed, abandon low value, high saliency options) and another in which exploitation is optimal (to succeed, refrain from switching between options). Sleep deprived subjects exhibited decreased performance on the exploitation task compared to non-sleep deprived controls, yet both groups exhibited increased performance on the exploratory task. These results speak to previous neuropsychological work on cognitive control. PMID:21686036

  18. After 24-hour scrub, another tower rollback for the Boeing Delta II rocket carrying Stardust

    NASA Technical Reports Server (NTRS)

    1999-01-01

    As tower rollback begins, the Boeing Delta II rocket carrying the Stardust spacecraft waits on Launch Pad 17-A, Cape Canaveral Air Station, for the second launch attempt at 4:04 p.m. EST. The original launch was scrubbed on Feb. 6 for 24 hours. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  19. Tasimelteon: A Review in Non-24-Hour Sleep-Wake Disorder in Totally Blind Individuals.

    PubMed

    Keating, Gillian M

    2016-05-01

    Tasimelteon (Hetlioz(®)) is a dual melatonin receptor agonist indicated for the treatment of Non-24-Hour Sleep-Wake Disorder (Non-24) (free-running disorder). In two randomized, double-masked, multicentre, phase III trials, totally blind individuals with Non-24 who received oral tasimelteon 20 mg once nightly were significantly more likely than those receiving placebo to entrain the circadian pacemaker (the SET trial) and maintain entrainment (the RESET trial). Sleep/wake parameters and functioning were also improved with tasimelteon. Oral tasimelteon was generally well tolerated in totally blind patients with Non-24. In conclusion, tasimelteon is a useful drug for the treatment of Non-24 in totally blind individuals. PMID:27003694

  20. Setting Spacecraft Maximum Allowable Concentrations for 1 hour or 24 hour contingency exposures to airborne chemicals

    NASA Technical Reports Server (NTRS)

    Garcia, Hector D.; Limero, Thomas F.; James, John T.

    1992-01-01

    Since the early years of the manned space program, NASA has developed and used exposure limits called Spacecraft Maximum Allowable Concentrations (SMACs) to help protect astronauts from airborne toxicants. Most of these SMACS are based on an exposure duration of 7 days, since this is the duration of a 'typical' mission. A set of 'contingency SMACs' is also being developed for scenarios involving brief (1-hour or 24- hour) exposures to relatively high levels of airborne toxicants from event-related 'contingency' releases of contaminants. The emergency nature of contingency exposures dictates the use of different criteria for setting exposure limits. The NASA JSC Toxicology Group recently began a program to document the rationales used to set new SMACs and plans to review the older, 7-day SMACs. In cooperation with the National Research Council's Committee on Toxicology, a standard procedure has been developed for researching, setting, and documenting SMAC values.

  1. Home care of children and youth with complex health care needs and technology dependencies.

    PubMed

    Elias, Ellen Roy; Murphy, Nancy A

    2012-05-01

    Children and youth with complex medical issues, especially those with technology dependencies, experience frequent and often lengthy hospitalizations. Hospital discharges for these children can be a complicated process that requires a deliberate, multistep approach. In addition to successful discharges to home, it is essential that pediatric providers develop and implement an interdisciplinary and coordinated plan of care that addresses the child's ongoing health care needs. The goal is to ensure that each child remains healthy, thrives, and obtains optimal medical home and developmental supports that promote ongoing care at home and minimize recurrent hospitalizations. This clinical report presents an approach to discharging the child with complex medical needs with technology dependencies from hospital to home and then continually addressing the needs of the child and family in the home environment. PMID:22547780

  2. Developing competencies for end-of-life care in care homes.

    PubMed

    Lansdell, John; Mahoney, Mary

    2011-03-01

    The English Department of Health's End of Life Care Strategy suggests that suboptimal end-of-life care in care homes results from inadequate training of staff at all levels. This article reports on one hospice's pilot project that addressed the question, 'Does a competency development package provide a way in which the hospice can support improved end-of-life care in care homes in a sustainable way through education?' The project followed the Medical Research Council framework for the development and evaluation of complex interventions. Competency domains were identified and statements written with participating care homes. A five-day education course was delivered to support the competencies and an assessment workshop explored how the framework could be integrated into existing appraisal systems. At the end of the project, the care homes identified aspects of education and support that would ensure the competencies became fully embedded. From the conclusions drawn, a collaborative model of competency development, education, and assessment is proposed to enable a measurable and sustainable improvement in end-of-life care in the care home setting. PMID:21471911

  3. The association of knowledge, attitudes and behaviours related to salt with 24-hour urinary sodium excretion

    PubMed Central

    2014-01-01

    Aim Salt reduction efforts usually have a strong focus on consumer education. Understanding the association between salt consumption levels and knowledge, attitudes and behaviours towards salt should provide insight into the likely effectiveness of education-based programs. Methods A single 24-hour urine sample and a questionnaire describing knowledge, attitudes and behaviours was obtained from 306 randomly selected participants and 113 volunteers from a regional town in Australia. Results Mean age of all participants was 55 years (range 20–88), 55% were women and mean 24-hour urinary salt excretion was 8.8(3.6) g/d. There was no difference in salt excretion between the randomly selected and volunteer sample. Virtually all participants (95%) identified that a diet high in salt can cause serious health problems with the majority of participants (81%) linking a high salt diet to raised blood pressure. There was no difference in salt excretion between those who did 8.7(2.1) g/d and did not 7.5(3.3) g/d identify that a diet high in salt causes high blood pressure (p = 0.1). Nor was there a difference between individuals who believed they consumed “too much” 8.9(3.3) g/d “just the right amount” 8.4(2.6) g/d or “too little salt” 9.1(3.7) g/d (p = 0.2). Likewise, individuals who indicated that lowering their salt intake was important 8.5(2.9) g/d vs. not important 8.8(2.4) g/d did not have different consumption levels (p = 0.4). Conclusion The absence of a clear association between knowledge, attitudes and behaviours towards salt and actual salt consumption suggests that interventions focused on knowledge, attitudes and behaviours alone may be of limited efficacy. PMID:24708561

  4. Fasting for 24 Hours Heightens Reward from Food and Food-Related Cues

    PubMed Central

    Cameron, Jameason D.; Goldfield, Gary S.; Finlayson, Graham; Blundell, John E.; Doucet, Éric

    2014-01-01

    Introduction We examined the impact of a 24 hour complete fast (vs. fed state) on two measures of food reward: 1) ‘wanting’, as measured by response to food images and by the relative-reinforcing value of food (RRV), and 2) ‘liking’, as measured by response to food images and the hedonic evaluation of foods consumed. Methods Utilizing a randomized crossover design, 15 subjects (9 male; 6 female) aged 28.6±4.5 yrs with body mass index 25.3±1.4 kg/m2 were randomized and counterbalanced to normal feeding (FED) and 24-hour fast (FASTED) conditions. Trait characteristics were measured with the Three Factor Eating Questionnaire. Two computer tasks measured food reward: 1) RRV progressive ratio task, 2) explicit ‘liking’ and ‘wanting’ (Leeds Food Preference Questionnaire, LFPQ). Also measured were ad libitum energy intake (EI; buffet) and food ‘liking’ (visual analogue scale) of personalized stimuli. Results There were no significant anthropometric changes between conditions. Appetite scores, hedonic ratings of ‘liking’, and ad libitum EI all significantly increased under the FASTED condition (p<0.05). Under the FASTED condition there were significant increases in the RRV of snack foods; similarly, explicit ‘wanting’ and ‘liking’ significantly increased for all food categories. ‘Liking’ of sweet foods remained high across-meals under FASTED, but savory foods decreased in hedonic saliency. Conclusion Relative to a fed state, we observed an increase in hedonic ratings of food, the rewarding value of food, and food intake after a 24 hr fast. Alliesthesia to food and food cues is suggested by heightened hedonic ratings under the FASTED condition relative to FED. PMID:24454949

  5. A 24-Hour Study of the Hypothalamo-Pituitary Axes in Huntington’s Disease

    PubMed Central

    Nambron, Rajasree; Costelloe, Seán J.; Martin, Nicholas G.; Hill, Nathan R.; Frost, Chris; Watt, Hilary C.; Hindmarsh, Peter; Björkqvist, Maria; Warner, Thomas T.

    2015-01-01

    Background Huntington’s disease is an inherited neurodegenerative disorder characterised by motor, cognitive and psychiatric disturbances. Patients exhibit other symptoms including sleep and mood disturbances, muscle atrophy and weight loss which may be linked to hypothalamic pathology and dysfunction of hypothalamo-pituitary axes. Methods We studied neuroendocrine profiles of corticotropic, somatotropic and gonadotropic hypothalamo-pituitary axes hormones over a 24-hour period in controlled environment in 15 healthy controls, 14 premanifest and 13 stage II/III Huntington’s disease subjects. We also quantified fasting levels of vasopressin, oestradiol, testosterone, dehydroepiandrosterone sulphate, thyroid stimulating hormone, free triiodothyronine, free total thyroxine, prolactin, adrenaline and noradrenaline. Somatotropic axis hormones, growth hormone releasing hormone, insulin-like growth factor-1 and insulin-like factor binding protein-3 were quantified at 06:00 (fasting), 15:00 and 23:00. A battery of clinical tests, including neurological rating and function scales were performed. Results 24-hour concentrations of adrenocorticotropic hormone, cortisol, luteinizing hormone and follicle-stimulating hormone did not differ significantly between the Huntington’s disease group and controls. Daytime growth hormone secretion was similar in control and Huntington’s disease subjects. Stage II/III Huntington’s disease subjects had lower concentration of post-sleep growth hormone pulse and higher insulin-like growth factor-1:growth hormone ratio which did not reach significance. In Huntington’s disease subjects, baseline levels of hypothalamo-pituitary axis hormones measured did not significantly differ from those of healthy controls. Conclusions The relatively small subject group means that the study may not detect subtle perturbations in hormone concentrations. A targeted study of the somatotropic axis in larger cohorts may be warranted. However, the lack

  6. The effect of Operation 24 Hours on reducing collision in the City of Edmonton.

    PubMed

    Halim, Siana; Jiang, Heming

    2013-09-01

    In the City of Edmonton, in order to reduce the prevalence of collisions, the Operation 24 Hours program (OPS24) was developed by using existing police and transportation services resources. The program uses traditional manned police speed enforcement method, which are supplemented by traffic safety messages displayed on permanent and mobile dynamic messaging signs (DMS). In this paper, collision data analysis was performed by looking at the daily number of collisions from 2008 to 2011 that covers 28 Operation 24 Hours (OPS24) events. The objective of the collision data analysis is to analyze if there is a reduction in collision frequencies after OPS24 was held and examined how long the collision reduction effect last. Weather factors such as temperature, thickness of snow, and wind gust have been considered by many as a great influence on collision occurrences, especially in a city with long and cold winter such as Edmonton. Therefore, collision modeling was performed by considering these external weather factors. To analyze the linear and periodic trend of different collision types (injury, fatal, and property damage only (PDO)) and examine the influence of weather factors on collisions, negative binomial time series model that accounts for seasonality and weather factors was used to model daily collision data. The modeling also considered collision proportion to account for missing traffic volume data; the Gaussian time series model that accounts for seasonality and weather factors was used to model collision proportion. To estimate the collision trend and test for changes in collision levels before/after OPS24, interrupted time series model with segmented regression was used. While for estimating how long the effect of the OPS24 last, change point method was applied. PMID:23727551

  7. Effects of exenatide and liraglutide on 24-hour glucose fluctuations in type 2 diabetes.

    PubMed

    Nagakura, Jo; Yamakawa, Tadashi; Taguri, Masataka; Tsuchiya, Hirohisa; Shigematsu, Erina; Suzuki, Jun; Morita, Satoshi; Kadonosono, Kazuaki; Terauchi, Yasuo

    2016-03-31

    We evaluated the influence of short-term treatment with exenatide twice daily or liraglutide once daily on daily blood glucose fluctuations in 40 patients with type 2 diabetes inadequately controlled by sulfonylureas. The patients in a multicenter, open-label trial were randomly assigned to receive add-on exenatide (10 μg/day, n = 21) or add-on liraglutide (0.3-0.9 mg/day, n = 19), and underwent 24-hour continuous subcutaneous glucose monitoring. There was no significant between-group difference in glucose fluctuations during the day, as assessed by calculating mean amplitude of glycemic excursion (MAGE) and standard deviation (SD). However, the mean blood glucose levels at 3 hours after breakfast and dinner were significantly lower in the exenatide group than the liraglutide group (breakfast: 127.3 ± 24.1 vs. 153.4 ± 28.7 mg/dL; p = 0.006, dinner: 108.7 ± 17.3 vs. 141.9 ± 24.2 mg/dL; p < 0.001). In contrast, mean blood glucose levels and their SD were significantly lower between 0000 h and 0600 h in the liraglutide group than the exenatide group (average glucose: 126.9 ± 27.1 vs. 107.1 ± 24.0 mg/dL; p = 0.029, SD: 15.2 ± 10.5 vs. 8.7 ± 3.8; p = 0.020). Both groups had similar glucose fluctuations despite differences in 24-hour blood glucose profiles. Therefore, each of these agents may have advantages or disadvantages and should be selected according to the blood glucose profile of the patient. PMID:26743240

  8. Structuring payment to medical homes after the affordable care act.

    PubMed

    Edwards, Samuel T; Abrams, Melinda K; Baron, Richard J; Berenson, Robert A; Rich, Eugene C; Rosenthal, Gary E; Rosenthal, Meredith B; Landon, Bruce E

    2014-10-01

    The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings. PMID:24687292

  9. More Older Americans Cared for At Home

    MedlinePlus

    ... York City. He wasn't involved in the study. "Research has shown that 40 percent [of caregivers] spend 20 or more hours a week caring for an older relative -- that's half of a full-time job," Morrison said. Besides lost work and income, ...

  10. Medically Complex Home Care and Caregiver Strain

    ERIC Educational Resources Information Center

    Moorman, Sara M.; Macdonald, Cameron

    2013-01-01

    Purpose of the study: To examine (a) whether the content of caregiving tasks (i.e., nursing vs. personal care) contributes to variation in caregivers' strain and (b) whether the level of complexity of nursing tasks contributes to variation in strain among caregivers providing help with such tasks. Design and methods: The data came from the Cash…

  11. The "Unidentified Patient" in Home Health Care.

    ERIC Educational Resources Information Center

    Hamilton, Louise A.; Jones, Helen Carol

    Aging individuals are most often cared for by a spouse or middle-aged child, usually a daughter. As the aging population increases, as longevity increases along with the likelihood of chronic and disabling conditions, women will be facing many special problems related to their role as caregiver. Many women who are serving as caregivers to their…

  12. How to establish a perinatal home care program.

    PubMed

    Miller, T H

    1990-09-01

    Current clinical data indicates that despite advances in the obstetric and neonatal arenas, preterm birth and subsequent low birth weight infants continue to be born. Technology-based perinatal home care programs are the fastest growing segment of services available to high-risk pregnant women, recuperating post-partum women, and newborns. It is anticipated that these services will alter forever the traditional measures of care for high-risk pregnant women and newborns. PMID:10107048

  13. A Home Health Care System for Family Doctor

    NASA Astrophysics Data System (ADS)

    Hamabe, Ryuji; Taketa, Norihiro

    We propose a constitution technique of small-scale Home Health Care system for family doctor that has been developed by applying various API of JAVA. One function is vital data transmission which allows a family doctor to check the data of elderly persons with ease via Internet. Vital data is encrypted and transmitted for the purpose of security. The other function is telecommunication with voice and face image for care consulting.

  14. Leadership, staffing and quality of care in nursing homes

    PubMed Central

    2011-01-01

    Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is

  15. Pulsed lavage: promoting comfort and healing in home care.

    PubMed

    Morgan, D; Hoelscher, J

    2000-04-01

    The purpose of this study was to determine if hydrodebridement with pulsed lavage facilitates the removal of necrotic tissue, promotes healing, and increases comfort in the homebound patient. Home healthcare provides cost-effective care in the setting that is most conducive to healing. People want to be at home, yet many illnesses require services that cannot be obtained at home. Wound care sometimes falls into this category. Pulsed lavage has expanded treatment options for the homebound patient. Hydrodebridement with pulsed lavage is site specific, avoids cross contamination, and is less expensive than whirlpool therapy. It also may facilitate the removal of necrotic tissue and promote the formation of healthy granulation tissue. The authors performed a retrospective audit to gather data on 28 patients who received pulsed lavage treatments at home. A descriptive analysis of five variables that affect healing was undertaken including mobility/activity, nutritional status, cardiovascular/respiratory status, continence, and sensory perception. All of the clients in the sample achieved a clean, warm, moist wound bed, free of signs and symptoms of infection, absence of necrotic tissue, and the presence of granulation tissue to meet the definition of "ready for healing" as presented in the literature. The majority of clients experienced no pain. Although comorbid conditions required rehospitalization for 35.7% of the sample, the conditions did not interfere with healing. Hydrodebridement with pulsed lavage is a viable nontraumatic, noninvasive, site-specific treatment alternative for patients receiving care in the home. PMID:10788926

  16. Developing Initiatives for Home-Based Child Care: Current Research and Future Directions

    ERIC Educational Resources Information Center

    Porter, Toni; Paulsell, Diane

    2011-01-01

    Home-based child care accounts for a significant share of the child care supply in the United States, especially for infants and toddlers. A synthesis of the home-based care research literature and information about recent home-based care quality initiatives points to a critical need for more systematic efforts to develop and test quality…

  17. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  18. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  19. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  20. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  1. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...

  2. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    PubMed Central

    Phillips, Charles D.

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

  3. Theorizing accommodation in supportive home care for older people.

    PubMed

    Ceci, Christine; Purkis, Mary Ellen; Björnsdóttir, Kristin

    2013-01-01

    This paper examines the issue of what thinking is necessary in order to advance a notion of accommodation in the organization and provision of supportive home care for older people. Accommodation in this context is understood as responsiveness to the singularity of older adults, and we consider how this idea might be used to support opportunities for (independent) living for elders as they age and become frailer. To elaborate the question we draw on examples from our empirical work - ethnographic studies of home care practice undertaken in Canada and Iceland - and consider these examples in light of critical philosophical and social theory, particularly Agamben's (1993) work, The Coming Community. This is a relevant frame through which to consider the potential for the accommodation of the unique needs of older adults in home care because it helps us to problematize the systems through which care is accomplished and the current, dominant terms of relations between individuals and collectives. We argue that giving substance to a notion of accommodation contributes an important dimension to aligned ideas, such as patient-centeredness in care, by working to shift the intentionality of these practices. That is, accommodation, as an orientation to care practices, contests the organizational impulse to carry on in the usual way. PMID:23273554

  4. Hepatitis C therapy at home: a hospital and home care partnership.

    PubMed

    Jack, Kate; Barnett, Jenn; Holiday, Amanda; Heard, Greeba; Thomson, Brian

    Hepatitis C virus (HCV) is a significant public health threat in the UK, and is both underdiagnosed and undertreated. The treatment episode takes between 12 and 48 weeks. In the UK, HCV management is undertaken in secondary and tertiary centres. This does not meet the needs of all patients; they may have to travel long distances, incur travel costs, wait a long time to be seen and negotiate time off work while not divulging their illness. Providing care at home can increase patients' access to and acceptability of treatment, especially in areas remote from specialist centres. This paper describes the feasibility, safety and efficacy of treating HCV infected patients at home by a partnership between secondary care and an clinical home care company. The home care model had a significantly higher attendance rate than the clinic model. It allowed the trust to improve care at no extra cost. This model can optimise specialist nurses' time, allowing them to focus on patients with more complex needs. PMID:23752623

  5. Institutional and Home-Based Long-Term Care Alternatives: The 1965-85 Swedish Experience.

    ERIC Educational Resources Information Center

    Berg, Stig; And Others

    1988-01-01

    Discusses the Swedish experience in which the official old-age care policy has been to substitute home care for institutional care. Found some substitution of the two forms of long-term care which took place from 1965-75, but thereafter the use of long-term care institutions and home care remained stable or contracted. (Author/ABL)

  6. Staffing Subsidies and the Quality of Care in Nursing Homes

    PubMed Central

    Foster, Andrew D.; Lee, Yong Suk

    2015-01-01

    Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%. PMID:25814437

  7. Assisted Living Expansion and the Market for Nursing Home Care

    PubMed Central

    Grabowski, David C; Stevenson, David G; Cornell, Portia Y

    2012-01-01

    Objective To analyze the effect of market-level changes in assisted living supply on nursing home utilization and resident acuity. Data Sources Primary data on the supply of assisted living over time were collected from 13 states from 1993 through 2007 and merged with nursing home-level data from the Online Survey Certification and Reporting System and market-level information from the Area Resource File. Study Design Least squares regression specification incorporating market and time-fixed effects. Principal Findings A 10 percent increase in assisted living capacity led to a 1.4 percent decline in private-pay nursing home occupancy and a 0.2–0.6 percent increase in patient acuity. Conclusions Assisted living serves as a potential substitute for nursing home care for some healthier individuals with greater financial resources, suggesting implications for policy makers, providers, and consumers. PMID:22578039

  8. Predictors of mortality among elderly dependent home care patients

    PubMed Central

    2013-01-01

    Background The purpose of this study is to identify which variables –among those commonly available and used in the primary care setting– best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. Methods A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer’s characteristics, carer’s burden of care, health and social services received. Results 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1–2 OR = 2.94 (1.92-4.52); ulcers degree 3–4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. Conclusions Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care. PMID:23947599

  9. Implementing home care in Canada: four critical elements.

    PubMed

    Richardson, B

    2000-01-01

    While MacAdam proposes a "national approach to home care#8221; the obstacles to this are well known and substantial. They are the likely cost and the limitations of the federal government s role in healthcare. Building on MacAdam's assessment, this paper outlines four problems embedded in the various home-care service delivery models in Canada: the lack of factual client outcome information to support decision-making, the limited client choice of provider, the perverse incentive of fee for service and the bias against the for-profit provider. The paper proposes that the assessment, classification and measurement of outcomes for every recipient of home-care services be standardized using a proven assessment instrument, such as OASIS-B or MDS-HC, by healthcare professionals certified in its use. The resulting information would be captured in a regional database and available for analysis and research. CIHI would be contracted to manage a national database and to fund the training and certification of assessors. The paper proposes a new service delivery and funding model, utilizing standard client outcome information, different roles for regional health authorities and service providers, and a prospective payment mechanism replacing fee for service. A national home care program may be an elusive dream, but that shouldn't stop experimentation, evaluation and improvement. PMID:12811175

  10. Home Care for the Aged: A Fragile Partnership.

    ERIC Educational Resources Information Center

    Kaye, Lenard W.

    1985-01-01

    Examined the efforts of relatives, friends, and professional caregivers in serving the homebound elderly. Results indicate that although the informal support network was perceived to be the preferable source of most home care aid, formal intervention was seen as best for housekeeping functions, specialized duties, and repetitive tasks for the…

  11. Family Day Care: How to Provide it in Your Home.

    ERIC Educational Resources Information Center

    Squibb, Betsy

    Tips, recommendations, ideas, and background information are offered to providers of family day care. After a brief discussion of licensing and registration and a listing of learning activities for young children at home, additional learning activities and materials are described that are considered appropriate for infants, toddlers, preschool…

  12. Predictors of Home Based Long-Term Care Services.

    ERIC Educational Resources Information Center

    Luppens, Jean; And Others

    An attempt was made to determine predictors of service need, use, and outcome among chronically impaired adults and aged who were living in the community and using the home-based, long term care services of the Chronic Illness Center (CIC) of the Cuyahoga County Hospitals (Ohio). Randomly selected consumer service records (N=200) were coded for…

  13. Feds come knocking in search of home-care fraud.

    PubMed

    Burns, J

    1995-06-01

    Home care has become a target for federal investigators looking for ways to reduce the amount of money Medicare doles out to fraudulent providers. Companies and executives in the multibillion-dollar industry are facing charges ranging from filing bogus claims to money laundering. PMID:10142723

  14. The Ecological Context of In-Home Nonrelative Child Care.

    ERIC Educational Resources Information Center

    Monroe, Lisa; Dunn, Loraine

    1999-01-01

    Surveyed in-home child caregivers and employers about their child care environments. Found that the caregivers were mostly young, well-educated, hard-working, committed; typically, they showed child-related coursework in high school and were poorly compensated. Parents employing the caregivers were relatively affluent and satisfied with in-home…

  15. Nursing Home Care Quality: Insights from a Bayesian Network Approach

    ERIC Educational Resources Information Center

    Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

    2008-01-01

    Purpose: The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures…

  16. The ethics of using cameras in care homes.

    PubMed

    Fisk, Malcolm; Flórez-Revuelta, Francisco

    senior researcher, Digital Imaging Research There are concerns about how cameras in care homes might intrude on residents' and staff privacy but worries about resident abuse must be recognised. This article outlines an ethical way forward and calls for a rethink about cameras that focuses less on their ability to "see" and more on their use as data-gathering tools. PMID:27141719

  17. Social Support and the Receipt of Home Care Services.

    ERIC Educational Resources Information Center

    Chappell, Neena L.

    1985-01-01

    Compares differences between elderly who use formal home care services and those who do not. Data revealed users as less healthy and less active and as receiving more assistance from both formal and informal sources. Suggests that formal and informal services complement rather than substitute for one another. (NRB)

  18. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    PubMed Central

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2012-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486

  19. Assuring professional pastoral care for every nursing home resident.

    PubMed

    Knight, B

    1999-01-01

    Ministry to persons in nursing homes is built on two mandates: "... He has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim liberty to the captives, and release to the prisoners; ... to comfort all who mourn ..." (Isaiah 61:1-3). The federal government provides the second: "Quality of Life. A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life" (OBRA '87, Guidance to Surveyors in Long Term Care Facilities, Code of Federal Regulations, Health Care Financing Administration, 1995, section 483.15, F240). This article discusses both the religious and the U.S. political history of caring for the old and frail. It concludes by describing political efforts in one state to increase the quality of that care and pastoral efforts to support the nursing assistants in long-term care facilities. PMID:10387595

  20. Recruiting qualified home care aides: new candidate pools.

    PubMed

    Wilner, M A

    1999-04-01

    With the demographic surge of baby boomers and the number of women aged 25-45 projected to decline, the coming decades will see a shortage of workers to care for the elderly. Home care aide agencies will only be able to retain their competitive edge if they widen the pool of candidates from which they recruit and create an attractive and decent job. Creating a decent job with adequate pay, benefits, and support is a business strategy that will attract a wider range of workers, including those with minimal experience, and have positive ramifications for health care in the future--and now. PMID:10537510

  1. Problems faced by relatives caring for cancer patients at home.

    PubMed

    Tsigaroppoulos, Thomas; Mazaris, Evangelos; Chatzidarellis, Eleftherios; Skolarikos, Andreas; Varkarakis, Ioannis; Deliveliotis, Charalambos

    2009-02-01

    The care of patients suffering from advanced cancer is not limited in the hospital setting. It continues at home where the burden of care is borne by specific individuals. The aim of the present study was to survey and record the various problems faced by those who care for cancer patients at home. The study was conducted in our hospital during the summer of 2007. All participants completed, during a personal interview, a questionnaire which covered pathologic, social, psychological, spiritual/religious and financial problems. Seventy-six carers returned fully completed questionnaires. The most frequent problems reported were: anxiety regarding the patient's future (61.8%), troublesome symptoms such as pain (54%), increased economic burden-financial difficulty (51.3%), problems with patient's feeding (50%), unhappiness or depression (48,7%), emotional upset (47.4%), worsening of the patient's behaviour and personality (38.2%), difficulty of establishing a positive attitude regarding their current status (34.2%), transport to hospital (32.9%), assistance from the wider family circle (25%). Taking care of cancer patients at home creates several problems among carers. Many of them remain undetected. The acknowledgement and recognition of these problems by health-care professionals might contribute to finding solutions in order to assist the difficult task of these individuals. PMID:19187163

  2. Job satisfaction of home care assistants related to managerial practices.

    PubMed

    Buelow, J R; Winburn, K; Hutcherson, J

    1999-01-01

    This article addresses the question. "How do specific managerial practices support home care assistants' job satisfaction?" Staff from three home care agencies were surveyed regarding their perceptions of specific managerial practices and intrinsic job satisfaction. Results of a hierarchical regression model indicate that supportive leadership practices, client-centered in-service training style, and mission implementation together explained 52% of the variance in intrinsic job satisfaction. Supportive leadership was described as the extent to which a supervisor communicates effectively, shows personal concern or caring, and maintains high professional standards. Mission implementation was defined as how strongly the staff felt the mission influenced the hiring process, orientation, in-services, and everyday management. Effective in-services included discussions of types of clients and how to effectively handle common challenges. PMID:10539581

  3. Developing a cost-effective home care management support system for small nursing homes in Taiwan.

    PubMed

    Tu, Ming-Hsiang; Chang, Polun

    2009-01-01

    Home care is important in Taiwan but most of the institutes are small and cannot afford computerization. We develop a support system based on InterRAI case management system using Excel VBA which is the most "free" application in institutes. The prototype system shows promising. PMID:19592932

  4. Implementing a quality improvement programme in palliative care in care homes: a qualitative study

    PubMed Central

    2011-01-01

    Background An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care. Methods Nine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole. Results Perceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death. Conclusions Most of the barriers described by participants are relevant to other interventions to improve end of life care in care homes

  5. Time-Based Measurement of Personal Mite Allergen Bioaerosol Exposure over 24 Hour Periods.

    PubMed

    Tovey, Euan R; Liu-Brennan, Damien; Garden, Frances L; Oliver, Brian G; Perzanowski, Matthew S; Marks, Guy B

    2016-01-01

    Allergic diseases such as asthma and rhinitis are common in many countries. Globally the most common allergen associated with symptoms is produced by house dust mites. Although the bed has often been cited as the main site of exposure to mite allergens, surprisingly this has not yet been directly established by measurement due to a lack of suitable methods. Here we report on the development of novel methods to determine the pattern of personal exposure to mite allergen bioaerosols over 24-hour periods and applied this in a small field study using 10 normal adults. Air was sampled using a miniature time-based air-sampler of in-house design located close to the breathing zone of the participants, co-located with a miniature time-lapse camera. Airborne particles, drawn into the sampler at 2L/min via a narrow slot, were impacted onto the peripheral surface of a disk mounted on the hour-hand of either a 12 or 24 hour clock motor. The impaction surface was either an electret cloth, or an adhesive film; both novel for these purposes. Following a review of the time-lapse images, disks were post-hoc cut into subsamples corresponding to eight predetermined categories of indoor or outdoor location, extracted and analysed for mite allergen Der p 1 by an amplified ELISA. Allergen was detected in 57.2% of the total of 353 subsamples collected during 20 days of sampling. Exposure patterns varied over time. Higher concentrations of airborne mite allergen were typically measured in samples collected from domestic locations in the day and evening. Indoor domestic Der p 1 exposures accounted for 59.5% of total exposure, whereas total in-bed-asleep exposure, which varied 80 fold between individuals, accounted overall for 9.85% of total exposure, suggesting beds are not often the main site of exposure. This study establishes the feasibility of novel methods for determining the time-geography of personal exposure to many bioaerosols and identifies new areas for future technical

  6. Time-Based Measurement of Personal Mite Allergen Bioaerosol Exposure over 24 Hour Periods

    PubMed Central

    Tovey, Euan R.; Liu-Brennan, Damien; Garden, Frances L.; Oliver, Brian G.; Perzanowski, Matthew S.; Marks, Guy B.

    2016-01-01

    Allergic diseases such as asthma and rhinitis are common in many countries. Globally the most common allergen associated with symptoms is produced by house dust mites. Although the bed has often been cited as the main site of exposure to mite allergens, surprisingly this has not yet been directly established by measurement due to a lack of suitable methods. Here we report on the development of novel methods to determine the pattern of personal exposure to mite allergen bioaerosols over 24-hour periods and applied this in a small field study using 10 normal adults. Air was sampled using a miniature time-based air-sampler of in-house design located close to the breathing zone of the participants, co-located with a miniature time-lapse camera. Airborne particles, drawn into the sampler at 2L/min via a narrow slot, were impacted onto the peripheral surface of a disk mounted on the hour-hand of either a 12 or 24 hour clock motor. The impaction surface was either an electret cloth, or an adhesive film; both novel for these purposes. Following a review of the time-lapse images, disks were post-hoc cut into subsamples corresponding to eight predetermined categories of indoor or outdoor location, extracted and analysed for mite allergen Der p 1 by an amplified ELISA. Allergen was detected in 57.2% of the total of 353 subsamples collected during 20 days of sampling. Exposure patterns varied over time. Higher concentrations of airborne mite allergen were typically measured in samples collected from domestic locations in the day and evening. Indoor domestic Der p 1 exposures accounted for 59.5% of total exposure, whereas total in-bed-asleep exposure, which varied 80 fold between individuals, accounted overall for 9.85% of total exposure, suggesting beds are not often the main site of exposure. This study establishes the feasibility of novel methods for determining the time-geography of personal exposure to many bioaerosols and identifies new areas for future technical

  7. Non-24-Hour Sleep-Wake Disorder Revisited – A Case Study

    PubMed Central

    Garbazza, Corrado; Bromundt, Vivien; Eckert, Anne; Brunner, Daniel P.; Meier, Fides; Hackethal, Sandra; Cajochen, Christian

    2016-01-01

    The human sleep-wake cycle is governed by two major factors: a homeostatic hourglass process (process S), which rises linearly during the day, and a circadian process C, which determines the timing of sleep in a ~24-h rhythm in accordance to the external light–dark (LD) cycle. While both individual processes are fairly well characterized, the exact nature of their interaction remains unclear. The circadian rhythm is generated by the suprachiasmatic nucleus (“master clock”) of the anterior hypothalamus, through cell-autonomous feedback loops of DNA transcription and translation. While the phase length (tau) of the cycle is relatively stable and genetically determined, the phase of the clock is reset by external stimuli (“zeitgebers”), the most important being the LD cycle. Misalignments of the internal rhythm with the LD cycle can lead to various somatic complaints and to the development of circadian rhythm sleep disorders (CRSD). Non-24-hour sleep-wake disorders (N24HSWD) is a CRSD affecting up to 50% of totally blind patients and characterized by the inability to maintain a stable entrainment of the typically long circadian rhythm (tau > 24.5 h) to the LD cycle. The disease is rare in sighted individuals and the pathophysiology less well understood. Here, we present the case of a 40-year-old sighted male, who developed a misalignment of the internal clock with the external LD cycle following the treatment for Hodgkin’s lymphoma (ABVD regimen, four cycles and AVD regimen, four cycles). A thorough clinical assessment, including actigraphy, melatonin profiles and polysomnography led to the diagnosis of non-24-hour sleep-wake disorders (N24HSWD) with a free-running rhythm of tau = 25.27 h. A therapeutic intervention with bright light therapy (30 min, 10,000 lux) in the morning and melatonin administration (0.5–0.75 mg) in the evening failed to entrain the free-running rhythm, although a longer treatment duration and more intense therapy

  8. Non-24-Hour Sleep-Wake Disorder Revisited - A Case Study.

    PubMed

    Garbazza, Corrado; Bromundt, Vivien; Eckert, Anne; Brunner, Daniel P; Meier, Fides; Hackethal, Sandra; Cajochen, Christian

    2016-01-01

    The human sleep-wake cycle is governed by two major factors: a homeostatic hourglass process (process S), which rises linearly during the day, and a circadian process C, which determines the timing of sleep in a ~24-h rhythm in accordance to the external light-dark (LD) cycle. While both individual processes are fairly well characterized, the exact nature of their interaction remains unclear. The circadian rhythm is generated by the suprachiasmatic nucleus ("master clock") of the anterior hypothalamus, through cell-autonomous feedback loops of DNA transcription and translation. While the phase length (tau) of the cycle is relatively stable and genetically determined, the phase of the clock is reset by external stimuli ("zeitgebers"), the most important being the LD cycle. Misalignments of the internal rhythm with the LD cycle can lead to various somatic complaints and to the development of circadian rhythm sleep disorders (CRSD). Non-24-hour sleep-wake disorders (N24HSWD) is a CRSD affecting up to 50% of totally blind patients and characterized by the inability to maintain a stable entrainment of the typically long circadian rhythm (tau > 24.5 h) to the LD cycle. The disease is rare in sighted individuals and the pathophysiology less well understood. Here, we present the case of a 40-year-old sighted male, who developed a misalignment of the internal clock with the external LD cycle following the treatment for Hodgkin's lymphoma (ABVD regimen, four cycles and AVD regimen, four cycles). A thorough clinical assessment, including actigraphy, melatonin profiles and polysomnography led to the diagnosis of non-24-hour sleep-wake disorders (N24HSWD) with a free-running rhythm of tau = 25.27 h. A therapeutic intervention with bright light therapy (30 min, 10,000 lux) in the morning and melatonin administration (0.5-0.75 mg) in the evening failed to entrain the free-running rhythm, although a longer treatment duration and more intense therapy might have

  9. Home health care with telemonitoring improves health status for older adults with heart failure.

    PubMed

    Madigan, Elizabeth; Schmotzer, Brian J; Struk, Cynthia J; DiCarlo, Christina M; Kikano, George; Piña, Ileana L; Boxer, Rebecca S

    2013-01-01

    Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore, for older adults with heart failure, telemonitoring may be an important adjunct to home health care services to improve health status. PMID:23438509

  10. 75 FR 2595 - Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Activity: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Activity: Comment... use of other forms of information technology. Title: Care Coordination Home Telehealth (CCHT)...

  11. 75 FR 15496 - Agency Information Collection (Care Coordination Home Telehealth (CCHT)) Activity Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Care Coordination Home Telehealth (CCHT)) Activity Under OMB Review...).'' SUPPLEMENTARY INFORMATION: Title: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA...

  12. Home Visiting Programs: What the Primary Care Clinician Should Know.

    PubMed

    Finello, Karen Moran; Terteryan, Araksi; Riewerts, Robert J

    2016-04-01

    Responsibilities for primary care clinicians are rapidly expanding ascomplexities in families' lives create increased disparities in health and developmental outcomes for young children. Despite the demands on primary care clinicians to promote health in the context of complex family and community factors, most primary care clinicians are operating in an environment of limited training and a shortage of resources for supporting families. Partnerships with evidence-based home visiting programs for very young children and their families can provide a resource that will help to reduce the impact of adverse early childhood experiences and facilitate health equity. Home visiting programs in the United States are typically voluntary and designed to be preventative in nature, although families are usually offered services based on significant risk criteria since the costs associated with universal approaches have been considered prohibitive. Programs may be funded within the health (physical orbehavioral/mental health), child welfare, early education, or early intervention systems or by private foundation dollars focused primarily on oneof the above systems (e.g., health), with a wide range of outcomes targeted by the programs and funders. Services may be primarily focused on the child, the parent, or parent-child interactions. Services include the development of targeted and individualized intervention strategies, better coaching of parents, and improved modeling of interactions that may assist struggling families. This paper provides a broad overview ofthe history of home visiting, theoretical bases of home visiting programs, key components of evidence-based models, outcomes typically targeted, research on effectiveness, cost information, challenges and benefits of home visiting, and funding/sustainability concerns. Significance for primary care clinicians isdescribed specifically and information relevant for clinicians is emphasized throughout the paper. PMID:26872870

  13. A new model for home care for COPD.

    PubMed

    Alonso, Albert

    2004-01-01

    A new model for home care of COPD patients is investigated, as a part of a coordinated provision model across levels of care. In the Spanish pilot of the e-Vital project, relevant vital signs for COPD are closely monitored and used for early detection of deterioration in the state of the patient and all prompt treatment. This can also reduce the need for in-person check-ups and re-admission to hospital. Later analysis aims to determine whether the system has significant economic impact, and whether it will provide more convenience for patients and healthcare professionals. The present trial focuses on the impact of community based nurses visiting each patient in the home as a part of this shared care. The visits are part of the regular follow-up for patients with chronic conditions who belong to any of the home care programs currently available in our institution. In each one of these visits, the nurse performs a number of tasks in order to assess patient status. Vital signs are collected and may be transmitted to the data monitor centre automatically using 2.5-3G technology. Sensors communicate through a Body Area Network (BAN) with a PDA configured to display the data and transfer it to the server using GPRS. Patients can be trained to use the equipment on their own. Results so far are encouraging. In the previous phase, a similar set-up without monitoring facilities at the patient's home showed improvements in several clinical indicators (ER visits, SGRQ, Quality of life, LOS and costs) for a home hospitalisation program and in a prevention of exacerbation program. The current set-up aims at increasing such benefits and further extending the target population. PMID:15747942

  14. Psychiatric home care: a new tool for crisis intervention.

    PubMed

    Spiro, A H

    1994-03-01

    The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care. PMID:10132548

  15. Personal best marathon time and longest training run, not anthropometry, predict performance in recreational 24-hour ultrarunners.

    PubMed

    Knechtle, Beat; Knechtle, Patrizia; Rosemann, Thomas; Lepers, Romuald

    2011-08-01

    In recent studies, a relationship between both low body fat and low thicknesses of selected skinfolds has been demonstrated for running performance of distances from 100 m to the marathon but not in ultramarathon. We investigated the association of anthropometric and training characteristics with race performance in 63 male recreational ultrarunners in a 24-hour run using bi and multivariate analysis. The athletes achieved an average distance of 146.1 (43.1) km. In the bivariate analysis, body mass (r = -0.25), the sum of 9 skinfolds (r = -0.32), the sum of upper body skinfolds (r = -0.34), body fat percentage (r = -0.32), weekly kilometers ran (r = 0.31), longest training session before the 24-hour run (r = 0.56), and personal best marathon time (r = -0.58) were related to race performance. Stepwise multiple regression showed that both the longest training session before the 24-hour run (p = 0.0013) and the personal best marathon time (p = 0.0015) had the best correlation with race performance. Performance in these 24-hour runners may be predicted (r2 = 0.46) by the following equation: Performance in a 24-hour run, km) = 234.7 + 0.481 (longest training session before the 24-hour run, km) - 0.594 (personal best marathon time, minutes). For practical applications, training variables such as volume and intensity were associated with performance but not anthropometric variables. To achieve maximum kilometers in a 24-hour run, recreational ultrarunners should have a personal best marathon time of ∼3 hours 20 minutes and complete a long training run of ∼60 km before the race, whereas anthropometric characteristics such as low body fat or low skinfold thicknesses showed no association with performance. PMID:21642857

  16. Pregnancy Medical Home Care Pathways Improve Quality of Perinatal Care and Birth Outcomes.

    PubMed

    Berrien, Kate; Ollendorff, Arthur; Menard, M Kathryn

    2015-01-01

    The clinical leadership of the Pregnancy Medical Home (PMH) program develops and disseminates clinical pathways to promote evidence-based practice and to improve quality of care and outcomes. PMH pathways represent the first standardized clinical guidance for obstetric providers statewide across all care settings. PMID:26509523

  17. A Comprehensive, Multidisciplinary Approach to Providing Health Care for Children in Out-of-Home Care.

    ERIC Educational Resources Information Center

    Blatt, Steven D.; And Others

    1997-01-01

    Describes ENHANCE (Excellence in Health Care for Abused and Neglected Children) of Onondaga County, New York, a comprehensive, multidisciplinary clinic for children in out-of-home care involving pediatrics, child psychology, nursing, child development, and child welfare components. Also presents profiles of the health, mental health, and…

  18. Winning at Child Caring: Easier Ways with Young Children in Child Care Centers, Homes and Malls.

    ERIC Educational Resources Information Center

    Simons, Bette

    This booklet is a compilation of articles from a column in the "Warner Center News" written by an experienced early childhood educator on various topics related to child care. The brief articles describe the problems and pleasures that preschool children bring to child care centers, homes, markets, and malls. The articles are grouped into four…

  19. Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

    ERIC Educational Resources Information Center

    Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

    2008-01-01

    Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

  20. Diarrhea & Child Care: Controlling Diarrhea in Out-of-Home Child Care. NCEDL Spotlights, No. 4.

    ERIC Educational Resources Information Center

    Churchill, Robin B.; Pickering, Larry K.

    This report, the fourth in the National Center for Early Development and Learning's (NCEDL) "Spotlights" series, is based on excerpts from a paper presented during a "Research into Practice in Infant/Toddler Care" synthesis conference in fall 1997. The report addresses controlling diarrhea in out-of-home child care. The report notes that the rate…

  1. Who Will Deliver the Care? A Study of the Availability of Home Care Professionals in Ohio.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Aging, Columbus.

    A shortage of home care paraprofessionals in Ohio is causing concern about the quality and continuity of care. Worker turnover is high, ranging from 30-70 percent. Most paraprofessionals share several traits: middle-aged women; single, with dependents; sole breadwinners in their households; wage earners of less than $11,000 per year; part-time…

  2. Continuous 24 hour ambulatory monitoring of intragastric pH in man.

    PubMed

    Kapur, B K; Howlett, P J; Kenyon, N G; Lunt, M J; Mills, J G; Smallwood, R H; Wilson, A J; Bardhan, K D

    1987-05-01

    A system has been developed which permits continuous 24 hour ambulatory recording of intragastric pH under near-physiological conditions. The system utilises a Cecar combination pH electrode connected through a pre-amplifier to an Oxford Medical Systems Medilog 4-24 cassette recorder, and the pH recorded continuously on to tape. The data is replayed at high speed, digitised and then analysed. Sources of error included system drift, system noise and the effect of changes in electrode environment due to saliva, food, loss of fluid contact, temperature variations and electrode time constant. These were found to be small. In contrast, the major changes in pH detected reflect real changes at the electrode tip. These changes can be recorded by the system. Developments in electronics and improvements in both the size and quality of pH electrodes, over the past few decades, has enabled intragastric pH recordings to be made with greater ease. However, a large number of investigators still assess gastric acidity by infrequent, intermittent sampling of gastric secretion through a naso-gastric tube. This new ambulatory system is a significant improvement and its versatility allows studies in acid secretion physiology, pharmacology and pathophysiology. PMID:3595080

  3. The Canadian 24-Hour Movement Guidelines for Children and Youth: Implications for practitioners, professionals, and organizations.

    PubMed

    Latimer-Cheung, Amy E; Copeland, Jennifer L; Fowles, Jonathon; Zehr, Lori; Duggan, Mary; Tremblay, Mark S

    2016-06-01

    The new Canadian 24-Hour Movement Guidelines for Children and Youth emphasize the integration of all movement behaviours that occur over a whole day (i.e., light, moderate, and vigorous physical activity, sedentary behaviour, and sleep). These guidelines shift the paradigm away from considering each behaviour in isolation. This concept of the "whole day matters" not only calls for a change in thinking about movement but also for redevelopment of dissemination and implementation practice. Past guideline launch activities largely have aimed to create awareness through passive dissemination strategies (e.g., Website posts, distribution of print resources). For the integrated guidelines to have public health impact, we must move beyond dissemination and raising of awareness to implementation and behaviour change. Shifting this focus requires new, innovative approaches to intervention, including interdisciplinary collaboration, policy change, and refocused service provision. The purpose of this paper is to identify practitioners, professionals, and organizations with potential to disseminate and/or implement the guidelines, discuss possible implementation strategies for each of these groups, and describe the few resources being developed and those needed to support dissemination and implementation efforts. This discussion makes readily apparent the need for a well-funded, comprehensive, long-term dissemination, implementation, and evaluation plan to ensure uptake and activation of the guidelines. PMID:27306438

  4. [The diagnostic impact and limitations of 24 hour pH monitoring with multichannel intraluminal impedance].

    PubMed

    Korszun, Karolina; Dyrla, Przemysław; Wojtuń, Stanisław; Gil, Jerzy

    2014-08-01

    Gastroesophageal reflux disease (GERD) is a result of reflux of gastric contents into the esophagus. Gastroscopy is often the first examination performed in GERD diagnosis. Some patients have macroscopic lesions, namely erosions, in the esophagus above the cardia of stomach. It enables to diagnose gastroesophageal reflux disease. However, many patients have no macroscopic lesions of the esophageal mucosa in endoscopy. That is why 24-hour pH monitoring with multichannel intraluminal impedance is the gold standard in diagnosis establishing of GERD and make feasible to distinguish acid, weakly acid and nonacid reflux and its correlation with reported symptoms. Impedance-pH is used to establish diagnosis of GERD, in patient qualification to anti-reflux surgery, to find the cause of not efficient reflux disease treatment as well as the cause of extra-esophageal symptoms of reflux disease. During impedance-pH test catheter connected with the recorder is placed in patient's esophagus. Recorded data is analyzed with the computer program. The examination is safe, the only complication that can occur is nasal bleeding, which can be a result of mucosa damage caused while catheter implementation. Nowadays disposable catheters are used, that excludes the risk of catheter related infection. On the basis of pH-impedance results it is possible to divide patients into 3 groups: patients with functional heartburn, patients with esophageal hypersensitivity and abnormal esophageal acid exposure. This classification is very helpful in the choice of treatment - antireflux surgery, proton pump inhibitor or prokinetic therapy. PMID:25252438

  5. Evaluation study of the California Expanded Food and Nutrition Education Program: 24-hour food recall data.

    PubMed

    Del Tredici, A M; Joy, A B; Omelich, C L; Laughlin, S G

    1988-02-01

    The California Expanded Food and Nutrition Education program (EFNEP) Evaluation Study evaluated the effectiveness of the California program. The eating habits of 683 persons were studied in a group receiving EFNEP instruction (355 participants) and a control group (328 participants) that received no instruction. The 24-hour food recall was used to assess eating habits using the Synectics method. At the beginning of the study, there were no differences in food recall scores between the EFNEP and the control groups. After 6 months of instruction in the EFNEP group, there was a significant increase in food recall score for that group and no change in the control group. The improvements observed in the EFNEP group resulted from increased intakes from the milk, protein, and fruit and vegetable food groups. The program characteristics that led to those changes were determined to be in the length of the EFNEP visit, the number of EFNEP visits, and the EFNEP instruction topics. These results show that the California EFNEP is effective in producing significant changes in the eating habits of the low-income individuals it serves. PMID:3339205

  6. Electrodes for 24 hours pH monitoring--a comparative study.

    PubMed

    McLauchlan, G; Rawlings, J M; Lucas, M L; McCloy, R F; Crean, G P; McColl, K E

    1987-08-01

    Three pH electrodes in clinical use were examined--(1) antimony electrode with remote reference electrode (Synectics 0011), (2) glass electrode with remote reference electrode (Microelectrodes Inc. MI 506) and (3) combined glass electrode with integral reference electrode (Radiometer GK2801C). In vitro studies showed that both glass electrodes were similar and superior to the antimony electrode with respect to response time, drift, and sensitivity. The effect of the siting of the reference electrode on the recorded pH was examined in five human volunteers. The pH reading using a remote skin reference electrode was higher by a mean of 0.3 pH units (range 0.0-0.6) in the stomach, lower by 0.65 pH units (0.5-0.8) in the duodenum and lower by 0.3 pH units (0.0-0.6) in the oesophagus than that simultaneously obtained with an intraluminal reference electrode. Buccal reference electrodes gave similar readings to skin. Combined reference and glass pH electrodes are recommended for 24-hour ambulatory pH monitoring. PMID:3666560

  7. Depressive Symptoms and 24-Hour Ambulatory Blood Pressure in Africans: The SABPA Study

    PubMed Central

    Hamer, Mark; Frasure-Smith, Nancy; Lespérance, François; Harvey, Brian H.; Malan, Nico T.; Malan, Leoné

    2012-01-01

    Disturbances in circadian rhythm might play a central role in the neurobiology of depression. We examined the association between depressive symptoms and 24-hour ambulatory BP in a sample of 405 (197 black and 208 Caucasian) urbanized African teachers aged 25 to 60 yrs (mean 44.6 ± 9.6 yrs). Depressive symptoms were assessed using the self-administered 9-item Patient Health Questionnaire (PHQ-9). After adjusting for age, sex, and ethnicity, participants with severe depressive symptoms (PHQ-9 ≥ 15) had higher odds of hypertension defined from ambulatory BP and/or use of antihypertensive medication (odds ratio = 2.19, 95% CI, 1.00–4.90) in comparison to participants with no symptoms. Compared to Caucasians with no depressive symptoms, those with severe symptoms had blunted nocturnal systolic BP drop of 4.7 mmHg (95% CI, −0.5 to 10.0, P = 0.07). In summary, depressive symptoms were associated with the circadian BP profile in black and Caucasian Africans. PMID:22028954

  8. After 24-hour scrub, the Boeing Delta II rocket carrying Stardust launches on time

    NASA Technical Reports Server (NTRS)

    1999-01-01

    Flames sear the pristine blue sky behind the Boeing Delta II rocket carrying the Stardust spacecraft after the 4:04:15 p.m. launch from Launch Pad 17-A, Cape Canaveral Air Station. A 24- hour scrub postponed the launch from the originally scheduled date of Feb. 6. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  9. After 24-hour scrub, the Boeing Delta II rocket carrying Stardust waits for launch

    NASA Technical Reports Server (NTRS)

    1999-01-01

    In the late morning light at Launch Pad 17-A, Cape Cananveral Air Station, the fixed utility tower (right) casts a long shadow across the base of the Boeing Delta II rocket (left) waiting to launch the Stardust spacecraft. After a 24-hour scrub, the new targeted launch time is 4:04 p.m. EST. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  10. After 24-hour scrub, the Boeing Delta II rocket carrying Stardust waits for launch

    NASA Technical Reports Server (NTRS)

    1999-01-01

    After a 24-hour postponement, the Boeing Delta II rocket carrying the Stardust spacecraft waits on Launch Pad 17-A, Cape Canaveral Air Station, for its scheduled launch at 4:04 p.m. EST. Umbilical lines (at top) still attached to the fixed utility tower (at right) feed electricity, air conditioning and coolants for the Stardust spacecraft inside the fairing (enclosing the upper stage) before launch. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  11. Age and individual sleep characteristics affect cognitive performance in anesthesiology residents after a 24-hour shift.

    PubMed

    Tadinac, Meri; Sekulić, Ante; Hromatko, Ivana; Mazul-Sunko, Branka; Ivancić, Romina

    2014-03-01

    Previous research has shown that both shift work and sleep deprivation have an adverse influence on various aspects of human cognitive performance. The aim of this study was to explore changes in cognitive functioning and subjective sleepiness of anesthesiology residents after a 24-hour shift. Twenty-six anesthesiology residents completed a set of psychological instruments at the beginning and at the end of the shift, as well as a questionnaire regarding information about the shift, Stanford Sleepiness Scale, and Circadian Type Questionnaire. There was a significant decline in cognitive performance measured by the Auditory Verbal Learning Test after the shift. The effect was stronger in older participants and in those with high scores on rigidity of sleep scale and low scores on the ability to overcome sleepiness scale. There were no differences in the digits forward test (a measure of concentration), while digits backward test (a measure of working memory) even showed an improved performance after the shift. Although participants reported being significantly sleepier after the shift, the subjective sleepiness did not correlate with any of the objective measures of cognitive performance. In conclusion, the performance in short tasks involving concentration and working memory was not impaired, while performance in long-term and monotone tasks declined after sleep deprivation, and the magnitude of this decline depended on the specific individual characteristics of sleep and on age Surprisingly, age seemed to have an important impact on cognitive functions after shift work even in the relatively age-homogeneous population of young anesthesiology residents. PMID:24974663

  12. Importance of all movement behaviors in a 24 hour period for overall health.

    PubMed

    Chaput, Jean-Philippe; Carson, Valerie; Gray, Casey E; Tremblay, Mark S

    2014-12-01

    Physical inactivity and childhood obesity are well-recognized public health concerns that are associated with a range of adverse health outcomes. Historically, the benefits of physical activity (e.g., moderate-to-vigorous physical activity-MVPA) to overall health have dominated discussions and emerging evidence indicates that a broader, more integrated approach is needed to better understand and address current public health crises. Existing guidelines for children and youth around the world only focus on MVPA, and recently sedentary behavior, despite an accumulating body of evidence showing that light-intensity physical activity (LPA) such as walking can provide important health benefits. Furthermore, there is accumulating support for the importance of adequate sleep and that these behaviors moderate the health impact of each other. Ignoring the other components of the movement continuum (i.e., sleep, sedentary time, LPA) while focusing efforts exclusively on MVPA (accounting for <5% of the time in a 24 h period) limits the potential to optimize the health benefits of movement behaviors. In order to address this limitation, experts in Canada are currently developing the world's first Integrated 24 Hour Movement Behaviour Guidelines for Children and Youth to help advance an integrated healthy active living agenda that has the potential to significantly improve the overall health and well-being of children and youth. PMID:25485978

  13. [Ambulatory 24-hour blood pressure monitoring in patients with resistant hypertension].

    PubMed

    Sznajderman, M; Popławska, W; Cybulska, I; Niegowska, J; Makowiecka-Cieśla, M; Baranowski, R

    1990-01-01

    The aim of the study was to assess the usefulness of 24-hour blood pressure (BP) and heart rate (HR) monitoring in patients with "resistant" hypertension. 30 patients (44.1 +/- 9.9 years) with diastolic BP 100 mm Hg or more in spite of treatment with three or more antihypertensive drugs were studied. Ambulatory recording of BP and HR was performed by means of Del Mar Avionics monitoring system 9000. Mean recording time was 21.5 hours and mean number of measurements during one recording--56.7. Mean ambulatory systolic and diastolic BP values were significantly lower than mean value of three casual measurements (146.0 +/- 24.6 vs 171.5 +/- 21.2 mm Hg for systolic and 97.2 +/- 11.3 vs 110.4 +/- 7.5 mm Hg for diastolic BP p less than 0.01) In 14 (46.6%) systolic BP and in 10 patients (33.3%) diastolic BP were normal. The patients with normal and abnormal ambulatory BP recordings did not differ in regard to age and mean clinic BP levels. However, patients with abnormal ambulatory BP recordings were more often overweight and showed a greater frequency of left ventricular hypertrophy and family history of hypertension and its complications. The results of the study show that ambulatory BP monitoring may be of value in assessing the response to antihypertensive treatment in patients with so called resistant hypertension as judged on the basis of clinic pressure. PMID:2074634

  14. Accuracy of commercial 24-hour electrocardiogram analyzers for quantitation of total and repetitive ventricular arrhythmias.

    PubMed

    Salerno, D M; Granrud, G; Hodges, M

    1987-12-01

    The accuracy of 2 commercial 24-hour electrocardiogram analyzers was tested for quantitation of ventricular premature complexes (VPCs). Scanner 1 was the Cardiodata Systems Mark III and scanner 2 was the Avionics Trendsetter DCG VII. Twenty-four-hour electrocardiographic recordings from 19 consecutive ambulatory patients with frequent VPCs were analyzed by each device. Results were compared with those from hand counts of complete printouts of each of the 19 recordings. For total VPCs, scanner 1 had an average error of 13% (range 0 to 58%) and scanner 2 had an average error of 24% (range (1 to 80%). Scanner 1 had an error of more than 10% for 9 of the 19 recordings and scanner 2 more than 10% for 11 of the 19 recordings. For paired VPCs, scanner 1 had a mean error of 23% (range 4 to 77%), and scanner 2 of 56% (range 34 to 79%). For nonsustained ventricular tachycardia, scanner 1 had an average error of 20% (range 8 to 41%) and scanner 2 had an error of 56% (range 34 to 78%). Thus, when recordings from consecutive ambulatory patients with frequent VPCs were analyzed, neither device was consistently accurate for quantitation of total VPCs. Both analyzers had an unacceptable error for quantitation of repetitive VPCs. All currently available devices may have comparably large errors. This possibility is confirmed by recalculation of the reported data from a third scanner. PMID:2446488

  15. Obtaining liver tridimensional scaffold through the decellularization of rabbit whole liver in 24 hours

    NASA Astrophysics Data System (ADS)

    Federico, Schliamser; Ayelen, Rinaldi; Romina, Comin; Alba Nelly, Borchert; Adrian, Nari Gustavo; Alicia, Salvatierra Nancy; Mariana Paula, Cid

    2016-04-01

    In the present work, we development a new protocol for liver decellularization in which the hole decellularization was reached over 24 h. Introduction: the availability of transplantable livers is not sufficient to fulfill the current demand for grafts, with the search for therapeutic alternatives having generated different lines of research, one of which is the use of decellularized three-dimensional biological matrices and subsequent cell seeding to obtain a functional organ. Objective: to produce a decellularization protocol from rabbit liver to generate a three-dimensional matrixin which the time period involved didn't pass 24 h. Methods: The decellularization is obtained through the use of water and SDS (0,1-0,3 %), after freezing at -80 degrees, is the best alternative of different physical and/or chemical mechanisms to break down organ cells and leave only the extracellular matriz. After 24 h of retrograde perfusion, a decellularized translucent matrix was generated. To evaluate if the decellularization protocol was successful, with the extracellular matrix being preserved, we carried out histological (light microscopy) and biochemical (DNA quantification) studies. Results: the decellularization process was verified by macroscopic observation of the organ using microscopic observation corroborated the macroscopic results, with the hematoxylin-eosin and Masson staining showing no cells or nuclear material. In addition, the DNA quantification was less than 10% in the decellularized liver compared to control. Finally,the time taken to develop the decellularization protocol was less than 24 hours.

  16. Association between Diurnal Variation of Ozone Concentration and Stroke Occurrence: 24-Hour Time Series Study

    PubMed Central

    Han, Myung-Hoon; Yi, Hyeong-Joong; Kim, Young-Seo; Ko, Yong; Kim, Young-Soo

    2016-01-01

    Background and Purpose Increasing ozone concentrations have been known to damage human health and ecosystems. Although ozone tends to display diurnal variation, most studies have reported only on the association between daily ozone concentrations and ischemic stroke occurrence on the same day, or with a 1-day lag. We investigated the effect of the diurnal variation of ozone on ischemic stroke occurrence during the same day. Methods We included a consecutive series of 1,734 patients from January 1, 2008, to December 31, 2014, at a single tertiary hospital in Seoul, South Korea. We evaluated differences between temperature and pollutants at the time of stroke onset for each time interval and averaged those parameters across the 7-year study period. Results During the interval from 13:00 to 16:59, we found a positive association between ischemic stroke occurrence and ozone concentration relative to other time periods. Upper median ozone levels from 13:00 to 16:59 were positively correlated with ischemic stroke (odds ratio, 1.550; 95% confidence intervals, 1.220 to 1.970; P = <0.001) when compared with lower median levels. Conclusions The results show diurnal patterns of ischemic stroke occurrence based on upper and lower median ozone levels for a 24-hour period, which extends understanding of the association between stroke occurrence and environmental influences. PMID:27015421

  17. Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy

    SciTech Connect

    Seabold, J.E.; Conrad, G.R.; Ponto, J.A.; Kimball, D.A.; Frey, E.E.; Ahmed, F.; Coughlan, J.D.; Jensen, K.C.

    1987-11-01

    Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acute DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal.

  18. The 24-hour pulse wave velocity, aortic augmentation index, and central blood pressure in normotensive volunteers

    PubMed Central

    Kuznetsova, Tatyana Y; Korneva, Viktoria A; Bryantseva, Evgeniya N; Barkan, Vitaliy S; Orlov, Artemy V; Posokhov, Igor N; Rogoza, Anatoly N

    2014-01-01

    The purpose of this study was to examine the pulse wave velocity, aortic augmentation index corrected for heart rate 75 (AIx@75), and central systolic and diastolic blood pressure during 24-hour monitoring in normotensive volunteers. Overall, 467 subjects (206 men and 261 women) were recruited in this study. Participants were excluded from the study if they were less than 19 years of age, had blood test abnormalities, had a body mass index greater than 2 7.5 kg/m2, had impaired glucose tolerance, or had hypotension or hypertension. Ambulatory blood pressure monitoring (ABPM) with the BPLab® device was performed in each subject. ABPM waveforms were analyzed using the special automatic Vasotens® algorithm, which allows the calculation of pulse wave velocity, AIx@75, central systolic and diastolic blood pressure for “24-hour”, “awake”, and “asleep” periods. Circadian rhythms and sex differences in these indexes were identified. Pending further validation in prospective outcome-based studies, our data may be used as preliminary diagnostic values for the BPLab ABPM additional index in adult subjects. PMID:24812515

  19. [Role of the community pharmacist in the management of drug related problems in home care patients].

    PubMed

    Van de Putte, M; Appels, S; Boone, T; Collienne, S; Daems, T; De Lepeleire, J; Foulon, V

    2012-09-01

    Medication management in home care is an error prone process. In a small pilot project in Flanders, community pharmacists collaborated with physicians and home care nurses through a shared electronic care plan, to optimize the medication management of their home care patients. The pilot project shows that GPs and nurses are positive about the possible contribution of the pharmacist in medication management of home care patients. A larger follow up study is necessary to further identify possible roles of pharmacists in home care and to show related health benefits. PMID:23697093

  20. Correlates of Suicide among Home Health Care Utilizers Who Died by Suicide and Community Controls

    ERIC Educational Resources Information Center

    Rowe, Jennifer L.; Bruce, Martha L.; Conwell, Yeates

    2006-01-01

    Home health care patients often have several late-life risk factors for suicide and constitute a high risk group for suicidal behaviors. In this study, we examined the characteristics of 14 older adult home health care utilizers who died by suicide and four community controls who used similar services. Both groups of home health care utilizers had…

  1. Your Guide to Choosing a Nursing Home or Other Long-Term Care

    MedlinePlus

    ... if you have a complaint about a plan’s refusal to cover a service, supply, or prescription, you file an appeal. Home health agency (HHA): A n organization that provides home health care. Home health care: H ealth care services and ...

  2. Back disorders and lumbar load in nursing staff in geriatric care: a comparison of home-based care and nursing homes

    PubMed Central

    2009-01-01

    Background Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care. Methods 1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings. Results Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance. Conclusions Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices should be improved especially

  3. Palliative and end of life care for people living with dementia in care homes: part 1.

    PubMed

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-22

    The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care. PMID:27332611

  4. The Ethnic Elderly in Metro Toronto Hospitals, Nursing Homes, and Homes for the Aged: Communication and Health Care.

    ERIC Educational Resources Information Center

    Saldov, Morris; Chow, Peter

    1994-01-01

    Developed database on ethnic elderly persons; examined extent of communication problems they face in hospitals, nursing homes, and homes for aged in Metro Toronto; and reported on institutional response. Nursing home supervisors (n=77) reported that communication was essential to health care needs of ethnic elderly individuals. Most health care…

  5. A 24-HOUR AMBULATORY ECG MONITORING IN ASSESSMENT OF QT INTERVAL DURATION AND DISPERSION IN ROWERS WITH PHYSIOLOGICAL MYOCARDIAL HYPERTROPHY

    PubMed Central

    Kim, Z.F.; Bilalova, R.R.; Tsibulkin, N.A.; Almetova, R.R.; Mudarisova, R.R.; Ahmetov, I.I.

    2013-01-01

    Myocardial hypertrophy (MH) due to cardiac pathology is characterized by an increase in QT interval duration and dispersion, while the findings for exercise-induced myocardial hypertrophy are contradictory. The majority of published research findings have not explored this relationship, but there have only been a few conducted studies using 24-hour ECG monitoring. The aim of the study was to determine the QT interval duration and dispersion in short-term and 24-hour ECG in endurance athletes with myocardial hypertrophy and without it. Methods: A total of 26 well-trained rowers underwent a resting 12-lead ECG, 24-hour ECG monitoring and echocardiography. Results: Athletes with MH (n = 7) at rest did not show any increase in QTc interval duration and dispersion, or mean and maximal QTc duration in Holter monitoring compared to athletes without MH (n = 19). Left ventricular mass was not significantly correlated with any QTc characteristics. Furthermore, athletes with MH had significantly longer mean QT (P = 0.01) and maximal QT (P = 0.018) intervals in Holter monitoring and higher 24-hour heart rate variability indexes due to stronger vagal effects. Conclusions: The present study demonstrated that athlete's heart syndrome with myocardial hypertrophy as a benign phenomenon does not lead to an increase in QT interval duration, or increases in maximal and mean duration in a 24-hour ECG. An increase in QT interval duration in athletes may have an autonomic nature. PMID:24744494

  6. Regulation and Mindful Resident Care in Nursing Homes

    PubMed Central

    Colón-Emeric, Cathleen S.; Plowman, Donde; Bailey, Donald; Corazzini, Kirsten; Utley-Smith, Queen; Ammarell, Natalie; Toles, Mark; Anderson, Ruth

    2009-01-01

    Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple case study including field notes, interviews, and documents collected in 8 nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities. PMID:20479137

  7. Diabetes medication incidents in the care home setting.

    PubMed

    Milligan, Frank

    This article analyses data received from a Freedom of Information Act 2000 request made to the National Patient Safety Agency in June 2010. Information was requested about adverse drug event reports in relation to insulin therapy and oral glucose-lowering agents in the care home setting. Data identified were reported to the National Patient Safety Agency between January 12005 and December 312009 and were processed through the National Reporting and Learning Service. There were 684 reports related to insulin and 84 incidents related to oral glucose-lowering agents. The most common error involved wrong or unclear dose: 173 reports for insulin, including one death, and 20 reports for oral glucose-lowering agents. Evidence shows that residents with diabetes in care homes are at risk of harm from adverse drug events involving insulin and oral glucose-lowering agents. PMID:22662553

  8. Reporting and Charting Residents' Behaviors and Care in an Adult Residential Care Home. Adult Residential Care Home 12, Lesson Plan No. 2.

    ERIC Educational Resources Information Center

    Basuel, Terry

    Designed as part of a 40-hour course on adult residential care homes (ARCH's), this lesson plan was developed to explain the importance of and correct procedures for charting (i.e., keeping a written record of observations and care of ARCH residents). The objectives of the 50-minute lesson are to enable students to: (1) list reasons why the…

  9. Home Care Workers' Skills in the Context of Task Shifting: Complexities in Care Work.

    PubMed

    Barken, Rachel; Denton, Margaret; Plenderleith, Jennifer; Zeytinoglu, Isik U; Brookman, Catherine

    2015-08-01

    Task shifting, which involves the transfer of care work from regulated health-care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs' skills. Task shifting may be understood as a form of downward substitution-and an effort to increase control over workers while minimizing costs-as some of health-care professionals' responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health-care providers in Ontario, which focused explicitly on HCWs' role in care provision, problematize the belief that "low skilled" care workers have little control over their work. HCWs' skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work. PMID:26286959

  10. Resist the call to install cameras in care homes.

    PubMed

    Scott, Graham

    2014-05-13

    Last week's BBC Panorama documentary depicting the abuse of older people in a south London care home reignited the debate about whether CCTV should be installed in such settings. Those in favour argue that abuse would be prevented if the perpetrators feared being caught on camera. However, there is a long list of reasons why the introduction of such surveillance systems on a routine basis should be resisted. PMID:24802418

  11. Arbitration agreements in health care nursing home contracts.

    PubMed

    Infante, Marie C; Lovitch, Karen S

    2003-11-01

    Increasingly, long-term care facilities are adopting alternative dispute resolution measures, such as arbitration, in admission contracts. Whereas avoiding the onus of civil lawsuits is understandable, nursing homes must ensure that the arbitration wording in the contract is precise, enforceable, and most importantly, pursuant to state and federal laws, regulations, and guidelines. Otherwise, the contract itself may be the subject of a court action. PMID:14650372

  12. 'Redefining health care': medical homes or archipelagos to navigate?

    PubMed

    Enthoven, Alain C; Crosson, Francis J; Shortell, Stephen M

    2007-01-01

    This paper provides an analysis of the structure of the health care delivery system, emphasizing physician group practices. The authors argue for comprehensive integrated delivery systems (IDSs). The jumping-off point for their analysis is the recently published Redefining Health Care: Creating Value-Based Competition on Results, by Michael Porter and Elizabeth Teisberg. The authors focus on the book's core idea that competitors should be freestanding integrated practice units (or "islands in archipelagos") versus IDSs (or "medical homes"). In any case, the authors contend that this issue should be resolved by competition to attract and serve informed, cost-conscious, responsible consumers on a level playing field. PMID:17848447

  13. Navigating the field of temporally framed care in the Danish home care sector.

    PubMed

    Tufte, Pernille; Dahl, Hanne Marlene

    2016-01-01

    The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in-depth perspective on the broader feminist literature on the dilemmas of care. PMID:26474802

  14. Providing end-of-life care in care homes for older people: a qualitative study of the views of care home staff and community nurses.

    PubMed

    Goddard, Cassie; Stewart, Frances; Thompson, Genevieve; Hall, Sue

    2013-02-01

    The study aimed to explore the views of care home staff (CHS) and community nurses (CNs) on providing end-of-life care (EOLC) in care homes. Participants were randomly selected and qualitative interviews conducted with 80 CHS and 10 CNs. Themes emerging from the data included the following: The meaning of EOLC; starting EOLC; dying in the care home; stress of providing EOLC; improving EOLC; and the role of the CN. CHS felt that planning for the end of life was important before residents reached the dying phase, which some found difficult to determine. Although CHS wished to avoid residents being transferred to hospital to die, they acknowledged that improvements in their skills and the resources available to them were needed to manage EOLC effectively. CNs were critical of the EOLC provided in some care homes, reporting tensions over their relationship with CHS. As the number of older people who die in care homes increases, there is a need to overcome these barriers to provide good EOLC. PMID:25473926

  15. The Aging Brain Care Medical Home: Preliminary Data.

    PubMed

    LaMantia, Michael A; Alder, Catherine A; Callahan, Christopher M; Gao, Sujuan; French, Dustin D; Austrom, Mary G; Boustany, Karim; Livin, Lee; Bynagari, Bharath; Boustani, Malaz A

    2015-06-01

    The Aging Brain Care (ABC) Medical Home aims to improve the care, health outcomes, and medical costs of Medicare beneficiaries with dementia or depression across central Indiana. This population health management program, funded by the Centers for Medicare and Medicaid Services Innovation Center, expanded an existing collaborative dementia and depression care program to serve 1,650 older adults in a local safety-net hospital system. During the first year, 20 full-time clinical staff were hired, trained, and deployed to deliver a collaborative care intervention. In the first 18 months, an average of 13 visits was provided per person. Thirty percent of the sample had a diagnosis of dementia, and 77% had a diagnosis of depression. Sixty-six percent of participants with high depression scores (Patient Health Questionnaire-9 score ≥14) had at least a 50% reduction in their depressive symptoms. Fifty-one percent of caregivers of individuals with dementia had at least a 50% reduction in caregiver stress symptoms (measured by the Healthy Aging Brain Care Monitor-Caregiver Version). After 18 months, the ABC Medical Home has demonstrated progress toward improving the health of older adults with dementia and depression. Scalable and practical models like this show initial promise for answering the challenges posed by the nation's rapidly aging population. PMID:26096394

  16. Sleep-Disordered Breathing and 24-Hour Blood Pressure Pattern Among Older Adults

    PubMed Central

    White, William B.; Kutner, Michael; Ouslander, Joseph G.; Bliwise, Donald L.

    2009-01-01

    Background To examine the association between sleep-disordered breathing (SDB) and 24-hour blood pressure (BP) pattern among community-dwelling older adults. Methods A convenience sample of 70 community-dwelling older adults, recruited from senior housing, community centers, and learning centers, were admitted to General Clinical Research Center, Emory University Hospital, Atlanta, Ga. Information regarding demographic and clinical history was obtained using questionnaires. Twenty-four–hour BP monitoring in supine position was performed using Spacelabs model 20207. Breathing during sleep was monitored with the use of a modified sleep recording system (Embletta, PDS), which monitors nasal and oral airflow, chest and abdominal movements, and pulse oximetry. Night time–daytime (night-day) BP ratio (average night-time BP divided by daytime BP) was calculated both for systolic and diastolic BPs. Results Sixty-nine participants, mean age 74.9 ± 6.4 years (41 [57%] women), completed the study. The mean apnea-hypopnea index (AHI) was 13 ± 13 per hour of sleep, and 20 participants (29%) had AHI ≥15 per hour of sleep, indicating moderate to severe SDB. Moderate to severe SDB (AHI ≥15 per hour of sleep) was significantly associated with nocturnal hypertension, whereas there was no statistically significant difference in wake-time BP between those with and without moderate to severe SDB. Stepwise multiple regressions showed that AHI independently predicted increased night-day systolic and night-day diastolic BP ratio, even after controlling for nocturia frequency. Conclusions The results indicate increased BP load associated with increased AHI in this group of older adults. This increased BP load may contribute to increased hypertension-related morbidity and disease burden. PMID:19196901

  17. Usability of a smartphone food picture app for assisting 24-hour dietary recall: a pilot study

    PubMed Central

    Pope, Benjamin T.; Bilgiç, Pelin; Orr, Barron J.; Suzuki, Asuka; Kim, Angela Sarah; Merchant, Nirav C.; Roe, Denise J.

    2015-01-01

    BACKGROUND/OBJECTIVES The Recaller app was developed to help individuals record their food intakes. This pilot study evaluated the usability of this new food picture application (app), which operates on a smartphone with an embedded camera and Internet capability. SUBJECTS/METHODS Adults aged 19 to 28 years (23 males and 22 females) were assigned to use the Recaller app on six designated, nonconsecutive days in order to capture an image of each meal and snack before and after eating. The images were automatically time-stamped and uploaded by the app to the Recaller website. A trained nutritionist administered a 24-hour dietary recall interview 1 day after food images were taken. Participants' opinions of the Recaller app and its usability were determined by a follow-up survey. As an evaluation indicator of usability, the number of images taken was analyzed and multivariate Poisson regression used to model the factors determining the number of images sent. RESULTS A total of 3,315 food images were uploaded throughout the study period. The median number of images taken per day was nine for males and 13 for females. The survey showed that the Recaller app was easy to use, and 50% of the participants would consider using the app daily. Predictors of a higher number of images were as follows: greater interval (hours) between the first and last food images sent, weekend, and female. CONCLUSIONS The results of this pilot study provide valuable information for understanding the usability of the Recaller smartphone food picture app as well as other similarly designed apps. This study provides a model for assisting nutrition educators in their collection of food intake information by using tools available on smartphones. This innovative approach has the potential to improve recall of foods eaten and monitoring of dietary intake in nutritional studies. PMID:25861429

  18. Difference in 24-Hour Urine Composition between Diabetic and Non-Diabetic Adults without Nephrolithiasis

    PubMed Central

    Qin, Jing; Duan, Xiaolu; Liu, Yang; Zhao, Zhijian; Yuan, Jian; Wan, Shaw P.; Zeng, Guohua

    2016-01-01

    Background Diabetic patients are more likely to develop kidney stones than the general population. The underlying mechanisms for this disparity remain to be elucidated. Little is known about the relationship between urine composition and diabetes mellitus in non-stone-forming individuals. We sought to examine the differences in the 24-hour (24-h) urine composition between diabetic and non-diabetic adults who were not stone formers. Methods A convenience sample of 538 individuals without a history of nephrolithiasis, gout, hyperparathyroidism, or gastroenteric diseases participated in this study. The 24-h urine profiles of 115 diabetic adults were compared with those of 423 non-diabetic adults. Diabetes was defined by self-reported physician diagnosis or medication use. All participants were non-stone formers confirmed by urinary tract ultrasonography. Participants provided a fasting blood sample and a single 24-h urine collection for stone risk analysis. Student’s t-test was used to compare mean urinary values. Linear regression models were adjusted for age, gender, body mass index, hypertension, fasting serum glucose, serum total cholesterol, estimated creatinine clearance rate and urinary factors. Results Univariable analysis showed that the diabetic participants had significantly higher 24-h urine volumes and lower urine calcium and magnesium excretions than non-diabetic participants (all P < 0.05). After multivariate adjustment, no significant differences in 24-h urine composition were observed between diabetic and non-diabetic participants except for a slightly increased 24-h urine volume in diabetic participants (all P > 0.05). The main limitation of this study is that the convenience samples and self-reported data may have been sources of bias. Conclusion Our data showed that there were no differences in 24-h urine composition between diabetic and non-diabetic adults who are not stone formers. The reason for it might be the improved glycemic control in

  19. Relationships, Expertise, Incentives, and Governance: Supporting Care Home Residents' Access to Health Care. An Interview Study From England

    PubMed Central

    Goodman, Claire; Davies, Sue L.; Gordon, Adam L.; Meyer, Julienne; Dening, Tom; Gladman, John R.F.; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C.

    2015-01-01

    Objectives To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Methods Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Results Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. Conclusion The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. PMID:25687930

  20. Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form

    PubMed Central

    2012-01-01

    Residents in training, medical students and other staff in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding burn care. Treatment of burns is not always straightforward. Furthermore, National and International guidelines differ from one region to another. On one hand, it is important to understand pathophysiology, classification of burns, surgical treatment, and the latest updates in burn science. On the other hand, the clinical situation for treating these cases needs clear guidelines to cover every single aspect during the treatment procedure. Thus, 10 questions have been organised and discussed in a step-by-step form in order to achieve the excellence of education and the optimal treatment of burn injuries in the first 24 hours. These 10 questions will clearly discuss referral criteria to the burn unit, primary and secondary survey, estimation of the total burned surface area (%TBSA) and the degree of burns as well as resuscitation process, routine interventions, laboratory tests, indications of Bronchoscopy and special considerations for Inhalation trauma, immediate consultations and referrals, emergency surgery and admission orders. Understanding and answering the 10 questions will not only cover the management process of Burns during the first 24 hours but also seems to be an interactive clear guide for education purpose. PMID:22583548

  1. Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes.

    PubMed Central

    Hood, Kerenza; Nuttall, Jacqui; Gillespie, David; Shepherd, Victoria; Wood, Fiona; Duncan, Donna; Stanton, Helen; Espinasse, Aude; Wootton, Mandy; Acharjya, Aruna; Allen, Stephen; Bayer, Antony; Carter, Ben; Cohen, David; Francis, Nick; Howe, Robin; Mantzourani, Efi; Thomas-Jones, Emma; Toghill, Alun; Butler, Christopher C

    2014-01-01

    BACKGROUND Antibiotic prescribing rates in care homes are higher than in the general population. Antibiotics disrupt the normal gut flora, sometimes causing antibiotic-associated diarrhoea (AAD). Clostridium difficile (Hall and O'Toole 1935) Prévot 1938 is the most commonly identified cause of AAD. Little is known either about the frequency or type of antibiotics prescribed in care homes or about the incidence and aetiology of AAD in this setting. OBJECTIVES The Probiotics for Antibiotic-Associated Diarrhoea (PAAD) study was designed as a two-stage study. PAAD stage 1 aimed to (1) prospectively describe antibiotic prescribing in care homes; (2) determine the incidence of C. difficile carriage and AAD (including C. difficile-associated diarrhoea); and (3) to consider implementation challenges and establish the basis for a sample size estimation for a randomised controlled trial (RCT) of probiotic administration with antibiotics to prevent AAD in care homes. If justified by PAAD stage 1, the RCT would be implemented in PAAD stage 2. However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2. DESIGN PAAD stage 1 was a prospective observational cohort study in care homes in South Wales with up to 12 months' follow-up for each resident. SETTING Recruited care homes had management and owner's agreement to participate and three or more staff willing to take responsibility for implementing the study. PARTICIPANTS Eleven care homes were recruited, but one withdrew before any residents were recruited. A total of 279 care home residents were recruited to the observational study and 19 withdrew, 16 (84%) because of moving to a non-participating care home. MAIN OUTCOME MEASURES The primary outcomes were the rate of antibiotic prescribing, incidence of AAD, defined as three or more loose stools (type 5-7 on the Bristol Stool Chart) in a 24-hour period, and C. difficile

  2. To Compare the Microleakage Among Experimental Adhesives Containing Nanoclay Fillers after the Storages of 24 Hours and 6 Months

    PubMed Central

    Mousavinasab, Seyed Mostafa; Atai, Mohammad; Alavi, Bagher

    2011-01-01

    Objectives: To compare the microleakage among experimental adhesives containing nanoclay fillers after the storages of 24 hours and 6 months. Materials and Methods: Class V cavities were prepared on extracted human molars with the occlusal margins located in enamel and the cervical margins in cementum. Phosphoric acid was applied to the enamel and dentin margins.Subsequently, the cavities were treated using four groups of experimental adhesive systems and restored with a resin composite. Adper Single Bond® was used as control group. After 24- hour and 6- month storages, the samples were subjected to thermocycling shocks and then immersed in silver nitrate as well as developer solution and finally evaluated for leakage. The data were analyzed using SPSS software. Results: Based on Kruskal –Wallis test, significant differences were found between groups regarding microleakage. The Mann- Whitney test showed that Leakage was significantly lower in Adper Single Bond® compared to the other groups in dentinal margins after 24 hours and 6 months and in enamel margins after 6 months. The Wilcoxon Signed Ranks test showed that the enamel leakage in experimental adhesives was significantly lower than dentinal leakage after 24 hours as well as enamel leakage in Adper Single Bond and adhesive with 0.5% PMAA-g-nanoclay was significantly lower than dentinal margins after storage period of 6 months. Conclusion: All the experimental adhesives were effective in reducing enamel leakage after 24 hours, but were not effective in reducing dentinal leakage after 24 hours as well as in enamel and dentinal leakage after a 6-month storage. No improvement was observed in the microleakage in dentin in both short (24 hrs) and long times (6 months). The high microleakage in the adhesives is probably attributed to the high concentration of HEMA in the recipe of the bonding agent. PMID:21566692

  3. Executive Functions are not Affected by 24 Hours of Sleep Deprivation: A Color-Word Stroop Task Study

    PubMed Central

    Dixit, Abhinav; Mittal, Tushar

    2015-01-01

    Background: Sleep is an important factor affecting cognitive performance. Sleep deprivation results in fatigue, lack of concentration, confusion and sleepiness along with anxiety, depression and irritability. Sleep deprivation can have serious consequences in professions like armed forces and medicine where quick decisions and actions need to be taken. Color-Word Stroop task is one of the reliable tests to assess attention and it analyzes the processing of information in two dimensions i.e., reading of words and naming of colour. The evidence regarding the effect of sleep deprivation on Stroop interference is conflicting. The present study evaluated the effect of 24 hours of sleep deprivation on reaction time and interference in Stroop task. Materials and Methods: The present study was done on 30 healthy male medical student volunteers in the age group of 18-25 years after taking their consent and clearance from Institute Ethics Committee. Recordings of Stroop task were at three times: baseline (between 7-9 am), after 12 hours (7-9 pm) and after 24 hours (7-9 am, next day). The subjects were allowed to perform normal daily activities. Results: The study revealed a significant increase in reaction time after 24 hours of sleep deprivation in comparison to baseline and after 12 hours of sleep deprivation. There was no significant change in interference and facilitation after sleep deprivation in comparison to baseline. The number of errors also did not show any significant change after sleep deprivation. Conclusion: The study indicated that there was slowing of responses without change in executive functions after 24 hours of sleep deprivation. It is probable that 24 hours of sleep deprivation does not bring about change in areas of brain affecting executive functions in healthy individuals who have normal sleep cycle. The present study indicated that in professions like armed forces and medicine working 24 hours at a stretch can lead to decrease in motor responses

  4. Specialized Pediatric Palliative Home Care: A Prospective Evaluation

    PubMed Central

    Borasio, Gian Domenico; Nickolay, Carla; Bender, Hans-Ulrich; von Lüttichau, Irene; Führer, Monika

    2013-01-01

    Abstract Objectives: In Germany since 2007 children with advanced life-limiting diseases are eligible for Pediatric Palliative Home Care (PPHC), which is provided by newly established specialized PPHC teams. The objective of this study was to evaluate the acceptance and effectiveness of PPHC as perceived by the parents. Methods: Parents of children treated by the PPHC team based at the Munich University Hospital were eligible for this prospective nonrandomized study. The main topics of the two surveys (before and after involvement of the PPHC team) were the assessment of symptom control and quality of life (QoL) in children; and the parents' satisfaction with care, burden of patient care (Häusliche Pflegeskala, home care scale, HPS), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), and QoL (Quality of Life in Life-Threatening Illness–Family Carer Version, QOLLTI-F). Results: Of 43 families newly admitted to PPHC between April 2011 and June 2012, 40 were included in the study. The median interval between the first and second interview was 8.0 weeks. The involvement of the PPHC team led to a significant improvement of children's symptoms and QoL (P<0.001) as perceived by the parents; and the parents' own QoL and burden relief significantly increased (QOLLTI-F, P<0.001; 7-point change on a 10-point scale), while their psychological distress and burden significantly decreased (HADS, P<0.001; HPS, P<0.001). Conclusions: The involvement of specialized PPHC appears to lead to a substantial improvement in QoL of children and their parents, as experienced by the parents, and to lower the burden of home care for the parents of severely ill children. PMID:24168349

  5. Tasimelteon (Hetlioz™): A New Melatonin Receptor Agonist for the Treatment of Non-24-Hour Sleep-Wake Disorder.

    PubMed

    Bonacci, Janene M; Venci, Jineane V; Gandhi, Mona A

    2015-10-01

    In January 2014, the US Food and Drug Administration approved tasimelteon (Hetlioz™), a melatonin-receptor agonist for the treatment of non-24-hour sleep-wake disorder. This article provides an overview of the mechanism of action, pharmacokinetic properties, as well as the clinical efficacy, safety, and tolerability of tasimelteon. Relevant information was identified through a comprehensive literature search of several databases using the key words tasimelteon, Non-24-hour Sleep-Wake disorder, Non-24, and melatonin. Further information was obtained from the tasimelteon package insert, fda.gov, clinicaltrials.gov, briefing materials provided by Vanda Pharmaceuticals, and posters from scientific meetings. PMID:25092604

  6. 45 CFR 156.245 - Treatment of direct primary care medical homes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING... 45 Public Welfare 1 2014-10-01 2014-10-01 false Treatment of direct primary care medical homes... direct primary care medical homes. A QHP issuer may provide coverage through a direct primary...

  7. 45 CFR 156.245 - Treatment of direct primary care medical homes.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING... 45 Public Welfare 1 2013-10-01 2013-10-01 false Treatment of direct primary care medical homes... direct primary care medical homes. A QHP issuer may provide coverage through a direct primary...

  8. 45 CFR 156.245 - Treatment of direct primary care medical homes.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING... 45 Public Welfare 1 2012-10-01 2012-10-01 false Treatment of direct primary care medical homes... direct primary care medical homes. A QHP issuer may provide coverage through a direct primary...

  9. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1,...

  10. A service model for delivering care closer to home.

    PubMed

    Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

    2011-04-01

    Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects. PMID:21457595

  11. Job Stress and Job Satisfaction: Home Care Workers in a Consumer-Directed Model of Care

    PubMed Central

    Delp, Linda; Wallace, Steven P; Geiger-Brown, Jeanne; Muntaner, Carles

    2010-01-01

    Objective To investigate determinants of job satisfaction among home care workers in a consumer-directed model. Data Sources/Setting Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. Data Collection and Analysis Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. Principal Findings Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work-health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. Conclusions Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer-directed models of care and efforts to retain long-term care workers. PMID:20403063

  12. Client-centered home care: balancing between competing responsibilities.

    PubMed

    Schoot, Tineke; Proot, Ireen; Legius, Marja; ter Meulen, Ruud; de Witte, Luc

    2006-11-01

    This study explores and describes the perceptions of nurses with respect to everyday client-centered care. A grounded theory study was conducted with 10 Dutch nurses and auxiliary nurses giving home care to chronically ill clients. Participatory observations and semistructured interviews were held. Nurses perceived roles and responsibilities competing with the role as a responsive professional to the client demand: a critical professional, developer of client competencies, individual, and employee. Strategies in balancing between competing responsibilities were distinguished: pleasing, dialoguing, directing, and detaching. Directing (related to impaired client competencies) and detaching (related to organizational barriers) were also used as second choice strategies. Effectively balancing between competing responsibilities was seen in dialoguing and directing as second choice. Conditions identified related to these strategies are awareness of, and responsibility taking for competing responsibilities. Recommendations for practice concern a care relationship and a dialogue with the client, critical ethical reflection, professional autonomy, self-assertiveness and organizational support. PMID:17056768

  13. Experiences from development of home health care applications based on emerging Java technology.

    PubMed

    Lind, L; Sundvall, E; Ahlfeldt, H

    2001-01-01

    Home health care is an expanding area within the health care system. The idea of moving parts of the health care process from expensive specialised hospital care to primary health care and home health care might be attractive in a cost perspective. The introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure a safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging Java technologies such as the OSGi platform. A pilot application for follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications. PMID:11604851

  14. Can district nurses and care home staff improve bowel care for older people using a clinical benchmarking tool?

    PubMed

    Goodman, Claire; L Davies, Sue; Norton, Christine; Fader, Mandy; Morris, Jackie; Wells, Mandy; Gage, Heather

    2013-12-01

    A quasi-experimental study tested a clinical benchmarking tool (Essence of Care) to improve bowel-related care for older people living in six care homes. In the intervention care homes, district nurses and care home staff used the clinical benchmarking tool to discuss and plan how to improve bowel care for residents. In the control care homes, staff were provided with detailed information about the residents and continence services contact details. The intervention was acceptable to care home and district nursing staff, and possible to incorporate into existing working patterns. The study did not demonstrate a significant reduction in bowel-related problems, although there was evidence in one care home of reduction in episodes of avoidable faecal incontinence. At an individual level of care, there were observable benefits, and examples of person-centred care were prompted through participating in the intervention and improved staff awareness. Clinical benchmarking tools can be used to structure discussion between district nurses and care home staff to review and plan care for residents. However, it takes time to achieve change and embedding this kind of approach requires either robust pre-existing working relationships or the involvement of a facilitator. PMID:24335790

  15. Self-Renewal and Differentiation Capacity of Urine-Derived Stem Cells after Urine Preservation for 24 Hours

    PubMed Central

    Shi, Yingai; Bharadwaj, Shantaram; Leng, Xiaoyan; Zhou, Xiaobo; Liu, Hong; Atala, Anthony; Zhang, Yuanyuan

    2013-01-01

    Despite successful approaches to preserve organs, tissues, and isolated cells, the maintenance of stem cell viability and function in body fluids during storage for cell distribution and transportation remains unexplored. The aim of this study was to characterize urine-derived stem cells (USCs) after optimal preservation of urine specimens for up to 24 hours. A total of 415 urine specimens were collected from 12 healthy men (age range 20–54 years old). About 6×104 cells shed off from the urinary tract system in 24 hours. At least 100 USC clones were obtained from the stored urine specimens after 24 hours and maintained similar biological features to fresh USCs. The stored USCs had a “rice grain” shape in primary culture, and expressed mesenchymal stem cell surface markers, high telomerase activity, and normal karyotypes. Importantly, the preserved cells retained bipotent differentiation capacity. Differentiated USCs expressed myogenic specific proteins and contractile function when exposed to myogenic differentiation medium, and they expressed urothelial cell-specific markers and barrier function when exposed to urothelial differentiation medium. These data demonstrated that up to 75% of fresh USCs can be safely persevered in urine for 24 hours and that these cells stored in urine retain their original stem cell properties, indicating that preserved USCs could be available for potential use in cell-based therapy or clinical diagnosis. PMID:23349776

  16. Accuracy and Usefulness of Select Methods for Assessing Complete Collection of 24-Hour Urine: A Systematic Review.

    PubMed

    John, Katherine A; Cogswell, Mary E; Campbell, Norm R; Nowson, Caryl A; Legetic, Branka; Hennis, Anselm J M; Patel, Sheena M

    2016-05-01

    Twenty-four-hour urine collection is the recommended method for estimating sodium intake. To investigate the strengths and limitations of methods used to assess completion of 24-hour urine collection, the authors systematically reviewed the literature on the accuracy and usefulness of methods vs para-aminobenzoic acid (PABA) recovery (referent). The percentage of incomplete collections, based on PABA, was 6% to 47% (n=8 studies). The sensitivity and specificity for identifying incomplete collection using creatinine criteria (n=4 studies) was 6% to 63% and 57% to 99.7%, respectively. The most sensitive method for removing incomplete collections was a creatinine index <0.7. In pooled analysis (≥2 studies), mean urine creatinine excretion and volume were higher among participants with complete collection (P<.05); whereas, self-reported collection time did not differ by completion status. Compared with participants with incomplete collection, mean 24-hour sodium excretion was 19.6 mmol higher (n=1781 specimens, 5 studies) in patients with complete collection. Sodium excretion may be underestimated by inclusion of incomplete 24-hour urine collections. None of the current approaches reliably assess completion of 24-hour urine collection. PMID:26726000

  17. Population Pharmacokinetic Model Characterizing 24-Hour Variation in the Pharmacokinetics of Oral and Intravenous Midazolam in Healthy Volunteers

    PubMed Central

    van Rongen, A; Kervezee, L; Brill, MJE; van Meir, H; den Hartigh, J; Guchelaar, H-J; Meijer, JH; Burggraaf, J; van Oosterhout, F

    2015-01-01

    Daily rhythms in physiology may affect the pharmacokinetics of a drug. The aim of this study was to evaluate 24-hour variation in the pharmacokinetics of the CYP3A substrate midazolam. Oral (2 mg) and intravenous (1 mg) midazolam was administered at six timepoints throughout the 24-hour period in 12 healthy volunteers. Oral bioavailability (population mean value [RSE%] of 0.28 (7.1%)) showed 24-hour variation that was best parameterized as a cosine function with an amplitude of 0.04 (17.3%) and a peak at 12:14 in the afternoon. The absorption rate constant was 1.41 (4.7%) times increased after drug administration at 14:00. Clearance (0.38 L/min (4.8%)) showed a minor 24-hour variation with an amplitude of 0.03 (14.8%) L/min and a peak at 18:50. Simulations show that dosing time minimally affects the concentration time profiles after intravenous administration, while concentrations are higher during the day compared to the night after oral dosing, reflecting considerable variation in intestinal processes. PMID:26380154

  18. Population Pharmacokinetic Model Characterizing 24-Hour Variation in the Pharmacokinetics of Oral and Intravenous Midazolam in Healthy Volunteers.

    PubMed

    van Rongen, A; Kervezee, L; Brill, Mje; van Meir, H; den Hartigh, J; Guchelaar, H-J; Meijer, J H; Burggraaf, J; van Oosterhout, F

    2015-08-01

    Daily rhythms in physiology may affect the pharmacokinetics of a drug. The aim of this study was to evaluate 24-hour variation in the pharmacokinetics of the CYP3A substrate midazolam. Oral (2 mg) and intravenous (1 mg) midazolam was administered at six timepoints throughout the 24-hour period in 12 healthy volunteers. Oral bioavailability (population mean value [RSE%] of 0.28 (7.1%)) showed 24-hour variation that was best parameterized as a cosine function with an amplitude of 0.04 (17.3%) and a peak at 12:14 in the afternoon. The absorption rate constant was 1.41 (4.7%) times increased after drug administration at 14:00. Clearance (0.38 L/min (4.8%)) showed a minor 24-hour variation with an amplitude of 0.03 (14.8%) L/min and a peak at 18:50. Simulations show that dosing time minimally affects the concentration time profiles after intravenous administration, while concentrations are higher during the day compared to the night after oral dosing, reflecting considerable variation in intestinal processes. PMID:26380154

  19. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... use the information submitted by the homes to produce an actual count, by type and by category (tier I... system, day care homes shall be required to submit the number of meals served, by type, to enrolled... calculation. Under this system, day care homes shall be required to submit the number of meals served, by...

  20. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... use the information submitted by the homes to produce an actual count, by type and by category (tier I... system, day care homes shall be required to submit the number of meals served, by type, to enrolled... calculation. Under this system, day care homes shall be required to submit the number of meals served, by...

  1. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... use the information submitted by the homes to produce an actual count, by type and by category (tier I... system, day care homes shall be required to submit the number of meals served, by type, to enrolled... calculation. Under this system, day care homes shall be required to submit the number of meals served, by...

  2. Home Health Care Utilization: A Review of the Research for Social Work

    ERIC Educational Resources Information Center

    Kadushin, Goldie

    2004-01-01

    The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing,…

  3. Assessing contributors to cost of care in nursing homes.

    PubMed

    Hicks, L L; Rantz, M J; Petroski, G F; Madsen, R W; Conn, V S; Mehr, D R; Porter, R

    1997-01-01

    In 1994 12.7% of the population was 65 and over, while 10.6% were 85 and over. Expenditures for nursing homes reached $72.3 billion in 1994 (much of which is tax-supported) accounting for 8.7% of all personal health money spent. Data from the 1993 Missouri Medicaid cost reports for 403 nursing homes were reviewed to determine differences in costs per resident day (PRD) and discover which factors most influenced these differences. Mid-sized facilities with 60-120 beds reported the lowest resident-related PRD costs. PRD expenses for aides and orderlies were higher in tax-exempt facilities, which was thought to be related to their "more altruistic" mission. Investor-owned facilities showed significantly greater administrative costs PRD, which may relate to higher administrative salaries and fancier offices. The authors suggest further study that would incorporate location, occupancy rate, quality of care, case mix, and payer mix data. PMID:9282032

  4. Ineffective Staff, Ineffective Supervision, or Ineffective Administration? Why Some Nursing Homes Fail to Provide Adequate Care.

    ERIC Educational Resources Information Center

    Sheridan, John E.; And Others

    1992-01-01

    This study involved 530 nursing staff working in 25 for-profit and nonprofit nursing homes, 2 of which failed to meet residential care standards. Nursing home climate in failed homes was perceived as being significantly lower in human relations and higher in laissez-faire and status orientation dimensions that the climate in the successful homes.…

  5. In-home medication reviews: a novel approach to improving patient care through coordination of care.

    PubMed

    Willis, Joel S; Hoy, Robert H; Jenkins, Wiley D

    2011-12-01

    The use of multiple medications, in persons 65 years and older, has been linked to increased risk for cognitive impairment, falls, hip fractures, hospitalizations, adverse drug reactions, and mortality. The purpose of this study was to determine if trained undergraduate students, in conjunction with pharmacists, could provide in-home medication reviews and demonstrate benefit to the health and welfare of a senior population affiliated with a primary care facility. Students received training in the completion of an in-home medication inventory, assessing a home for fall risk, and performing blood pressures. Once trained and proven proficient students performed the assessments in homes of Decatur Family Medicine Residency patients 65 years and older. Collected medication inventories were reviewed by a hospital pharmacist for fall risk medications, major drug interactions, or duplicate therapy. Changes to patient management were made by the primary care provider as needed. In all, 75 students visited 118 patients in Fall 2010. Findings from the medication review include: 102 (86%) patients were prescribed at least one fall risk medication; 43% were prescribed 3 or more; 14% had the potential for a major drug interaction; and 7% were prescribed duplicate therapies. Fifty-seven patients had a subsequent change made to their clinical medication list. The results demonstrate that an in-home outreach can be successfully performed by student volunteers and provide data of high clinical relevance and use. This application of the patient-centered medical home can readily and directly improve patient safety. PMID:21499935

  6. The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives.

    PubMed

    Grigorovich, Alisa

    2016-03-01

    Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy. PMID:25919504

  7. Is it worthwhile to invest in home care?

    PubMed

    Lavoie, Josée G; Forget, Evelyn L; Dahl, Matt; Martens, Patricia J; O'Neil, John D

    2011-05-01

    The objective of this study was to estimate the impact of the First Nations and Inuit Home and Community Care Program (FNIHCCP) on the rates of hospitalization for ambulatory care sensitive conditions (ACSCs) in the province of Manitoba. A population-based time trend analysis was conducted using the de-identified administrative data housed at the Manitoba Centre for Health Policy, including data from 1984/85 to 2004/05. Findings show a significant decline in the rates of hospitalization (all conditions) following the introduction of the FNIHCCP in communities served by health offices (p<0.0001), health centres (p<0.0001) and nursing stations (p=0.0022). Communities served by health offices or health centres also experienced a significant reduction in rates of hospitalization for chronic conditions (p<0.0001).The results of this study suggest that investment in home care resulted in a significant decline in rates of avoidable hospitalization, especially in communities that otherwise had limited access to primary healthcare. PMID:22548097

  8. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  9. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  10. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  11. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  12. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care...

  13. Value of 24-hour Delayed Film of Barium Enema for Evaluation of Colon Transit Function in Young Children with Constipation

    PubMed Central

    Yoo, Ha Yeong; Son, Jae Sung; Park, Hye Won; Kwak, Byung Ok; Kim, Hyeong Su; Bae, Sun Hwan

    2016-01-01

    Background/Aims A colon transit time test using radio-opaque markers (CTTRM) is considered the gold standard for evaluating colon transit function. A 24-hour delayed film of barium enema (BE) has been used as a supplementary method in structural evaluations. The aim of this study was to evaluate the utility of a 24-hour delayed BE film for assessing colon transit function in young children with constipation. Methods In total, 93 children with constipation who performed both single-contrast BE and CTTRM were enrolled in this study. Of these, the data from 70 children were analyzed (males 33, females 37; mean age [range], 5.63 ± 2.94 [2–14] years). The basic principle of the study is “velocity = distance/time”. Time values were identified in both studies, and the colon length and distance of barium movement were measured on the 24-hour delayed BE film. Thus, colon transit velocity values could be calculated using both methods. The correlation between colon transit velocity using a 24-hour delayed BE film versus CTTRM was analyzed statistically. Results Median value (interquartile range) of colon transit velocity using CTTRM was 1.57 (1.07–2.89) cm/hr, and that using BE of that was 1.58 (0.94–2.07) cm/hr. The Spearman correlation coefficient was 0.438 (P < 0.001) for the overall group. The correlation was strongest in children younger than 4 years (r = 0.537, P = 0.032). Conclusions Although the correlation between BE and CTTRM was not very strong, the 24-hour delayed BE film could provide broad information about colon transit function in young children, especially those under 4 years who usually cannot undergo CTTRM. PMID:26979249

  14. Microleakage of Two Self-Adhesive Cements in the Enamel and Dentin After 24 Hours and Two Months

    PubMed Central

    Jaberi Ansari, Zahra; Kalantar Motamedi, Mojdeh

    2014-01-01

    Objective: Microleakage is a main cause of restorative treatment failure. In this study, we compared occlusal and cervical microleakage of two self-adhesive cements after 24 hours and two months. Materials and Methods: In this in-vitro experimental study, class II inlay cavities were prepared on 60 sound human third molars. Composite inlays were fabricated with Z100 composite resin. The teeth were randomly assigned to six groups. RelyX-Arc (control), RelyX-Unicem and Maxcem were used for the first three groups and specimens were stored in distilled water at 37°C for 24 hours. The same cements were used for the remaining three groups, but the specimens were stored for 2 months. The teeth were subjected to 500 thermal cycles (5°C and 55°C) and immersed in 0.5% basic fuchsin for 24 hours and then sectioned mesiodistally and dye penetration was evaluated in a class II cavity with occlusal and cervical margins using X20 magnification stereomicroscope. Data were analyzed using Kruskal Wallis and Mann-Whitney U tests. Results: After 24 hours, cements had significant differences only in cervical margin microleakage (P=0.0001) and microleakage of RelyX-Unicem and Maxcem was significantly more than that of RelyX-Arc (both P=0.0001). Cervical microleakage in RelyX-Unicem and Maxcem was greater than occlusal (P=0.0001 and P=0.001, respectively). Microleakage was not significantly different between the occlusal and cervical margins after 2 months. Conclusion: Cervical microleakage was greater than occlusal in RelyX-Unicem and Maxcem after 24h. The greatest microleakage was reported for the cervical margin of RelyX-Unicem after 24 hours. PMID:25584053

  15. Cancer patient-centered home care: a new model for health care in oncology

    PubMed Central

    Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445

  16. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-26

    ... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2013 Through June 30, 2014 AGENCY: Food and Nutrition Service...-risk afterschool care centers, and adult day care centers; the food service payment rates for meals...

  17. Changes in platelet morphology and function during 24 hours of storage.

    PubMed

    Braune, S; Walter, M; Schulze, F; Lendlein, A; Jung, F

    2014-01-01

    aggregates could be visualized microscopically. After four hours, first debris and very small aggregates occurred. After 24 hours, platelet aggregates and also debris progressively increased. In accordance to this, the CASY system revealed an increase of platelet aggregates (up to 90 μm diameter) with increasing storage time. The percentage of CD62P positive platelets and PF4 increased significantly with storage time in resting PRP. When soluble ADP was added to stored PRP samples, the number of activatable platelets decreased significantly over storage time. The present study reveals the importance of a consequent standardization in the preparation of WB and PRP. Platelet morphology and function, particularly platelet reactivity to adherent or soluble agonists in their surrounding milieu, changed rapidly outside the vascular system. This knowledge is of crucial interest, particularly in the field of biomaterial development for cardiovascular applications, and may help to define common standards in the in vitro hemocompatibility testing of biomaterials. PMID:25227196

  18. Irregular 24-hour Activity Rhythms and the Metabolic Syndrome in Older Adults

    PubMed Central

    Sohail, Shahmir; Yu, Lei; Bennett, David A.; Buchman, Aron S.; Lim, Andrew S.P.

    2015-01-01

    Circadian rhythms – near 24-hour intrinsic biological rhythms – modulate many aspects of human physiology and hence disruption of circadian rhythms may have an important impact on human health. Experimental work supports a potential link between irregular circadian rhythms and several key risk factors for cardiovascular disease including hypertension, obesity, diabetes, and dyslipidemia, collectively termed the metabolic syndrome. While several epidemiological studies have demonstrated an association between shift-work and the components of the metabolic syndrome in working-age adults, there is a relative paucity of data concerning the impact of non-occupational circadian irregularity in older women and men. To address this question, we studied 7 days of actigraphic data from 1137 older woman and men participating in the Rush Memory and Aging Project, a community-based cohort study of the chronic conditions of aging. The regularity of activity rhythms was quantified using the nonparametric interdaily stability metric, and was related to the metabolic syndrome and its components obesity, hypertension, diabetes, and dyslipidemia. More regular activity rhythms were associated with a lower odds of having the metabolic syndrome (OR=0.69, 95%CI=0.60–0.80, p=5.8×10−7), being obese (OR=0.73, 95%CI=0.63–0.85, p=2.5×10−5), diabetic (OR=0.76, 95%CI=0.65–0.90, p=9.3×10−4), hypertensive (OR=0.78, 95%CI=0.66–0.91, p=2.0×10−3), or dyslipidemic (OR=0.82, 95%CI=0.72–0.92, p=1.2×10−3). These associations were independent of differences in objectively measured total daily physical activity or rest, and were not accounted for by prevalent coronary artery disease, stroke, or peripheral artery disease. Moreover, more regular activity rhythms were associated with lower odds of having cardiovascular disease (OR=0.83; 95%CI=0.73–0.95, p=5.7×10−3), an effect that was statistically mediated by the metabolic syndrome. We conclude that irregular activity

  19. From risky to safer home care: health care assistants striving to overcome a lack of training, supervision, and support

    PubMed Central

    Swedberg, Lena; Chiriac, Eva Hammar; Törnkvist, Lena; Hylander, Ingrid

    2013-01-01

    Patients receiving home care are becoming increasingly dependent upon competent caregivers’ 24-h availability due to their substantial care needs, often with advanced care and home care technology included. In Sweden, care is often carried out by municipality-employed paraprofessionals such as health care assistants (HC assistants) with limited or no health care training, performing advanced care without formal training or support. The aim of this study was to investigate the work experience of the HC assistants and to explore how they manage when delivering 24-h home care to patients with substantial care needs. Grounded theory methodology involving multiple data sources comprising interviews with HC assistants (n=19) and field observations in patients’ homes was used to collect data and constant comparative analysis was used for analysis. The initial analysis revealed a number of barriers, competence gap; trapped in the home setting; poor supervision and unconnected to the patient care system, describing the risks associated with the situations of HC assistants working in home care, thus affecting their working conditions as well as the patient care. The core process identified was the HC assistants’ strivings to combine safe home care with good working conditions by using compensatory processes. The four identified compensatory processes were: day-by-day learning; balancing relations with the patient; self-managing; and navigating the patient care system. By actively employing the compensatory processes, the HC assistants could be said to adopt an inclusive approach, by compensating for their own barriers as well as those of their colleagues’ and taking overall responsibility for their workplace. In conclusion, the importance of supporting HC assistants in relation to their needs for training, supervision,and support from health care professionals must be addressed when organising 24-h home care to patients with substantial care needs in the future. PMID

  20. Day Care in Caracas: A Day Care Homes Program Evaluation Report. Volume I: Executive Summary.

    ERIC Educational Resources Information Center

    de Ruesta, Maria Carlota; de Vidal, Amalia Barrios

    This document provides a summary of a formative evaluation research project concerning the neighborhood day care homes program in Caracas, Venezuela. The evaluation included nine lines of study: (1) an assessment of sociodemographic conditions of Venezuelan preschool age children, legal and employment status of Venezuelan women, and general social…

  1. What proportion of dental care in care homes could be met by direct access to dental therapists or dental hygienists?

    PubMed Central

    Monaghan, N. P.; Morgan, M. Z.

    2015-01-01

    Background Many care home residents require simple dental treatment which is complicated by the need for extra time to deliver dental care. The proportion of their care which could be delivered wholly by hygienists or therapists is unknown. Method 2010 Welsh dental care home survey data on clinical opinion of treatment need and special care skill level required was cross referenced with General Dental Council guidance on direct access. Results Care home residents treatment needs could be wholly addressed by a generalist dental hygienist or therapist for 22% and 27% of cases respectively. With special care experience these figures increase to 43% and 53%. Discussion A large proportion of need in care homes could be wholly provided by hygienists or therapists, especially those with special care experience. The potential efficiency gain of direct access arises from individuals who do not need to see a dentist for any aspects of their care. Direct access to hygienists/therapists for dental care of care home residents should be piloted and evaluated. Conclusion Hygienists and therapists could make a large contribution to addressing dental treatment needs of care home residents and direct access could be an efficient model of care for this setting. PMID:26657440

  2. Home health, long-term care, and other compliance activities.

    PubMed

    Anderson, T D; Sadoff, J W

    1999-04-01

    The Federal government continues to crack down on fraud and abuse in the healthcare industry with such initiatives and tools as Operation Restore Trust and intermediate tax sanctions. Home health and long-term care organizations are the latest entities under study by the Office of Inspector General, and the result of these studies likely will be more antifraud and abuse measures being taken against these entities. All healthcare organizations should pay particular attention to their tax risk exposure. Healthcare organizations that put effective compliance programs in place should be able to reduce the overall risk of challenges to their financial practices. PMID:10557979

  3. A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service

    PubMed Central

    Lewin, Gill; Allan, Janine; Patterson, Candice; Knuiman, Matthew; Boldy, Duncan; Hendrie, Delia

    2014-01-01

    Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. PMID:24438385

  4. Exploring the Medical Home in Ryan White HIV Care Settings: A Pilot Study

    PubMed Central

    Beane, Stephanie N.; Culyba, Rebecca J.; DeMayo, Michael; Armstrong, Wendy

    2014-01-01

    Amid increased attention to the cost of health care, health information technology, and specialization and fragmentation in medicine, the medical home has achieved recognition as a model for more effective and efficient health care. Little data are available on recently funded HIV medical home demonstration projects, and no research richly describes existing medical home characteristics, implementation challenges, and impact on outcomes in longstanding HIV outpatient settings. The Ryan White HIV/AIDS Program (RWP) provides federal funding for primary and specialty care for people living with HIV. Although RWP clinics developed independently of the medical home model, existing data indirectly support that, with emphasis on primary, comprehensive, and patient-centered care, RWP clinics operate as medical homes. This study explores the development, definition, and implementation of medical home characteristics by RWP-funded providers in order to better understand how it fits with broader debates about medical homes and health care reform. PMID:24560357

  5. [Specifics of Analgesia in Palliative Care Patients at Home].

    PubMed

    Pautex, Sophie

    2015-02-25

    Pain management at home for a patient, suffering from one or more advanced progressive diseases, goes beyond the prescription of an opioid. Apart from the importance of finding the most suitable analgesic drug (controlled pain with least possible adverse effects), three important dimensions will be addressed: interprofessionnal care (shared care goals, evaluation, monitoring of pain and other symptoms; physiotherapy, etc.) information, education and support for patients and relatives in particular on the use of opioids, and finally the importance of anticipation. This includes for example the requirement of breakthrough pain treatment in case of pain exacerbation or the definition of the place of hospitalization in case of worsening general condition or of death. PMID:25711785

  6. Twelve Home Cleaning Recipes

    MedlinePlus

    ... for Safe and Effective Disinfection Twelve Home Cleaning Recipes Safer alternatives to hazardous cleaning products exist for ... 24 hours at room temperature. All Purpose Cleaner recipes for use on counters, floors and other hard ...

  7. Sensor network infrastructure for a home care monitoring system.

    PubMed

    Palumbo, Filippo; Ullberg, Jonas; Stimec, Ales; Furfari, Francesco; Karlsson, Lars; Coradeschi, Silvia

    2014-01-01

    This paper presents the sensor network infrastructure for a home care system that allows long-term monitoring of physiological data and everyday activities. The aim of the proposed system is to allow the elderly to live longer in their home without compromising safety and ensuring the detection of health problems. The system offers the possibility of a virtual visit via a teleoperated robot. During the visit, physiological data and activities occurring during a period of time can be discussed. These data are collected from physiological sensors (e.g., temperature, blood pressure, glucose) and environmental sensors (e.g., motion, bed/chair occupancy, electrical usage). The system can also give alarms if sudden problems occur, like a fall, and warnings based on more long-term trends, such as the deterioration of health being detected. It has been implemented and tested in a test environment and has been deployed in six real homes for a year-long evaluation. The key contribution of the paper is the presentation of an implemented system for ambient assisted living (AAL) tested in a real environment, combining the acquisition of sensor data, a flexible and adaptable middleware compliant with the OSGistandard and a context recognition application. The system has been developed in a European project called GiraffPlus. PMID:24573309

  8. Sensor Network Infrastructure for a Home Care Monitoring System

    PubMed Central

    Palumbo, Filippo; Ullberg, Jonas; Štimec, Ales; Furfari, Francesco; Karlsson, Lars; Coradeschi, Silvia

    2014-01-01

    This paper presents the sensor network infrastructure for a home care system that allows long-term monitoring of physiological data and everyday activities. The aim of the proposed system is to allow the elderly to live longer in their home without compromising safety and ensuring the detection of health problems. The system offers the possibility of a virtual visit via a teleoperated robot. During the visit, physiological data and activities occurring during a period of time can be discussed. These data are collected from physiological sensors (e.g., temperature, blood pressure, glucose) and environmental sensors (e.g., motion, bed/chair occupancy, electrical usage). The system can also give alarms if sudden problems occur, like a fall, and warnings based on more long-term trends, such as the deterioration of health being detected. It has been implemented and tested in a test environment and has been deployed in six real homes for a year-long evaluation. The key contribution of the paper is the presentation of an implemented system for ambient assisted living (AAL) tested in a real environment, combining the acquisition of sensor data, a flexible and adaptable middleware compliant with the OSGistandard and a context recognition application. The system has been developed in a European project called GiraffPlus. PMID:24573309

  9. Family Members Providing Home-Based Palliative Care to Older Adults: The Enactment of Multiple Roles

    ERIC Educational Resources Information Center

    Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy

    2008-01-01

    Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis…

  10. Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

    ERIC Educational Resources Information Center

    Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

    2007-01-01

    Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

  11. An Evaluation of Health and Safety Hazards in Family Based Day Care Homes in Philadelphia

    ERIC Educational Resources Information Center

    Perez, Hernando; Haynes, Sonia; Michael, Karen; Burstyn, Igor; Jandhyala, Malica; Palermo, Peter

    2011-01-01

    In Pennsylvania, Family Day Care Homes (FDCH) are private residences used to care for up to six children in a 24 h period. These homes are often times the most affordable alternative to day care centers parents have in low-income communities. The aims of this study were to evaluate FDCH providers' knowledge of hazards and their understanding of…

  12. Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

    ERIC Educational Resources Information Center

    Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.

    2003-01-01

    Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…

  13. Rethinking Teaching Nursing Homes: Potential for Improving Long-Term Care

    ERIC Educational Resources Information Center

    Mezey, Mathy D.; Mitty, Ethel L.; Burger, Sarah Green

    2008-01-01

    To meet the special needs of and provide quality health care to nursing home residents, the health care workforce must be knowledgeable about the aging process. Health professionals are minimally prepared in their academic programs to care for older adults, and few programs have required rotations in geriatrics. Teaching nursing homes (TNHs) have…

  14. Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

    ERIC Educational Resources Information Center

    Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne

    2011-01-01

    The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…

  15. Children Can't Wait: Reducing Delays in Out-of-Home Care.

    ERIC Educational Resources Information Center

    Cahn, Katharine, Ed.; Johnson, Paul, Ed.

    It is estimated that the average child entering out-of-home care will remain for 3 years. This book provides a collection of essays based on the need for permanent homes for children in foster care. The essays support the concept of shortening a child's time spent in temporary foster care. The six articles in the book are: (1) "Critical Issues in…

  16. Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

    ERIC Educational Resources Information Center

    Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

    2010-01-01

    Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

  17. Why are some care homes better than others? An empirical study of the factors associated with quality of care for older people in residential homes in Surrey, England.

    PubMed

    Gage, Heather; Knibb, Wendy; Evans, Joanne; Williams, Peter; Rickman, Neil; Bryan, Karen

    2009-11-01

    This paper reports an empirical study that investigated associations between the quality of care received by older people in residential settings and features of the care homes in which they live. Data were gathered from the first announced inspection reports (2002-2003) of all 258 care homes for older people in one county of England (Surrey). The number of inspected standards failed in each home was used as the main indicator of quality of care. Independent variables (for each home) were: size, type, specialist registration, on-site nursing, ownership, year registered, location, maximum fee, vacancies, resident dependency, whether the home took publicly funded residents, care staff qualifications and managerial quality. Quality of care was modelled using a Poisson count maximum likelihood method based on 245 (91%) of the inspected homes for which relevant data were available. The results showed that quality of care (as defined by failures on national standards) was statistically associated with features of care homes and their residents. A higher probability of failing a standard was significantly associated with being a home that: was a for-profit small business (adjusted risk ratio (RR) = 1.17); was registered before 2000 (adj. RR = 1.22), accommodated publicly funded residents (adj. RR = 1.12); was registered to provide nursing care (adj. RR = 1.12). Fewer failures were associated with homes that were corporate for-profit (adj. RR = 0.82); held a specialist registration (adj. RR = 0.91); charged higher maximum fees (adj. RR = 0.98 per 100 pound sterling unit). A secondary analysis revealed a stronger model: higher scores on managerial standards correlated with fewer failures on other standards (r = 0.65, P < 0.001). The results of this study may help inform future policy. They are discussed in the context of alternative approaches to measuring quality of residential care, and in terms of their generalisability. PMID:19601991

  18. Changes in foot volume, body composition, and hydration status in male and female 24-hour ultra-mountain bikers

    PubMed Central

    2014-01-01

    Background The effects of running and cycling on changes in hydration status and body composition during a 24-hour race have been described previously, but data for 24-hour ultra-mountain bikers are missing. The present study investigated changes in foot volume, body composition, and hydration status in male and female 24-hour ultra-mountain bikers. Methods We compared in 49 (37 men and 12 women) 24-hour ultra-mountain bikers (ultra-MTBers) changes (Δ) in body mass (BM). Fat mass (FM), percent body fat (%BF) and skeletal muscle mass (SM) were estimated using anthropometric methods. Changes in total body water (TBW), extracellular fluid (ECF) and intracellular fluid (ICF) were determined using bioelectrical impedance and changes in foot volume using plethysmography. Haematocrit, plasma [Na+], plasma urea, plasma osmolality, urine urea, urine specific gravity and urine osmolality were measured in a subgroup of 25 ultra-MTBers (16 men and 9 women). Results In male 24-hour ultra-MTBers, BM (P < 0.001), FM (P < 0.001), %BF (P < 0.001) and ECF (P < 0.05) decreased whereas SM and TBW did not change (P > 0.05). A significant correlation was found between post-race BM and post-race FM (r = 0.63, P < 0.001). In female ultra-MTBers, BM (P < 0.05), %BF (P < 0.05) and FM (P < 0.001) decreased, whereas SM, ECF and TBW remained stable (P > 0.05). Absolute ranking in the race was related to Δ%BM (P < 0.001) and Δ%FM in men (P < 0.001) and to Δ%BM (P < 0.05) in women. In male ultra-MTBers, increased post-race plasma urea (P < 0.001) was negatively related to absolute ranking in the race, Δ%BM, post-race FM and Δ%ECF (P < 0.05). Foot volume remained stable in both sexes (P > 0.05). Conclusions Male and female 24-hour ultra-MTBers experienced a significant loss in BM and FM, whereas SM remained stable. Body weight changes and increases in plasma urea do not reflect a change in body hydration status. No oedema

  19. The Effect of Entry Regulation in the Health Care Sector: the Case of Home Health

    PubMed Central

    Polsky, Daniel; David, Guy; Yang, Jianing; Kinosian, Bruce; Werner, Rachel

    2013-01-01

    The consequences of government regulation in the post-acute care sector are not well understood. We examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries (about 4.5 million) and subsequent home health admissions to determine whether there is a significant difference in home health utilization, hospital readmission rates, and health care expenditures in states with and without Certificate of Need laws (CON) regulating entry. We identify these effects by looking across regulated and nonregulated states within Hospital Referral Regions, which characterize well-defined health care markets and frequently cross state boundaries. We find that CON states use home health less frequently, but system-wide rehospitalization rates, overall Medicare expenditures, and home health practice patterns are similar. Removing CON for home health would have negligible system-wide effects on health care costs and quality. PMID:24497648

  20. Co-learning with home care aides and their clients: collaboratively increasing individual and organizational capacities.

    PubMed

    Muramatsu, Naoko; Madrigal, Jessica; Berbaum, Michael L; Henderson, Vida A; Jurivich, Donald A; Zanoni, Joseph; Marquez, David X; Cruz Madrid, Katya

    2015-01-01

    Changes in health care provide unprecedented opportunities for collaboration across research, education, and practice for the common goal of enhancing the well-being of older adults and their caregivers. This article describes how a pilot project, Promoting Seniors' Health with Home Care Aides, has synergistic education, research, and practice effects that enhance individual and organizational capacities. This pilot is an innovative partnership with home care aides to deliver a safe physical activity program appropriate for frail seniors in a real-life public home care program. The intervention and research occur in older adults' homes and thus provide rare opportunities for the research team and partners to learn from each other about dynamics of home care in older adults' life contexts. Co-learning is essential for continuous quality improvement in education, research and practice. The authors propose to establish "teaching home care" to ensure ongoing co-learning in gerontology and geriatrics. PMID:25671492

  1. The Effect of Entry Regulation in the Health Care Sector: the Case of Home Health.

    PubMed

    Polsky, Daniel; David, Guy; Yang, Jianing; Kinosian, Bruce; Werner, Rachel

    2014-02-01

    The consequences of government regulation in the post-acute care sector are not well understood. We examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries (about 4.5 million) and subsequent home health admissions to determine whether there is a significant difference in home health utilization, hospital readmission rates, and health care expenditures in states with and without Certificate of Need laws (CON) regulating entry. We identify these effects by looking across regulated and nonregulated states within Hospital Referral Regions, which characterize well-defined health care markets and frequently cross state boundaries. We find that CON states use home health less frequently, but system-wide rehospitalization rates, overall Medicare expenditures, and home health practice patterns are similar. Removing CON for home health would have negligible system-wide effects on health care costs and quality. PMID:24497648

  2. Digital transformation in home care. A case study.

    PubMed

    Bennis, Sandy; Costanzo, Diane; Flynn, Ann Marie; Reidy, Agatha; Tronni, Catherine

    2007-01-01

    Simply implementing software and technology does not assure that an organization's targeted clinical and financial goals will be realized. No longer is it possible to roll out a new system--by solely providing end user training and overlaying it on top of already inefficient workflows and outdated roles--and know with certainty that targets will be met. At Virtua Health's Home Care, based in south New Jersey, implementation of their electronic system initially followed this more traditional approach. Unable to completely attain their earlier identified return on investment, they enlisted the help of a new role within their health system, that of the nurse informaticist. Knowledgeable in complex clinical processes and not bound by the technology at hand, the informaticist analyzed physical workflow, digital workflow, roles and physical layout. Leveraging specific tools such as change acceleration, workouts and LEAN, the informaticist was able to redesign workflow and support new levels of functionality. This article provides a view from the "finish line", recounting how this role worked with home care to assimilate information delivery into more efficient processes and align resources to support the new workflow, ultimately achieving real tangible returns. PMID:19195281

  3. Expanded, but not regulated: ambiguity in home-care policy in Ireland.

    PubMed

    Timonen, Virpi; Doyle, Martha; O'Dwyer, Ciara

    2012-05-01

    This article argues that home-care policy in Ireland was ambiguous throughout the first decade of the 21st century: policy-makers expanded home care, but failed to develop policies to govern this expanded provision. As a result, home care became more widely available in the absence of a framework to govern access to services and to regulate care providers. We analysed official policy documents, statistics and policy critiques published between 2000 and 2010 in order to understand this incongruity between the expansion of home-care services and the failure to develop policies to govern access to and quality of services. The key factors that motivated home-care expansion in the Irish case were: (1) problems in the acute hospital sector and the perception of home care as a partial solution to these (political blame avoidance) and (2) significant GDP growth (until 2007) that provided politicians with the means to fund expansion in home-care services (political credit claiming). The key factors that inhibited the development of a policy framework to govern home-care services were: (1) weak governance structures in health services and decision-making at national level based on short-term political gain; (2) Ireland's adherence to the liberal welfare state model and concern about uncontrollable care costs in the face of population ageing; (3) until 2010, paucity of attention to home-care issues in the Irish media and (4) weak provider interest representation. The recent budgetary cutbacks in Ireland bring into sharp relief the political expediency of an unregulated domiciliary care sector and absence of entitlements to home care. We conclude that the forces that drive expanded provision are different from drivers of policy to govern home care and that weakness of governance structures and political advantages of the absence of regulation are the main reasons for the lack of standards and entitlement rules. PMID:22168468

  4. Rehospitalization of Older Adults Discharged to Home Hospice Care

    PubMed Central

    Goldenheim, Anna; Oates, Daniel; Parker, Victoria; Russell, Matthew; Winter, Michael

    2014-01-01

    Abstract Background: Acute hospital readmission of older adults receiving hospice care is not aligned with hospice goals. Objective: To identify factors associated with 30-day readmission among older adults newly discharged to hospice. Design/Subjects: Medical record review of 59 patients, 19 readmitted within 30 days and 40 randomly selected controls not readmitted, from 206 patients newly discharged to home hospice care between February 1, 2005 and January 31, 2010. Measures/Analysis: Information was collected about hospital course, end-of-life planning, and posthospitalization follow-up. We calculated bivariate associations and developed a Cox Proportional Hazards model examining the relation between index admission characteristics and readmission. Results: Patients' mean age was 79.7±8.4; 74.6% were female; 52.5% were black. Among those readmitted, 25% had received a palliative care consultation, compared to 47.1% of those not readmitted (p=0.06). Patients without a participating decision-maker involved in their hospice decision had 3.5 times the risk of readmission within 30 days, compared to those with (hazard ratio [HR] 3.53, confidence interval [CI] 0.97, 12.82). Patients who had one or more telephone contacts with their primary care physician (PCP) during week 1 after discharge had 2.4 times the readmission risk within 30 days, compared to patients with no such contacts during this period (HR 2.35, CI 0.9, 6.1). Conclusions: Readmission within 30 days of initial discharge to hospice is associated with several measures of care and care planning. Further study of these measures may identify opportunities for interventions to improve the hospital-to-hospice transition and to decrease hospital readmissions. PMID:24708490

  5. Decision Makers' Allocation of Home-Care Therapy Services: A Process Map

    PubMed Central

    Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine

    2013-01-01

    ABSTRACT Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care. PMID:24403672

  6. Re-Imagining the Care Home: A Spatially Responsive Approach to Arts Practice with Older People in Residential Care

    ERIC Educational Resources Information Center

    Hatton, Nicola

    2014-01-01

    This paper considers some of the spatial challenges of doing arts projects with older people in care homes, including those living with dementia. It reflects on the author's own experience of running a performance project with residents with at a care home in North London. Drawing on Lefebvre's concept of socially produced space, it argues that…

  7. Food Intake Recording Software System, version 4 (FIRSSt4): A Self-Completed 24 Hour Dietary Recall for Children

    PubMed Central

    Baranowski, Tom; Islam, Noemi; Douglass, Deirdre; Dadabhoy, Hafza; Beltran, Alicia; Baranowski, Janice; Thompson, Debbe; Cullen, Karen W.; Subar, Amy F.

    2012-01-01

    The Food Intake Recording Software System, version 4(FIRSSt4), is a web-based 24 hour dietary recall (24hdr) self-administered by children based on the Automated Self-Administered 24-hour recall (ASA24) (a self-administered 24hdr for adults). The food choices in FIRSST4 are abbreviated to include only those reported by children in U.S. national surveys; and detailed food probe questions are simplified to exclude those that children could not be expected to answer (for example questions regarding food preparation and added fats). ASA24 and FIRSSt4 incorporate 10,000+ food images with up to eight images per food to assist in portion size estimation. This paper reviews the formative research conducted during the development of FIRSSt4. When completed, FIRSSt4 will be hosted and maintained for investigator use on the National Cancer Institute’s ASA24 website. PMID:22616645

  8. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    PubMed Central

    Siriphuwanun, Visith; Punjasawadwong, Yodying; Lapisatepun, Worawut; Charuluxananan, Somrat; Uerpairojkit, Ketchada

    2014-01-01

    than or equal to 65 years of age (OR =4.30, 95% CI =1.13–16.42), upper abdominal site of surgery (OR =10.86, 95% CI =1.99–59.13), shock prior to cardiac arrest (OR =3.62, 95% CI =1.30–10.12), arrhythmia prior to cardiac arrest (OR =4.61, 95% CI =1.01–21.13), and cardiac arrest occurring in the postoperative period (OR =3.63, 95% CI =1.31–10.02). Conclusion The mortality and morbidity in patients who received anesthesia for emergency surgery within 24 hours of their first CPR were high, and were associated with identifiable patient comorbidity, age, shock, anatomic site of operation, the timing of cardiac arrest, EKG rhythm, and the duration of CPR. EKG monitoring helps to identify cardiac arrest quickly and diagnose the EKG rhythm as a shockable or nonshockable rhythm, with CPR being performed as per the American Heart Association (AHA) CPR Guidelines 2010. The use of the fast track system in combination with an interdisciplinary team for surgery, CPR, and postoperative care helps to rescue patients in a short time. PMID:25378961

  9. [Terminal home care "Ikigai no Yoake--The real aim of our life"--case report].

    PubMed

    Funato, T; Funato, H; Kato, A; Matsuoka, Y; Shibuya, R; Usui, Y; Niwa, Y

    1998-12-01

    It is difficult to provide home care especially for terminal cancer patients as their physical conditions deteriorate due to the cancer. It is important to enhance the will of home care providers to make this possible. Although a universal method has been worked out, personal and religious beliefs have made it difficult to create an effective method. We would like to introduce our experience in the paper entitled "Ikigai no Yoake" and subtitled "Influence of scientific study of reincarnation on view of life" by Fumihiko Ida of Fukushima University. It has encouraged home care providers and made it possible to provide home care to terminal patients along with benefits. PMID:9884644

  10. Quality of death: a dimensional analysis of palliative care in the nursing home.

    PubMed

    Trotta, Rebecca L

    2007-10-01

    Palliative care in nursing homes is increasingly discussed, investigated, and implemented, yet the term lacks conceptual clarity and definition. Furthermore, the components, process, and outcomes of palliative care as it is delivered in the nursing home have not been clearly articulated. This paper provides a dimensional analysis of palliative care in the nursing home to elucidate the concept and its context and consequences, as portrayed through available literature. As a method, dimensional analysis is rooted in symbolic interaction and grounded theory. As such, it provides a useful tool with which to analyze existing literature on palliative care in the nursing home. In this dimensional analysis, communication is the dominant perspective of palliative care in the nursing home. This analysis demonstrates that the consequences of palliative care in the nursing home are personhood and identity, and quality of death rather than quality of life. These consequences suggest that the focus of palliative care should be on the nursing home resident and the dying experience, rather than quality of life and issues around living that exclude the dying experience and do not acknowledge the personhood and identity of the resident. These elements represent a shift in focus away from one that does not include death, toward the dying experience, and that such a change in focus is necessary to achieve palliative care in the nursing home. Finally, the analysis elucidates potential outcome measures for the study of palliative care in nursing homes and outlines possibilities for further research. PMID:17985968

  11. [Decision making support for chemotherapy outpatients and their families: role of the home care professional].

    PubMed

    Nakayama, Shinya; Watanabe, Go; Yamagiwa, Tetsuya; Hasuike, Shiga; Ito, Satoko; Suzuki, Kaoru; Yamaoka, Yoshio; Yasugi, Mayumi

    2014-12-01

    The intervention of palliative care from the early stages of cancer is advocated, however, current situation remains virtually unchanged. Since the Baptist Home Hospice Palliative Care Clinic opened, the percentage of patients who have been introduced to the clinic during chemotherapy and have received home-visit care is 16.1%. Of those, the percentage of patients who passed away more than two months since the start of home-visit care is 45.7%. We determine the direction in care by listening closely to our patients and their families, and putting advance care planning (ACP) into effect. One of our roles is to offer support in deciding to discontinue the treatment in the final stages of chemotherapy. It is recognized that a number of patients are undergoing ineffective chemotherapy, despite the strong side effects. Our clinic strives to help these patients spend time the way they want by providing home-visit care and home-visit nursing. PMID:25595072

  12. Dipstick Spot urine pH does not accurately represent 24 hour urine PH measured by an electrode

    PubMed Central

    Omar, Mohamed; Sarkissian, Carl; Jianbo, Li; Calle, Juan; Monga, Manoj

    2016-01-01

    ABSTRACT Objectives To determine whether spot urine pH measured by dipstick is an accurate representation of 24 hours urine pH measured by an electrode. Materials and Methods We retrospectively reviewed urine pH results of patients who presented to the urology stone clinic. For each patient we recorded the most recent pH result measured by dipstick from a spot urine sample that preceded the result of a 24-hour urine pH measured by the use of a pH electrode. Patients were excluded if there was a change in medications or dietary recommendations or if the two samples were more than 4 months apart. A difference of more than 0.5 pH was considered an inaccurate result. Results A total 600 patients were retrospectively reviewed for the pH results. The mean difference in pH between spot urine value and the 24 hours collection values was 0.52±0.45 pH. Higher pH was associated with lower accuracy (p<0.001). The accuracy of spot urine samples to predict 24-hour pH values of <5.5 was 68.9%, 68.2% for 5.5 to 6.5 and 35% for >6.5. Samples taken more than 75 days apart had only 49% the accuracy of more recent samples (p<0.002). The overall accuracy is lower than 80% (p<0.001). Influence of diurnal variation was not significant (p=0.588). Conclusions Spot urine pH by dipstick is not an accurate method for evaluation of the patients with urolithiasis. Patients with alkaline urine are more prone to error with reliance on spot urine pH. PMID:27286119

  13. 24-hour evaluation of dental plaque bacteria and halitosis after consumption of a single placebo or dental treat by dogs.

    PubMed

    Jeusette, Isabelle C; Román, Aurora Mateo; Torre, Celina; Crusafont, Josep; Sánchez, Nuria; Sánchez, Maria C; Pérez-Salcedo, Leire; Herrera, David

    2016-06-01

    OBJECTIVE To determine whether consumption of a single dental treat with specific mechanical properties and active ingredients would provide a 24-hour effect on dental plaque bacteria and halitosis in dogs. ANIMALS 10 dogs of various breeds from a privately owned colony that had received routine dental scaling and polishing 4 weeks before the study began. PROCEDURES Dogs were randomly assigned to receive 1 placebo or dental treat first. A 4-week washout period was provided, and then dogs received the opposite treatment. Oral plaque and breath samples were collected before and 0.5, 3, 12, and 24 hours after treat consumption. Volatile sulfur compounds (VSCs) concentration was measured in breath samples. Total aerobic, total anaerobic, Porphyromonas gulae, Prevotella intermedia-like, Tannerella forsythia, and Fusobacterium nucleatum bacterial counts (measured via bacterial culture) and total live bacterial counts, total live and dead bacterial counts, and bacterial vitality (measured via quantitative real-time PCR assay) were assessed in plaque samples. RESULTS Compared with placebo treat consumption, dental treat consumption resulted in a significant decrease in breath VSCs concentration and all plaque bacterial counts, without an effect on bacterial vitality. Effects of the dental treat versus the placebo treat persisted for 12 hours for several bacterial counts and for 24 hours for breath VSCs concentration. CONCLUSIONS AND CLINICAL RELEVANCE Although clinical benefits should be investigated in larger scale, longer-term studies, results of this study suggested that feeding the evaluated dental treat may help to decrease oral bacterial growth in dogs for 12 hours and oral malodor for 24 hours. A feeding interval of 12 hours is therefore recommended. PMID:27227499

  14. HOW RELIABLE IS 24 HOUR SERUM LITHIUM LEVEL AFTER A TEST DOSE OF LITHIUM IN PREDICTING OPTIMAL LITHIUM DOSE?

    PubMed Central

    Kuruvilla, K.; Shaji, K.S.

    1989-01-01

    SUMMARY 57% of a group of 35 patients treated with Lithium Carbonate at dosages predicted by the nomogram suggested by Cooper et al (1973) failed to reach therapeutic levels of serum lithium. This finding casts serious doubts on the usefulness of the claim by Cooper et al (1973 & 1976) that 24 hour serum lithium level after a test dose of 600 mg. lithium can predict the daily lithium dose. PMID:21927360

  15. 75 FR 41793 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-19

    ..., 2009, at 74 FR 34295. Child and Adult Care Food Program (CACFP) Lunch and Centers Breakfast supper \\1... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2010 Through June 30, 2011 AGENCY: Food and Nutrition...

  16. 76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-20

    ..., 2010, at 75 FR 41793. Child and Adult Care Food Program (CACFP) [Per meal rates in whole or fractions... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2011 Through June 30, 2012 AGENCY: Food and Nutrition...

  17. What Makes Migrant Live-in Home Care Workers in Elder Care Be Satisfied with Their Job?

    ERIC Educational Resources Information Center

    Iecovich, Esther

    2011-01-01

    Purpose: The study aims to examine job satisfaction of migrant live-in home care workers who provide care to frail older adults and to examine the extent to which quality of relationships between the care provider and care recipient and workplace characteristics is associated with job satisfaction. Design and Methods: A convenience sample that…

  18. Palliative and end-of-life care for people living with dementia in care homes: part 2.

    PubMed

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-29

    This article, the second of two, provides healthcare practitioners with an overview of best practice in palliative and end-of-life care, including nutrition, hydration, oral hygiene and pain management. Communication and spiritual care are discussed, as well as care after death. Providing support and education for families is an important aspect of palliative and end-of-life care. Care home nurses should ensure that the person living with dementia is at the centre of decision making, and provide care that is inclusive of their needs and wishes. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. PMID:27353937

  19. Task shifting in the provision of home and social care in Ontario, Canada: implications for quality of care.

    PubMed

    Denton, Margaret; Brookman, Catherine; Zeytinoglu, Isik; Plenderleith, Jennifer; Barken, Rachel

    2015-09-01

    Growing healthcare costs have caused home-care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home-care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home-care workers (HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010-2011. Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home-care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G-tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust-based relationships with clients; and because task shifting reduced the number of care providers entering the client's home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed. PMID:25471361

  20. [Inefficient management of personal health in oral anticoagulation. Home nursing care in primary health care].

    PubMed

    López Castañón, Lorena

    2012-01-01

    This case report describes an 83 year-old immobilised patient with multiple diseases and on polypharmacy. Nursing care is developed at home. The patient is included in patient care programs for the anticoagulated and polymedicated patient. Nursing assessments were made using the Marjory Gordon functional health patterns, by which we identified, among others, problems related to non-compliance with the pharmacological treatment. The Nurse's Diagnosis was: Ineffective Management of own health. With the support of NANDA, NOC and NIC taxonomy we determined the nursing objectives and interventions. The expected results of the Care Plan were achieved. Polypharmacy in the elderly can lead to treatment problems, increasing hospital admissions, morbidity and mortality and health expenditure Nursing care at home is a continuous development process and is increasing due to aging of the population, the prevalence of chronic diseases, as well as the increased life expectancy. It is estimated that in 2030, 24% of the Spanish population will be over 64 years. The physical, sensory, cognitive and chronic disabilities of aging make this type of care necessary. It is a major element in the comprehensive care of these patients, by checking the correct use of medication, symptom control, helping them to be autonomous in managing their disease and establishing a fluid relationship between the patients and their family. PMID:22284363

  1. Nutrition and Physical Activity Policies and Practices in Family Child Care Homes in Oregon: Baseline Findings from the Healthy Home Child Care Project

    ERIC Educational Resources Information Center

    Gunter, Katherine B.; Rice, Kelly R.; Trost, Stewart G.

    2012-01-01

    Baseline findings from the Healthy Home Child Care Project include data from Family Child Care Providers (FCCPs) in Oregon (n=53) who completed assessments of nutrition and physical activity policies and practices and BMI data for children in the care of FCCPs (n=205). Results show that a significant percentage of FCCPs failed to meet child care…

  2. Comparing food intake using the Dietary Risk Assessment with multiple 24-hour dietary recalls and the 7-Day Dietary Recall.

    PubMed

    Olendzki, B; Hurley, T G; Hebert, J R; Ellis, S; Merriam, P A; Luippold, R; Rider, L; Ockene, I S

    1999-11-01

    The Dietary Risk Assessment (DRA) is a brief dietary assessment tool used to identify dietary behaviors associated with cardiovascular disease. Intended for use by physicians and other nondietitians, the DRA identifies healthful and problematic dietary behaviors and alerts the physician to patients who require further nutrition counseling. To determine the relative validity of this tool, we compared it to the 7-Day Dietary Recall (an instrument developed to assess intake of dietary fat) and to the average of 7 telephone-administered 24-hour dietary recalls. Forty-two free-living subjects were recruited into the study. The 7-Day Dietary Recall and DRA were administered to each subject twice, at the beginning and the end of the study period, and the 24-hour recalls were conducted during the intervening time period. Correlation coefficients were computed to compare the food scores derived from the 3 assessment methods. Correlations between the DRA and 7-Day Dietary Recall data were moderate (r = .47, on average, for postmeasures); correlations between the DRA and 24-hour recalls were lower. The ability of the DRA to assess dietary fat consumption and ease of administration make it a clinically useful screening instrument for the physician when counseling patients about dietary fat reduction. PMID:10570682

  3. [Exercise tolerance in angina patients 3 and 24 hours after administration of a new delayed-action preparation of metoprolol].

    PubMed

    Giusti, C; Verdecchia, P; Pentimone, F; Regoli, F; Cordoni, M; Bongini, A M

    1981-01-01

    To assess the duration of improved exercise tolerance by metoprolol given in a new sustained-release formulation, 40 in-patients affected by stable exercise-induced angina pectoris received single-blind placebo in day 1 and thereafter, in double-blind cross-over once daily administration, metoprolol RETARD 100 mg and 200 mg in days 3 and 5. Symptom-limited cycloergometric exercise tests were performed at 3 and 24 hours after placebo and after each of the two doses of metoprolol RETARD. Duration of exercise, maximal workload and total work performed did significantly increase at 3 and 24 hours after metoprolol RETARD 100 mg (P less than 0.01) and 200 mg (P less than 0.01), without any significant difference between the two doses. Peak systolic arterial pressure and heart rate were lowered by metoprolol RETARD 200 mg at 3 (P less than 0.01) and 24 (P less than 0.01) hours, whereas only the peak heart rate at 3 hours was lowered (P less than 0.05) by the 100 mg dose. It is concluded that in patients with stable exercise-induced angina pectoris, metoprolol RETARD 200 mg appears to be able to increase exercise tolerance and to reduce exercise-induced myocardial oxygen consumption throughout 24 hours period. This may justify a once daily dosing schedule of the 200 mg dose, aimed at improving patient compliance. PMID:7343379

  4. Flow cytometric comparison of platelets from a whole blood and finger-prick sample: impact of 24 hours storage.

    PubMed

    Swanepoel, Albe C; Stander, Andre; Pretorius, Etheresia

    2013-03-01

    In this study, we investigate the validity and laboratory utility of flow cytometry when analyzing platelet activation by studying CD41, CD42b, CD62P and CD63. We compare flow cytometry results from citrated whole-blood and finger-prick samples directly after collection and also after storing both a finger-prick and whole-blood sample for 24 hours. Citrated whole-blood and finger-prick samples were taken from three healthy individuals on two occasions, and a total of 60,000 cells were analyzed for each of the four phycoerythrin-labeled monoclonal antibodies. Half of each sample was analyzed immediately after sampling while the other half was kept in the fridge at 6 °C for 24 hours before analysis. No significant difference was found between the sampling methods or the period of time before analysis. Results therefore suggest that an appropriately prepared finger-prick sample can be used for platelet function analysis, and samples can be stored for 24 hours in the fridge at 6 °C before analysis. PMID:23320994

  5. Assessment of 24-hours Aldosterone Administration on Protein Abundances in Fluorescence-Sorted Mouse Distal Renal Tubules by Mass Spectrometry

    PubMed Central

    Jensen, Thomas B; Pisitkun, Trairak; Hoffert, Jason D; Jensen, Uffe B; Fenton, Robert A; Praetorius, Helle A; Knepper, Mark A; Praetorius, Jeppe

    2013-01-01

    Background/Aims Aldosterone exerts multiple long-term effects in the distal renal tubules. The aim of this study was to establish a method for identifying proteins in these tubules that change in abundance by only 24-hours aldosterone administration. Methods Mice endogenously expressing green fluorescent protein (eGFP) in the connecting tubule and cortical collecting ducts were treated with a subcutaneous injection of 2.0 mg/kg aldosterone or vehicle (n=5), and sacrificed 24 hours later. Suspensions of single cells were obtained enzymatically, and eGFP positive cells were isolated by fluorescence activated cell sorting (FACS). Samples of 100 μg proteins were digested with trypsin and labeled with 8-plex iTRAQ reagents and processed for liquid chromatography tandem mass spectrometry (LC-MS/MS). Results FACS yielded 1.4 million cells per mouse. The LC-MS/MS spectra were matched to peptides by the SEQUEST search algorithm, which identified 3002 peptides corresponding to 506 unique proteins of which 20 significantly changed abundance 24-hours after aldosterone injection. Conclusion We find the method suitable and useful for studying hormonal effects on protein abundance in distal tubular segments. PMID:23428628

  6. The Geriatrics in Primary Care Demonstration: Integrating Comprehensive Geriatric Care into the Medical Home: Preliminary Data.

    PubMed

    Engel, Peter A; Spencer, Jacqueline; Paul, Todd; Boardman, Judith B

    2016-04-01

    Three thousand nine hundred thirty-one veterans aged 75 and older receive primary care (PC) in two large practices of the Department of Veterans Affairs (VA) Boston Healthcare System. Cognitive and functional disabilities are endemic in this group, creating needs that predictably exceed available or appropriate resources. To address this problem, Geriatrics in Primary Care (GPC) embeds geriatric services directly into primary care. An on-site consulting geriatrician and geriatric nurse care manager work directly with PC colleagues in medicine, nursing, social work, pharmacy, and mental health within the VA medical home. This design delivers interdisciplinary geriatric care within PC that emphasizes comprehensive evaluations, care management, planned transitions, informed resource use, and a shift in care focus from multiple subspecialties to PC. Four hundred thirty-five veterans enrolled during the project's 4-year course. Complex, fragmented care was evident in a series of 50 individuals (aged 82 ± 7) enrolled during Months 1 to 6. The year before, these individuals made 372 medical or surgical subspecialty clinic visits (7.4 ± 9.8); 34% attended five or more subspecialty clinics, 48% had dementia, and 18% lacked family caregivers. During the first year after enrollment the mean number of subspecialty clinic visits declined significantly (4.7 ± 5.0, P = .01), whereas the number of PC-based visits remained stable (3.1 ± 1.5 and 3.3 ± 1.5, respectively, P = .50). Telephone contact by GPC (2.3 ± 2.0) and collaboration with PC clinicians replaced routine follow-up geriatric care. GPC facilitated planned transitions to rehabilitation centers (n = 5), home hospice (n = 2), dementia units (n = 3), and home care (n = 37). GPC provides efficient, comprehensive geriatric care and case management while preserving established relationships between patients and the PC team. Preliminary results suggest "care defragmentation," as reflected by a

  7. Protecting care home residents from mistreatment and abuse: on the need for policy

    PubMed Central

    Phelan, Amanda

    2015-01-01

    With a rising older person population with increasing life expectancies, the demand for care homes will increase in the future. Older people in care homes are particularly vulnerable due to their dependencies related to cognitive and/or functional self-care challenges. Although many care homes provide good care, maltreatment and abuse of older people can and does occur. One major step in preventing and addressing maltreatment in care homes is having comprehensive and responsive policy, which delineates national expectations that are locally implemented. This paper examines the literature related to maltreatment in care homes and argues for policy based on a multisystems approach. Policy needs to firstly acknowledge and address general societal issues which tacitly impact on older person care delivery, underpin how care homes and related systems should be operationalized, and finally delineate expected standards and outcomes for individual experience of care. Such a policy demands attention at every level of the health care and societal system. Furthermore, contemporary issues central to policy evolution in care homes are discussed, such as safeguarding education and training and fostering organization whistle-blowing protection. PMID:26640391

  8. Good clinical practice guidelines for care home residents with diabetes: an executive summary.

    PubMed

    Sinclair, A J

    2011-07-01

    A Task and Finish Group of Diabetes UK was convened over 14 months to undertake a systematic review of the original 1999 British Diabetic Association guidance on care home diabetes, incorporate new research findings and produce a set of recommendations that are evidenced-based, practical and implementable within UK care home settings. The anticipation of Diabetes UK is that these guidelines will represent a national policy of good clinical practice for diabetes care within care homes. This executive summary demonstrates how the full guidelines should provide a framework of assessment of the quality of diabetes care within care homes, for use by regulatory bodies who have responsibility for this provision of diabetes care. This document is primarily based on recommendations for adults living within British care home environments and its focus, by virtue of the nature and characteristics of residents, is on older adults. Improvements in diabetes care within residential and nursing homes are likely to follow a sustained commitment by health and social care professionals to ensure that the well-being of residents with diabetes is paramount, that high-quality policies of diabetes care are implemented and monitored and effective diabetes education is a mandatory and integral part of care home staff training. PMID:21672001

  9. New concepts and technologies in home care and ambulatory monitoring.

    PubMed

    Dittmar, A; Axisa, F; Delhomme, G; Gehin, C

    2004-01-01

    The world is becoming more and more health conscious. Society, health policy and patients' needs are all changing dramatically. The challenges society is currently facing are related to the increase in the aging population, changes in lifestyle, the need for healthcare cost containment and the need for improvement and monitoring of healthcare quality. The emphasis is put on prevention rather than on treatment. In addition, patients and health consumers are waiting for non-invasive or minimally-invasive diagnosis and treatment methods, for home care, short stays in hospital, enhancement of rehabilitation, information and involvement in their own treatment. Progress in science and technology offers, today, miniaturization, speed, intelligence, sophistication and new materials at lower cost. In this new landscape, microtechnologies, information technologies and telecommunications are key factors. Telemedicine has also evolved. Used initially to exchange patients' files, radiographic data and other information between health providers, today telemedicine contributes to new trends in "hospital extension" through all-day monitoring of vital signs, professional activities, entertainment and home-based activities. The new possibilities for home care and ambulatory monitoring are provided at 4 levels: a) Microsensors. Microtechnologies offer the possibility of small size, but also of intelligent, active devices, working with low energy, wireless and non-invasive or minimally-invasive; b) Wrist devices are particularly user friendly and combine sensors, circuits, supply, display and wireless transmission in a single box, very convenient for common physical activities; c) Health smart clothes make contact with 90 % of the skin and offer many possibilities for the location of sensors. These sensors have to be thin, flexible and compatible with textiles, or made using textile technologies, such as new fibers with specific (mechanical, electrical and optical) properties; d

  10. 77 FR 64386 - Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-19

    ... AFFAIRS Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes) Under OMB Review AGENCY: Veterans Health... day health services care to Veterans. VA requires facilities providing nursing home and adult...

  11. House Calls: The Impact of Home-Based Care for Older Adults With Alzheimer's and Dementia.

    PubMed

    Wilson, Kasey; Bachman, Sara S

    2015-01-01

    Older adults with Alzheimer's/dementia have high health care costs; they may benefit from home-based care, but few have home visits. This article describes a home-based care program for frail elders, including those with Alzheimer's/dementia. Descriptive statistics are provided for Medicare-enrolled program participants and matched controls with Alzheimer's/dementia on expenditures along six services: skilled nursing facility, inpatient acute, physician, home health, hospice, and social services. Cases with dementia were significantly more likely to have home health and hospice expenditures than controls, suggesting potential for the program to improve end-of-life care. Very few cases or controls had any social service expenditures. Social workers should advocate for the expanded role of home-based care for older adults with dementia and for increased Medicare reimbursement of social work services. PMID:26186425

  12. Co-Learning With Home Care Aides and Their Clients: Collaboratively Increasing Individual and Organizational Capacities

    PubMed Central

    MURAMATSU, NAOKO; MADRIGAL, JESSICA; BERBAUM, MICHAEL L.; HENDERSON, VIDA A.; JURIVICH, DONALD A.; ZANONI, JOSEPH; MARQUEZ, DAVID X.; MADRID, KATYA CRUZ

    2015-01-01

    Changes in health care provide unprecedented opportunities for collaboration across research, education, and practice for the common goal of enhancing the well-being of older adults and their caregivers. This article describes how a pilot project, “Promoting Seniors’ Health with Home Care Aides,” has synergistic education, research and practice effects that enhance individual and organizational capacities. This pilot is an innovative partnership with home care aides to deliver a safe physical activity program appropriate for frail seniors in a real-life public home care program. The intervention and research occur in older adults’ homes and thus provide rare opportunities for the research team and partners to learn from each other about dynamics of home care in older adults’ life contexts. Co-learning is essential for continuous quality improvement in education, research and practice. We propose to establish “Teaching Home Care” to ensure ongoing co-learning in gerontology and geriatrics. PMID:25671492

  13. The 24-h recall instrument for home nursing to measure the activity profile of home nurses: development and psychometric testing.

    PubMed

    De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Gosset, Christiane; Heyden, Isabelle; Van Geert, Michel; Moons, Philip

    2015-01-01

    Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care. PMID:24479985

  14. Effects of Home Exercise on Physical Function and Activity in Home Care Patients with Parkinson’s Disease

    PubMed Central

    Nakae, Hideyuki; Tsushima, Hitoshi

    2014-01-01

    [Purpose] The aim of this study was to clarify the effects of guidance in home exercise on physical function and the amount of activity in home care patients with Parkinson’s disease (PD). [Subjects and Methods] A 2-month home exercise intervention consisting of self-administered exercise by patients (self-exercise) and home visit exercise therapy guided by a physical therapist (home visit exercise) was conducted in 10 home care patients with PD to compare changes in physical function, activities of daily living, and postural status between before and after the intervention. [Results] A decreased number of chief complaints and alleviation of fear of falling were observed after the intervention. In terms of physical function, a significant increase in flexibility and muscle strength were observed, although no significant changes were found in activities of daily living, gait, and balance. Although there was no significant change in the total amount of daily physical activity, the analysis of daily posture changes revealed a significant reduction in the percentage of time spent lying down and a significant increase in the percentage of time spent sitting after the intervention. [Conclusion] Guidance in home exercise in home care patients with PD can be effective in making self-exercise a habit, improving range of motion and muscle strength, and reducing the time spent in a supine position. PMID:25435681

  15. Pragmatic diabetes management in nursing homes: individual care plan.

    PubMed

    Benetos, Athanase; Novella, Jean-Luc; Guerci, Bruno; Blickle, Jean-Frederic; Boivin, Jean-Marc; Cuny, Pierre; Delemer, Brigitte; Gabreau, Thierry; Jan, Philippe; Louis, Jacques; Passadori, Yves; Petit, Jean-Michel; Weryha, Georges

    2013-11-01

    Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients. Given demands on NH personnel (manager, medical coordinator, nurses, and, at the front line of care provision, the undertrained and overworked carers), coupled with the quasiconstant of high staff turnover, the foundation stone of a patient's diabetes management is an Individual Care Plan (ICP) expressed in layman's language. This document that is opened on the patient's admission aims to make sure that the prescriptions established at admission are followed, notably to ensure correct treatment and adapted, regular monitoring with dates and times when examinations and tests are due. This includes monitoring of the diabetes control (HbA1c and, if necessary, blood and urine glucose) and its complications (cardiovascular disease, hypoglycemia, ocular problems, foot disorders, malnutrition, peripheral neuropathy, kidney failure). A necessary corollary is the training of staff to understand the specificities of caring for a frail patient with diabetes, on what to do in a potential emergency, and how to keep the ICP up to date for consultation by doctors and nurses. PMID:24113629

  16. Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over

    MedlinePlus

    ... April 18, 2012 Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over ... and Roberto Valverde, M.P.H., Division of Health Care Statistics Abstract Objective —This report presents national estimates ...

  17. Comfort Care Rounds: a staff capacity-building initiative in long-term care homes.

    PubMed

    Wickson-Griffiths, Abigail; Kaasalainen, Sharon; Brazil, Kevin; McAiney, Carrie; Crawshaw, Diane; Turner, Mickey; Kelley, Mary Lou

    2015-01-01

    This article reports a pilot evaluation of Comfort Care Rounds (CCRs)--a strategy for addressing long-term care home staff's palliative and end-of-life care educational and support needs. Using a qualitative descriptive design, semistructured individual and focus group interviews were conducted to understand staff members' perspectives and feedback on the implementation and application of CCRs. Study participants identified that effective advertising, interest, and assigning staff to attend CCRs facilitated their participation. The key barriers to their attendance included difficulty in balancing heavy workloads and scheduling logistics. Interprofessional team member representation was sought but was not consistent. Study participants recognized the benefits of attending; however, they provided feedback on how the scheduling, content, and focus could be improved. Overall, study participants found CCRs to be beneficial to their palliative and end-of-life care knowledge, practice, and confidence. However, they identified barriers and recommendations, which warrant ongoing evaluation. PMID:24971588

  18. [Quality of care among older adults with diabetes mellitus: comparison between community-dwelling adults attended to by home care services and nursing home residents in Dresden].

    PubMed

    Coll-Planas, Laura; Bergmann, Antje; Schwarz, Peter; Guillén-Grima, Francisco; Schulze, Jan

    2007-01-01

    Due to changes in the age structure of the population the number of frail elderly diabetics is rising. This change is accompanied by an increase in nursing care efforts and requirements in both home care services and nursing homes. The aim of this study was to evaluate the quality of care in the home care and nursing home setting concerning the structure, the process and the outcome quality at the institutional and patient level. This is an observational transversal study. At the institutional level a standardised questionnaire of the German Diabetes Research Institute was sent to all nursing homes (37) and home care services (88) in Dresden. At the patient level 37 homebound patients and 46 residents were recruited. A Geriatric assessment and a clinical examination were performed and a blood sample was analysed. Patients with moderate or severe cognitive impairment were excluded. The prevalence of diabetes in home care services was 27.2% and in nursing homes 36.1%. The participation rate among the institutions was 21.6% (n = 27). In 14% (n = 12) of the diabetic patients the HbA1c was above 8% (poor metabolic control) and in 24% (20) it was between 7% and 8% (regular metabolic control). 56.6% (n = 21) of the homebound elderly diabetics and 46.7% (n = 21) of the nursing home residents with diabetes were hospitalized at least once during the last 12 months. Our study showed a high prevalence of diabetes in both types of institutions in Dresden and a high hospitalisation rate of the elderly diabetics, although 62% of the patients had an optimum metabolic control. These facts indicate that the quality of care of frail elderly diabetics concerning the multimorbidity might be further improved. PMID:18269054

  19. No place like home? Potential pathways to loneliness in older adults under the care of a live-in foreign home care worker.

    PubMed

    Ayalon, Liat; Shiovitz-Ezra, Sharon; Palgi, Yuval

    2012-01-01

    The arrangement in which frail older adults from the developed world are cared for in their homes by individuals from the developing world has become increasingly prevalent worldwide. In Israel, this arrangement is termed foreign home care. In this article, the authors first describe the global phenomenon of foreign home care of frail older adults as well as the more local characteristics of this arrangement in Israel. The authors then describe the concept of loneliness. Based on empirical and theoretical knowledge in the field of loneliness, the authors argue that older adults under live-in foreign home care may be particularly prone to feelings of loneliness for several reasons: some that are general to older adults with cognitive or physical disability and others that are specific to this particular caregiving arrangement. The authors conclude by providing ideas for future practice and research on this highly vulnerable group that, to date, has received only minimal research attention. PMID:22303620

  20. "Intent to stay" among paid home care workers in California.

    PubMed

    Matthias, Ruth E; Benjamin, A E

    2005-01-01

    The continuing shortage of entry-level healthcare workers highlights the need to understand worker retention and turnover. This study focuses on intent to stay among 618 paid home care workers in California, half from agencies, and half employed under a consumer-directed model that includes both relatives and non-relatives of the client. Most workers (63.3%) report that they will very likely be working as a caregiver in 12 months, but more family than non-family caregivers say so. Being related to the client, and having fewer clients, more training, more job satisfaction, and hopes for a raise, all predict intent to stay. However, when we analyze family caregivers separately, there are no significant predictors of intent to stay. PMID:16203689