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Sample records for 24-hour home care

  1. Psychological evaluation of 24-hour home nursing care: application of an analytic hierarchy process to improve quality of life.

    PubMed

    Shibata, Takeo; Shimizu, Yoko; Wada, Hiroko

    2012-01-01

    Twenty-four-hour home nursing care services for patients with severe diseases such as amyotrophic lateral sclerosis have been started in Japan. To improve the quality of home nursing care as well as the patients quality of life (QOL), we undertook a psychological evaluation of the care services. An analytic hierarchy process (AHP) was applied to the psychological evaluation. Forty-eight staff replied to our questionnaire, of which twenty-nine staff showed a consistency index of less than 0.1. In the first hierarchy, the intensities of importance were 0.436 for "quality of care", 0.351 for "staff awareness", and 0.213 for "economic efficiency". Most staff appeared to feel that the relationships among patients, their families, and staffs were the most important criteria. While many staff might have increased their "physical profit" and "burden", the intensities of importance for those criteria were low.

  2. Impact of Different Normality Thresholds for 24-hour ABPM at the Primary Health Care Level

    PubMed Central

    Grezzana, Guilherme Brasil; Moraes, David William; Stein, Airton Tetelbon; Pellanda, Lucia Campos

    2017-01-01

    Background Hypertension is an important risk factor for cardiovascular outcomes. Primary health care (PHC) physicians should be prepared to act appropriately in the prevention of cardiovascular risk factors. However, the rates of patients with control of blood pressure (BP) remain low. The impact of the reclassification of high BP by 24-hour ambulatory BP monitoring (ABPM) can lead to different medical decisions in PHC. Objective To evaluate the agreement between the BP measured by a conventional method by PHC physicians and by 24-hour ABPM, considering different BP normal thresholds for the 24-hour ABPM according to the V Brazilian ABPM Guidelines and the European Society of Hypertension Guidelines. Methods A cross-sectional study including 569 hypertensive patients. The BP was initially measured by the PHC physicians and, later, by 24-hour ABPM. The BP measurements were obtained independently between the two methods. The therapeutic targets for the conventional BP followed the guidelines by the Eighth Joint National Committee (JNC 8), the V ABPM Brazilian Guidelines, and the 2013 European Hypertension Guidelines. Results There was an accuracy of 54.8% (95% confidence interval [95%CI] 0.51 - 0.58%) for the BP measured with the conventional method when compared with the 24-hour ABPM, with a sensitivity of 85% (95%CI 80.8 - 88.6%), specificity of 31.9% (95%CI 28.7 - 34.7%), and kappa value of 0.155, when considering the European Hypertension Guidelines. When using more stringent thresholds to characterize the BP as "normal" by ABPM, the accuracy was 45% (95%CI 0.41 - 0.47%) for conventional measurement when compared with 24-hour ABPM, with a sensitivity of 86.7% (95%CI 0.81 - 0.91%), specificity of 29% (95%CI 0.26 - 0.30%), and kappa value of 0.103. Conclusion The BP measurements obtained by PHC physicians showed low accuracy when compared with those obtained by 24-hour ABPM, regardless of the threshold set by the different guidelines. PMID:28099585

  3. Neonatal family care for 24 hours per day: effects on maternal confidence and breast-feeding.

    PubMed

    Wataker, Heidi; Meberg, Alf; Nestaas, Eirik

    2012-01-01

    In family care (FC) program for neonatal intensive care units (NICUs), parents are encouraged to reside together with their infant for 24 hours a day to actively be involved in the care. The aim of this study was to assess the impact of FC on maternal confidence and breast-feeding. Maternal confidence and rate of breast-feeding were assessed in 31 mothers offered FC that included special family rooms in the NICU, and in 30 mothers from a comparable NICU providing traditional care without such facilities. One week prior to hospital discharge, mothers in the FC group felt better informed regarding nursing issues and had more confidence in interpretation of the infants regarding feeding issues and in caregiving without staff attendance (P < .05). They also reported a higher level of empowerment (P < .05). Three months after discharge, the mothers in the FC group had a higher self-reported skill level for interpretation of the infant's signals and knowledge about breast-feeding (P < .05). Despite similar rate of breast-feeding at discharge, more infants in the FC group were breastfed 3 months after discharge (P < .05). An FC program in the NICU promoted better maternal confidence during the hospital stay and 3 months after discharge compared with traditional care.

  4. Bath water contamination with Legionella and nontuberculous mycobacteria in 24-hour home baths, hot springs, and public bathhouses of Nagano Prefecture, Japan.

    PubMed

    Kobayashi, Michiko; Oana, Kozue; Kawakami, Yoshiyuki

    2014-01-01

    Bath water samples were collected from 116 hot springs, 197 public bathhouses, and 38 24-hour home baths in Nagano Prefecture, Japan, during the period of April 2009 to November 2011, for determining the presence and extent of contamination with Legionella and nontuberculous mycobacteria. Cultures positive for Legionella were observed in 123 of the 3,314 bath water samples examined. The distribution and abundance of Legionella and/or combined contamination with Legionella and nontuberculous mycobacteria were investigated to clarify the contamination levels. The abundance of Legionella was demonstrated to correlate considerably with the levels of combined contamination with Legionella and nontuberculous mycobacteria. Legionella spp. were obtained from 61% of the water samples from 24-hour home baths, but only from 3% of the samples from public bathhouses and hot springs. This is despite the fact that a few outbreaks of Legionnaires' disease in Nagano Prefecture as well as other regions of Japan have been traced to bath water contamination. The comparatively higher rate of contamination of the 24-hour home baths is a matter of concern. It is therefore advisable to routinely implement good maintenance of the water basins, particularly of the 24-hour home baths.

  5. Home Care

    MedlinePlus

    ... Based Care Nursing Homes Join our e-newsletter! Aging & Health A to Z Home Care Basic Facts & ... March 2013 Posted: March 2012 © 2017 Health in Aging. All rights reserved. Feedback • Site Map • Privacy Policy • ...

  6. 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, ...

  7. 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 ...

  8. 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 ...

  9. 24-Hour Relativistic Bit Commitment

    NASA Astrophysics Data System (ADS)

    Verbanis, Ephanielle; Martin, Anthony; Houlmann, Raphaël; Boso, Gianluca; Bussières, Félix; Zbinden, Hugo

    2016-09-01

    Bit commitment is a fundamental cryptographic primitive in which a party wishes to commit a secret bit to another party. Perfect security between mistrustful parties is unfortunately impossible to achieve through the asynchronous exchange of classical and quantum messages. Perfect security can nonetheless be achieved if each party splits into two agents exchanging classical information at times and locations satisfying strict relativistic constraints. A relativistic multiround protocol to achieve this was previously proposed and used to implement a 2-millisecond commitment time. Much longer durations were initially thought to be insecure, but recent theoretical progress showed that this is not so. In this Letter, we report on the implementation of a 24-hour bit commitment solely based on timed high-speed optical communication and fast data processing, with all agents located within the city of Geneva. This duration is more than 6 orders of magnitude longer than before, and we argue that it could be extended to one year and allow much more flexibility on the locations of the agents. Our implementation offers a practical and viable solution for use in applications such as digital signatures, secure voting and honesty-preserving auctions.

  10. 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…

  11. 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.

  12. 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…

  13. Taking care of your back at home

    MedlinePlus

    Back strain treatment; Back pain - home care; Low back pain - home care; Lumbar pain - home care; LBP - home care; Sciatic - home care ... chap 48. Institute for Clinical Systems Improvement. Health care guideline: adult acute and subacute low back pain. ...

  14. 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…

  15. Ensuring Quality Nursing Home Care

    MedlinePlus

    Ensuring Quality Nursing Home Care Before you choose a nursing home Expert information from Healthcare Professionals Who Specialize in the Care ... Nearly 1.6 million older Americans live in nursing homes in the United States. The move to ...

  16. [Assessment of our home care and home palliative care].

    PubMed

    Midorikawa, Yasuhiko; Suzushino, Seiko; Tamotsu, Kiyokazu

    2014-12-01

    We conducted home care and home palliative care from the department of home care. We provided home care services to 190 patients(105 men, 85 women)in October 2013. Their average age was 78.7(range: 32-102)years old, and home care had been underway from 1 day to 8 years, 10 months. Among all participants, 168(88.4%)suffered from malignant diseases, 168 patients had died, and over half of deceased patients(88 out of 168)had died at home. We used opioids for control of cancer pain, carried out home parenteral nutrition(HPN), home enteral nutrition(HEN), percutaneous endoscopic gastrostomy( PEG), and removed pleural effusion and ascites during home care. In order to facilitate the practice of palliative care by the palliative care team, which consists of various medical staff in the hospital, we are giving high priority to education and enlightenment in the hospital. To provide enlightenment, education, and cooperation between regional home care and home palliative care, we are also conducting educational lectures in the regional party of the Iwaki city medical associate, and providing combined educational-medical training for home care and home palliative care by various medical staff.

  17. "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.

  18. 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…

  19. 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…

  20. 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…

  1. [The trial of the domiciliary nutrition support team in which a home medical care office offers].

    PubMed

    Yamashita, Hisaki; Kamei, Miwa; Yamada, Akiko; Toshima, Kazue; Morita, Hideki; Kodama, Naoto; Okabayashi, Kiyoshi

    2010-12-01

    The function of home care support by a medical office is to offer the best medical care for the patient. It is essential that the medical office is capable of taking a call 24-hour a day and 365-day a year from a patient who needs help at home. Our medical office was specialized in home care treatment. Furthermore, we offer a home rehabilitation or a home nutrition education to the patient. On the other hand, a nutritional support is important as well as medical supports. To offer a high quality medical care at home, we created a nutrient support system in our hospital, and formed an at-home nutrition support team(at-home NST). The team is consisted of a medical staff and dietitian, a physical therapist and a speech therapist. As a result of the at-home NST, We improved the followings: (1) we were able to collect a nutritional data basis including a patient 's height and weight, (2) we made a good use of patient's eating habit at home during the medical treatment, and (3) we could make a good use of medical service to a home care patient by managing the information accumulated by nutritional surveillance. In multidisciplinary collaboration, at-home NST can grasp a versatility status of the patient positively. We continue to offer a medical care that is demanded from a home care patient because the activity of the at-home NST raises a quality of medical service we provide.

  2. 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.

  3. Perspectives on Home Care Quality

    PubMed Central

    Kane, Rosalie A.; Kane, Robert L.; Illston, Laurel H.; Eustis, Nancy N.

    1994-01-01

    Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized “enabling” criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process. PMID:10140158

  4. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  5. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  6. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  7. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  8. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  9. [Social inequality in home care].

    PubMed

    Möller, A; Osterfeld, A; Büscher, A

    2013-06-01

    Social inequality in Germany is discussed primarily with regard to educational or social welfare issues. There is a political consensus that more action should be taken to ensure equality of chances and fulfillment of basic needs for everyone. In long-term care these considerations have not yet taken place and there are hardly any research studies in this field. However, the startling rise of the need for long-term care will definitely require a discussion of social inequality in various care arrangements. To learn more about social inequality in home care, a qualitative approach was used and 16 home care nurses were interviewed. Our study shows that many care recipients face numerous problems they cannot handle on their own, which may even worsen their situation. In addition, the results reveal that facing social inequalities place a burden on nurses and influence their work performance.

  10. 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.

  11. Home Child Care: A Caregiver's Guide.

    ERIC Educational Resources Information Center

    Dunster, Lee

    Intended for those already providing home child care or those considering becoming a caregiver in Canada, this book provides practical ideas and advice covering the many areas involved in home child care, from organization of the home to resources available to the provider. Chapter 1 describes how home child care can be provided, how to adapt to…

  12. High serum lactate level may predict death within 24 hours

    PubMed Central

    Zoubi, Abd Almajid; Kuria, Shiran; Blum, Nava

    2015-01-01

    Background Unexpected death within 24 hours of admission is a real challenge for the clinician in the emergency room. How to diagnose these patients and the right approach to prevent sudden death with 24 hours is still an enigma. The aims of our study were to find the independent factors that may affect the clinical outcome in the first 24 hours of admission to the hospital. Methods We performed a retrospective study defining unexpected death within 24 hours of admission in our Department of Medicine in the last 6 years. We found 43 patients who died within 24 hours of admission, and compared their clinical and biochemical characteristics to 6055 consecutive patients who were admitted in that period of time and did not die within the first 24 hours of admission. The parameters that were used include gender, age, temperature, clinical and laboratory criteria for SIRS, arterial blood lactate, and arterial blood pH. Results Most of the patients who died within 24 hours had sepsis with SIRS. These patients were older (78.6±14.7 vs. 65.2±20.2 years [p<.0001]), had higher lactate levels (8.0±4.8 vs. 2.1±1.8mmol/L [p<.0001]), and lower pH (7.2±0.2 vs. 7.4±0.1 [p<.0001]). Logistic regression analysis found that lactate was the strongest independent parameter to predict death within 24 hours of admission (OR 1.366 [95% CI 1.235–1.512]), followed by old age (OR 1.048 [95% CI 1.048–1.075] and low arterial blood pH (OR 0.007 [CI <0.001–0.147]). When gender was analyzed, pH was not an independent variable in females (only in males). Conclusions The significant independent variable that predicted death within 24 hours of admission was arterial blood lactate level on admission. Older age was also an independent variable; low pH affected only males, but was a less dominant variable. We suggest use of arterial blood lactate level on admission as a bio-marker in patients with suspected sepsis admitted to the hospital for risk assessment and prediction of death within 24

  13. Managing Home Health Care (For Parents)

    MedlinePlus

    ... Your 1- to 2-Year-Old Managing Home Health Care KidsHealth > For Parents > Managing Home Health Care A ... español La atención médica en el hogar Intensive Health Care at Home Kids can need intensive health care ...

  14. 24-hour rhythmicity of seizures in refractory focal epilepsy.

    PubMed

    Nzwalo, Hipólito; Menezes Cordeiro, Inês; Santos, Ana Catarina; Peralta, Rita; Paiva, Teresa; Bentes, Carla

    2016-02-01

    The occurrence of seizures in specific types of epilepsies can follow a 24-hour nonuniform or nonrandom pattern. We described the 24-hour pattern of clinical seizures in patients with focal refractory epilepsy who underwent video-electroencephalography monitoring. Only patients who were candidates for epilepsy surgery with an unequivocal seizure focus were included in the study. A total of 544 seizures from 123 consecutive patients were analyzed. Specific time of seizures were distributed along 3- or 4-hour time blocks or bins throughout the 24-hour period. The mean age of the subjects was 37.7 years, with standard deviation of 11.5 years, median of 37. The majority were females (70/56%). The majority of patients had a seizure focus located in the mesial temporal lobe (102/83%) and in the neocortical temporal lobe (13/11%). The remaining patients had a seizure focus located in the extratemporal lobe (8/6%). The most common etiology was mesial temporal sclerosis (86/69.9%). Nonuniform seizure distribution was observed in seizures arising from the temporal lobe (mesial temporal lobe and neocortical temporal lobe), with two peaks found in both 3- and 4-hour bins: 10:00-13:00/16:00-19:00 and 08:00-12:00/16:00-20:00 respectively (p=0.004). No specific 24-hour pattern was identified in seizures from extratemporal location. The 24-hour rhythmicity of seizure distribution is recognized in certain types of epilepsy, but studies on the topic are scarce. Their replication and validation is therefore needed. Our study confirms the bimodal pattern of temporal lobe epilepsy independently of the nature of the lesion. However, peak times differ between different studies, suggesting that the ambient, rhythmic exogenous factors or environmental/social zeitgebers, may modulate the 24-hour rhythmicity of seizures. Characterization of these 24-hour patterns of seizure occurrence can influence diagnosis and treatment in selected types of epilepsy, such as the case of temporal lobe

  15. Agreement between 24-hour salt ingestion and sodium excretion in a controlled environment.

    PubMed

    Lerchl, Kathrin; Rakova, Natalia; Dahlmann, Anke; Rauh, Manfred; Goller, Ulrike; Basner, Mathias; Dinges, David F; Beck, Luis; Agureev, Alexander; Larina, Irina; Baranov, Victor; Morukov, Boris; Eckardt, Kai-Uwe; Vassilieva, Galina; Wabel, Peter; Vienken, Jörg; Kirsch, Karl; Johannes, Bernd; Krannich, Alexander; Luft, Friedrich C; Titze, Jens

    2015-10-01

    Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed 2 independent ultralong-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 g/d and collected all urine. The subjects' daily menus consisted of 27 279 individual servings, of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady-state sodium balance in both studies. Even at fixed salt intake, 24-hour urine collection for sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-g difference in salt intake. Because of the biological variability in UNaV, only every other daily urine sample correctly classified a 3-g difference in salt intake (49%). By increasing the observations to 3 consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6 to 12 g salt per day were not suitable to detect a 3-g difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials.

  16. Integrating Advanced Practice Nurses in Home Care. Recommendations for a Teaching Home Care Program.

    ERIC Educational Resources Information Center

    Mitty, Ethel; Mezey, Mathy

    1998-01-01

    A telephone survey of home care agencies and providers revealed a need for the following: evidence of the effectiveness of nurse practitioners in home care, regulatory and financial support for nurse practitioner home care, and development of home care agencies as clinical sites for training. (SK)

  17. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    PubMed

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  18. 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.

  19. Experiences of 24-hour advice line services: a framework for good practice and meeting NICE guidelines.

    PubMed

    Yardley, Sarah J; Codling, Jan; Roberts, Dai; O Donnell, Valerie; Taylor, Sue

    2009-06-01

    This article presents a framework for the practical implementation of a 24-hour specialist palliative care advice line, illustrated by two case examples from the authors' experience. In the UK, National Institute for Health and Clinical Excellence guidance requires provision of 24-hour access to specialist palliative care advice for healthcare professionals and carers regardless of a patient's location. Effective implementation of a telephone advice line for specialist advice is one approach to addressing the current variability in palliative care service provision, both in the UK and elsewhere. The authors were unable to identify a model with documentation for ensuring adequate clinical governance of an advice line in the literature and so present their own. The accompanying case examples demonstrate the difference between 'evolution of services by demand' and taking a systemic approach to service design. Key recommendations for practice are outlined for an effective advice line service which incorporates training and education into the clinical governance structures of the host organization.

  20. 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.

  1. 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 [ ...

  2. 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.

  3. 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.

  4. Financing of Pediatric Home Health Care.

    PubMed

    Simpser, Edwin; Hudak, Mark L

    2017-03-01

    Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrictions on benefits. As a result, home care responsibilities assumed by family caregivers have increased and imposed financial, physical, and psychological burdens on the family. The Patient Protection and Affordable Care Act set forth 10 mandated essential health benefits. Home care should be considered as an integral component of the habilitative and rehabilitative services and devices benefit, even though it is not explicitly recognized as a specific category of service. Pediatric-specific home health care services should be defined clearly as components of pediatric services, the 10th essential benefit, and recognized by all payers. Payments for home health care services should be sufficient to maintain an adequate provider work force with the pediatric-specific expertise and skills to care for children with medical complexity or developmental disability. Furthermore, coordination of care among various providers and the necessary direct patient care from which these care coordination plans are developed should be required and enabled by adequate payment. The American Academy of Pediatrics advocates for high-quality care by calling for development of pediatric-specific home health regulations and the licensure and certification of pediatric home health providers.

  5. The Future of Home Health Care

    PubMed Central

    Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

    2016-01-01

    The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

  6. 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

  7. Is 24-hour Intraocular Pressure Monitoring Necessary in Glaucoma?

    PubMed Central

    Mansouri, Kaweh; Weinreb, Robert N.; Medeiros, Felipe A.

    2013-01-01

    Although intraocular pressure (IOP) is the only treatable risk factor for glaucoma, its 24-hour behavior is poorly understood. Conflicting information is available in the literature with regard to the importance and predictive value of IOP peaks and fluctuations on the risk of glaucoma development and progression. This may be secondary to lack of prospective studies designed to address this issue. This article critically reviews the current evidence for the importance of 24-h IOP measurements in glaucoma and discusses shortcomings of current methods to assess 24-h IOP data, drawing attention to new developments in this field. PMID:23697618

  8. Pharmacist-physician co-management of hypertension reduces 24-hour ambulatory blood pressures

    PubMed Central

    Weber, Cynthia A.; Ernst, Michael E.; Sezate, Genesis S.; Zheng, Shimin; Carter, Barry L.

    2010-01-01

    Background Pharmacist-physician co-management of hypertension has been shown to improve office blood pressures (BP). We sought to describe the effect of such a model on 24-hour ambulatory BPs. Methods We performed a prospective, cluster-randomised controlled clinical trial in 179 patients with uncontrolled hypertension from five primary care clinics in Iowa City, Iowa. Patients were randomized by clinic to receive pharmacist-physician collaborative management of hypertension (intervention) or usual care (control) for a 9-month period. In the intervention group, pharmacists helped patients identify barriers to BP control, counselled on lifestyle and dietary modifications, and adjusted antihypertensive therapy in collaboration with the patient’s primary care provider. Patients were seen by pharmacists a minimum every 2 months. Ambulatory BP was obtained at baseline and study end. Results Baseline and end of study ambulatory BP profiles were evaluated for 175 patients. Ambulatory BPs were reduced to a greater extent in the intervention compared to control group (daytime ΔSBP [SD] 15.2[11.5] vs 5.5[13.5], p<0.001; nighttime ΔSBP [SD] 12.2[14.8] vs 3.4[13.3], p<0.001; 24-hour ΔSBP [SD] 14.1[11.3] vs 5.5[12.5], p<0.001). More patients in the intervention group had BP controlled at the end of the study (75% vs 50.7%, p<0.001) as defined by overall 24-hour ambulatory BP monitoring. Conclusions Pharmacist-physician collaborative management of hypertension achieved consistent and significantly greater reduction in 24-hour BP and a high rate of BP control. PMID:20937921

  9. Ethical openings in palliative home care practice.

    PubMed

    Santos Salas, Anna; Cameron, Brenda L

    2010-09-01

    Understanding how a nurse acts in a particular situation reveals how nurses enact their ethics in day-to-day nursing. Our ethical frameworks assist us when we experience serious ethical dilemmas. Yet how a nurse responds in situations of daily practice is contingent upon all the presenting cues that build the current moment. In this article, we look at how a home care nurse responds to the ethical opening that arises when the nurse enters a person's home. We discuss how the home presents the nurse with knowledge that informs the provision of ethical nursing care. The analysis is based on findings from an interpretive research study in palliative home care in Canada. Through interpretive analysis of a nursing situation we delineate how the nurse engages with the whole and acts inside the moment. The analysis shows how home care nurses are ethically determined to engage with whatever is going on in a patient's home.

  10. 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.

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

    MedlinePlus

    ... care + Share widget - Select to show What’s home health care? 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 ...

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

    MedlinePlus

    ... The “Speak Up” program is sponsored by The Joint Commission. They agree that patients should be involved in ... has been carefully checked out. For example, The Joint Commission visits home care organizations to see if they ...

  13. Moving Parkinson care to the home.

    PubMed

    Dorsey, E Ray; Vlaanderen, Floris P; Engelen, Lucien Jlpg; Kieburtz, Karl; Zhu, William; Biglan, Kevin M; Faber, Marjan J; Bloem, Bastiaan R

    2016-09-01

    In many ways, the care of individuals with Parkinson disease does not meet their needs. Despite the documented benefits of receiving care from clinicians with Parkinson disease expertise, many patients (if not most) do not. Moreover, current care models frequently require older individuals with impaired mobility, cognition, and driving ability to be driven by overburdened caregivers to large, complex urban medical centers. Moving care to the patient's home would make Parkinson disease care more patient-centered. Demographic factors, including aging populations, and social factors, such as the splintering of the extended family, will increase the need for home-based care. Technological advances, especially the ability to assess and deliver care remotely, will enable the transition of care back to the home. However, despite its promise, this next generation of home-based care will have to overcome barriers, including outdated insurance models and a technological divide. Once these barriers are addressed, home-based care will increase access to high quality care for the growing number of individuals with Parkinson disease. © 2016 International Parkinson and Movement Disorder Society.

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

    PubMed

    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.

  15. 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

  16. 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

  17. [Aging problem in the home hospice care].

    PubMed

    Watanabe, Go; Yamagiwa, Tetsuya; Nakayama, Shinya; Ito, Satoko; Fukuda, Akiko; Shiotani, Tomohiro; Yamaoka, Yoshio

    2012-12-01

    Home hospice care is not merely an extension of hospital-based medical care administered at the hospital, but refers to hospice care for patients with life-threatening diseases that can only be given at their homes. The rapid growth of the elderly population in Japan has led to not only the need for home hospice care, but also social problems such as living alone, living with only one elderly family member, and problems that are particularly acute in cancer patients with dementia. We analyzed data for 262 patients for whom home hospice care was provided by our clinic. Overall, elderly persons with dementia tended to request admission before death, but most elderly persons living alone preferred home hospice care. We found that 58% of the patients living with only one elderly family member requested admission before death, which was lower than the rate of the study group as a whole. We further performed an in-depth analysis of the current situation in order to improve home hospice care of terminally ill patients in Japan, focusing on problems related to the aging population.

  18. Hospital information technology in home care.

    PubMed

    Zhang, Xiao-Ying; Zhang, Pei-Ying

    2016-10-01

    The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.

  19. 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

  20. 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…

  1. 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.

  2. Home Care Services: Questions to Ask

    MedlinePlus

    ... billing? Ask for literature explaining all services and fees, as well as detailed explanations of all costs associated with home care. Will agency fees be covered by health insurance or Medicare? Check ...

  3. [Role of pediatric medical home care].

    PubMed

    Garrec, N; Patte, R

    2004-02-01

    According to the decree of 1992, the Paris hospitals (AP-HP) pediatric medical home care network offers care for all children irrespective of their pathology within the framework of a medico-psycho-social therapeutic project provided as an in alternative to traditional hospitalization. 30% of the admissions occur during the neonatal period. We studied the files of 249 newborn or preterm infants given in medical home care between January and September 2003. 71% were preterm infants. 46.4% of the children had been admitted at least once in an intensive care unit. At their admission in the pediatric medical home care unit, the median corrected gestational age was 39 weeks 6 days; 43% weighed less than 2500g, 9% less than 2000g, 22.5% of the preterm infants had a corrected gestational age less than 37 weeks, 65% of the infants presented gastrointestinal and/or feeding disorders. The average duration of stay in the pediatric medical home care unit was 20.5 days. The competence of pediatric nurses working in an integrated multidisciplinary team including psychologists and social workers is the key to success of pediatric medical home care.

  4. The personal impact of home-care nursing: an alternative perspective to home-care satisfaction.

    PubMed

    Porter, Eileen J

    2008-04-01

    In this phenomenological study, I aimed to describe the personal impact of home-care nursing and to compare the findings to domains of the construct of home-care satisfaction (HCS). I report data from interviews with 11 women (ages 82 to 96) who had home-care nurses during a 3-year period. None of the women mentioned satisfaction, but when asked about their nurses, they shared memorable incidents exemplifying how home-care nursing was relevant to their personal goals. Using a previously developed descriptive phenomenological method, I discerned this feature of personal-social context (or life-world) as the main finding: Being Aware of What Stands Out for Me About Having a Nurse at Home. This main finding had six descriptors, including Sensing that the Nurse Knows How to Do What Nurses Do and Linking the Nurse's Help to Sustaining Myself Here. I compared the findings to domains of HCS on three parameters, including evaluation of satisfaction versus relevance of nursing activities. I concluded that compared with satisfaction with home care, the personal impact of home-care nursing was a more basic interest to the women and that the perceived relevance of nursing activities is an important standard for appraising that impact. I recommend that researchers use phenomenological methods to discern life-world descriptors of the personal impact of home-care nursing and use those descriptors to develop indicators to measure the personal impact of home-care nursing.

  5. An Evaluation of the Senior Home Care Project.

    ERIC Educational Resources Information Center

    Wolf, Rosalie S.

    The Senior Home Care Program (SHCP) attempted to demonstrate the feasibility of integrating and coordinating medical, home health services, and home care for members of a senior health plan. It was designed to show how a state-supported home care system could work with health maintenance organizations to improve community-based long-term care. A…

  6. Chronic care infrastructures and the home.

    PubMed

    Langstrup, Henriette

    2013-09-01

    In this article I argue that attention to the spatial and material dimensions of chronic disease management and its place-making effects is necessary if we are to understand the implications of the increased mobilisation--technologically or otherwise--of the home in chronic disease management. Analysing home treatment in asthma and haemophilia care, I argue that in relation to chronic disease management the home is not only always connected to the clinic but moreover, what the home is in part depends on the specificities of these attachments. Drawing primarily on the work of Susan Leigh Star and scholars of human geography I propose the concept of chronic care infrastructures designating the often inconspicuous socio-material elements (such as medication, control visits, phone calls, doses and daily routines), which are embedded in everyday life (of both the clinic and the home) and participate in producing the effect of treatment but also the effect of home. These chronic care infrastructures demand the emplacement of various objects and activities in everyday life and thus relate to negotiations of 'keepings'--hat to keep and care for and where to grant it room vis á vis other 'keepings'.

  7. Misalignment between Medicare Policies and Depression Care in Home Health Care: Home health provider perspectives

    PubMed Central

    Bao, Yuhua; Eggman, Ashley; Richardson, Joshua; Bruce, Martha

    2013-01-01

    Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients. PMID:24632686

  8. Neighborhood socioeconomic disadvantage is associated with higher ratio of 24-hour urinary sodium to potassium in young Japanese women.

    PubMed

    Murakami, Kentaro; Sasaki, Satoshi; Takahashi, Yoshiko; Uenishi, Kazuhiro

    2009-09-01

    Information on the relationship of neighborhood characteristics to objective indicators of dietary intake is extremely limited. The aim of this observational cross-sectional study was to examine the association between neighborhood socioeconomic status (SES) and 24-hour urinary excretion of sodium and potassium in a population with a high ratio of urinary sodium to potassium. Subjects were 1,032 female Japanese dietetics students aged 18 to 22 years, residing in 293 municipalities in Japan. Neighborhood SES index was defined by seven municipal-level variables, namely unemployment, household overcrowding, poverty, education, income, home ownership, and vulnerable groups, with an increasing index signifying increasing neighborhood socioeconomic disadvantage. Urinary excretion of sodium and potassium was estimated from a single 24-hour urine sample. Neighborhood SES index was not significantly associated with 24-hour urinary excretion of sodium (mean value for each quartile of neighborhood SES: 133.5, 135.2, 126.5, and 141.7 mmol/day, respectively; P for trend 0.10) or potassium (mean value for each quartile: 43.5, 42.2, 38.4, and 42.5 mmol/day, respectively; P for trend 0.44). However, neighborhood SES index was significantly positively associated with the ratio of 24-hour urinary sodium to potassium (mean value for each quartile: 3.14, 3.28, 3.37, and 3.41, respectively; P for trend 0.03). This significant association remained after adjustment for household SES variables (mean value for each quartile: 3.15, 3.35, 3.29, and 3.41, respectively; P for trend 0.04). Neighborhood socioeconomic disadvantage was associated with higher ratio of 24-hour urinary sodium to potassium in young Japanese women.

  9. Developing Caring Conversations in care homes: an appreciative inquiry.

    PubMed

    Dewar, Belinda; MacBride, Tamsin

    2017-02-19

    Relationship-centred practice is key to delivering quality care in care homes. Evidence is strong about the centrality of human interaction in developing relationships that promote dignity and compassion. The Caring Conversations framework is a framework for delivering compassionate care based on human interactions that was developed in the acute healthcare setting. The key attributes are: be courageous, connect emotionally, be curious, consider other perspectives, collaborate, compromise and celebrate. This paper reports on a study to explore its relevance to the care home setting and the development of an educational intervention, based on the framework, to enhance development of human interaction. The study used the approach of appreciative inquiry to develop Caring Conversations in the care home setting. Appreciative inquiry has a unique focus on what is working well, understanding why these aspects work well and co-creating strategies to help these good practices happen more of the time. The aim of the study was to celebrate and develop excellent human interaction that promotes dignity between staff, residents and families in care homes. The study took place in 2013-2014 in one care home in Scotland, over 10 months. Participants included staff (n = 37), residents (n = 20) and relatives (n = 18). Data generation methods involving residents, relatives and staff included observation and interviews about experiences of interaction. An iterative process of data analysis involved mapping core themes to the Caring Conversations framework with findings showing how people communicated correlated well with the Caring Conversations framework. Building on knowledge of what works well, staff developed small 'tests of change' that enabled these good practices to happen more of the time. Appreciative inquiry proved a valuable approach to exploring Caring Conversations, developing practice and developing an educational intervention that could be shared across other

  10. Nursing home care quality: a cluster analysis.

    PubMed

    Grøndahl, Vigdis Abrahamsen; Fagerli, Liv Berit

    2017-02-13

    Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients' perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents ( n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ(2) tests and one-way between-groups ANOVA were performed to characterise the clusters ( p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents' care quality perceptions.

  11. Reliability assessment of home health care services.

    PubMed

    Spyrou, Stergiani; Bamidis, Panagiotis; Kilintzis, Vassilis; Lekka, Irini; Maglaveras, Nicos; Pappas, Costas

    2007-01-01

    In this paper, a model of reliability assessment of services in Home Health Care Delivery is presented. Reliability is an important quality dimension for services and is included in non-functional requirements of a system. A stochastic Markov model for reliability assessment is applied to patient communication services, in the field of home health care delivery. The methodology includes the specification of scenarios, the definition of failures in scenarios as well as the application of the analytical model. The results of the methodology reveal the critical states of the Home Health Care System and recommendations for improvement of the services are proposed. The model gives valuable results in predicting service reliability and, independently of the error types, it can be applied to all fields of Regional Health Network (RHN).

  12. Home care for horses with chronic laminitis.

    PubMed

    Orsini, James A; Wrigley, Jennifer; Riley, Patrick

    2010-04-01

    Home care for horses with chronic laminitis has been discussed rarely in the veterinary literature even though, at any given time, most of us have at least 1 chronic laminitis case in our care that is being managed at home by the owner. Almost all of our knowledge on this aspect of laminitis treatment has been gleaned through experience, by individually working through the medical, ethical, financial, and emotional challenges these cases can present. Much has already been presented on the medical management of the laminitic horse and on strategies for trimming and shoeing the laminitic foot. This article focuses on the other challenges so often faced when directing the home care of a horse with chronic laminitis.

  13. Comparison of 24-hour intragastric pH using four liquid formulations of lansoprazole and omeprazole.

    PubMed

    Sharma, V K

    1999-12-01

    The results of previous studies evaluating the effect of four liquid formulations of proton-pump inhibitors on 24-hour intragastric pH are described. Patients with a gastrostomy who were resident in a Veterans Affairs medical center or its affiliated nursing home were eligible for enrollment in one of four open-label studies in which each patient served as his own control. Patients underwent 24-hour intragastric pH studies before and after receiving seven consecutive days of one of the following liquid formulations of a proton-pump inhibitor administered once daily: omeprazole granules 20 mg in orange juice, lansoprazole granules 30 mg in orange juice, simplified omeprazole suspension 20 mg, and simplified lansoprazole suspension 30 mg. The suspensions were prepared with 10 mL of 8.4% sodium bicarbonate solution. Mean intragastric pH was measured, as was the time pH stayed above 3.0 and 4.0 during the 24-hour period. Six to 14 patients participated in each study. The mean posttreatment pH was 4.9+/-0.8, 4.7+/-0.6, 4.1+/-1.5, and 5.1+/-1.1 for omeprazole granules in orange juice, lansoprazole granules in orange juice, simplified omeprazole suspension, and simplified lansoprazole suspension, respectively. Both drugs in orange juice maintained pH above 4.0 longer than 14 hours and above 3.0 for close to 20 hours, which are the levels deemed optimal for healing erosive esophagitis and duodenal ulcers, respectively. Simplified lansoprazole suspension maintained pH above those thresholds for the optimal times, but simplified omeprazole suspension did not (20 and 15 hr above 3.0, 17 and 12 hr above 4.0 for lansoprazole and omeprazole, respectively). Further development of liquid formulations of proton-pump inhibitors may have important implications for the treatment of acid-related diseases in patients, including children, who are unable to swallow capsules.

  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. Fixing the broken image of care homes, could a 'care home innovation centre' be the answer?

    PubMed

    Hockley, Jo; Harrison, Jennifer Kirsty; Watson, Julie; Randall, Marion; Murray, Scott

    2016-09-08

    The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of 'good' from regulators, still significant numbers are identified as requiring 'improvement' or are 'inadequate'. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible-as well as impacting on the career choices of health and social care students. Projections of current demographics highlight that, within 10 years, the part of our population that will be growing the fastest will be those people older than 80 years old with the suggestion that spending on long-term care provision needs to rise from 0.6% of our Gross Domestic Product in 2002 to 0.96% by 2031. Teaching/research-based care homes have been developed in the USA, Canada, Norway, the Netherlands and Australia in response to scandals about care, and the shortage of trained geriatric healthcare staff. There is increasing evidence that such facilities help to reduce inappropriate hospital admissions, increase staff competency and bring increased enthusiasm about working in care homes and improve the quality of care. Is this something that the UK should think of developing? This commentary details the core goals of a Care Home Innovation Centre for training and research as a radical vision to change the culture and image of care homes, and help address this huge public health issue we face.

  16. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Day care home provisions. 226.18 Section 226.18... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.18 Day care home provisions. (a) Day care homes shall have current Federal, State or local licensing...

  17. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 4 2011-01-01 2011-01-01 false Day care home provisions. 226.18 Section 226.18... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.18 Day care home provisions. (a) Day care homes shall have current Federal, State or local licensing...

  18. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 4 2013-01-01 2013-01-01 false Day care home provisions. 226.18 Section 226.18... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.18 Day care home provisions. (a) Day care homes shall have current Federal, State or local licensing...

  19. 7 CFR 226.18 - Day care home provisions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 4 2014-01-01 2014-01-01 false Day care home provisions. 226.18 Section 226.18... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.18 Day 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

    ... 7 Agriculture 4 2012-01-01 2012-01-01 false Day care home provisions. 226.18 Section 226.18... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.18 Day care home provisions. (a) Day care homes shall have current Federal, State or local licensing...

  1. How to use advance care planning in a care home.

    PubMed

    Storey, Les; Sherwen, Eleanor

    2013-03-01

    Admission to a care home is a major event for many individuals and, for some, a time when they may lose their independence. It is at this juncture that they should be given the opportunity to participate in planning their future care. An advance care plan (ACP) is a means for people with capacity to document their preferences for their care and to enable providers to advocate on their behalf. Some people will have lost mental capacity before admission to a care facility, so it is essential for staff to be familiar with the complexities of the Mental Capacity Act 2005 to support residents approaching the end of life. This article outlines the processes of ACP and identifies resources available to support the introduction of ACP into care homes.

  2. [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.

  3. Pressure ulcer prevention in care home settings.

    PubMed

    Ellis, Michael

    2017-03-31

    Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.

  4. 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.

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. First-time parents' experiences of home-based postnatal care in Sweden

    PubMed Central

    Aarts, Clara; Darj, Elisabeth

    2010-01-01

    Aim To gain a deeper understanding of first-time parents' experiences of early discharge from hospital after delivery and home-based postnatal care. Material and methods The study was comprised of focus group interviews, interviews with couples and with fathers. Twenty-one parents participated. Inclusion criteria: healthy women who have given birth to their first child after a normal pregnancy and delivery, the women's partners, healthy and full term babies, Swedish-speaking, discharge from the delivery ward within 24 hours, resident in the Uppsala community, the parents cohabited at the time of the delivery. The material was analysed by qualitative content analysis. Results Three themes emerged: The family's strategy, which describes the family's expectations of postnatal care and their experiences of the real situation. Some are flexible concerning going home early, and others have decided in advance. Self-reliance and strength, which explores the parents' feelings of security and uncertainty, freedom and independence, and shared responsibility. Breast-feeding is described as the ‘main thing’, an interactive learning process. Professional support in the home summarizes the parents' experience of the midwife's support at home. While conflicting feelings may be revealed during the first days, the midwife confirms their new roles as parents. The midwife is seen as a support and adviser to the parents. Conclusion This study shows that parents welcome home-based postnatal care with professional support from midwives. We conclude that this care suits healthy families. We think it will be more important in the future to discriminate between healthy families and those in need of hospital care, than to focus on the moment when they leave the hospital, early or late. PMID:20074000

  11. Physicians' attitudes and behaviors toward home health care services.

    PubMed

    Javalgi, R; Joseph, W B

    1991-12-01

    The authors investigate physicians' attitudes, information-seeking behaviors, and behavioral intentions toward home health care programs. Survey results show that physicians favor the concept, but knowledge and awareness levels about available programs vary with the physicians' specialties. Evidence also is reported on specific problems encountered, sources of information used to make home care referrals, and physicians' perceptions of the impact of home care programs on their practice. Finally, policy implications are drawn for marketers of home health care programs.

  12. Transitional Care Strategies From Hospital to Home

    PubMed Central

    Ranji, Sumant R.

    2015-01-01

    Hospitals are challenged with reevaluating their hospital’s transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a “bridging” strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care. PMID:25553228

  13. A comparison of overnight and 24 hour collection to measure urinary catecholamines.

    PubMed

    White, I R; Brunner, E J; Barron, J L

    1995-02-01

    The period of urine collection used to measure excretion of catecholamines varies in epidemiological practice. We set out to compare overnight with 24 hour collection. Twenty-four subjects each collected urine for 24 hours, with the overnight urine being separately collected. The correlation of overnight and 24 hour catecholamines was highest when both measures were standardised for creatinine excretion and when creatinine excretion was adjusted for urine flow rate. The observed correlations were 0.74 for dopamine, 0.81 for noradrenaline and 0.54 for adrenaline. The use of overnight collections may therefore require a sample size up to 1.5 times as large (for noradrenaline) or 3.4 times as large (for adrenaline) to achieve the same power as with 24 hour collections. However, the figures given exaggerate the advantage of 24 hour collections if these incorporate measurement errors that are not present in overnight collections.

  14. A sense of home in residential care.

    PubMed

    Falk, Hanna; Wijk, Helle; Persson, Lars-Olof; Falk, Kristin

    2013-12-01

    Moving into a residential care facility requires a great deal of adjustment to an environment and lifestyle entirely different from that of one's previous life. Attachment to place is believed to help create a sense of home and maintain self-identity, supporting successful adjustment to contingencies of ageing. The purpose of this study was to deepen our understanding of processes and strategies by which older people create a sense of home in residential care. Our findings show that a sense of home in residential care involves strategies related to three dimensions of the environment - attachment to place, to space and attachment beyond the institution - and that the circumstances under which older people manage or fail in creating attachment, consist of psychosocial processes involving both individual and shared attitudes and beliefs. Assuming that attachment is important to human existence regardless of age, attention must be paid to optimize the circumstances under which attachment is created in residential care, and how nursing interventions can help speed up this process due to the frail and vulnerable state of most older residents.

  15. The challenge of marketing home health care in the nineties.

    PubMed

    Balazs, A L

    1990-01-01

    This paper explores the recent growth and development of home health care services. Rising medical costs and technological and social changes have made home care a competitive alternative to hospitalization and other forms of institutionalization. Providers of home health care need to familiarize themselves with the demographic trends affecting their customer base. A strategic marketing orientation is suggested for future growth and profitability.

  16. How To Start a Licensed Child Care Home.

    ERIC Educational Resources Information Center

    Henry, Jeanie

    This booklet was designed as a resource for people applying for a license as a family child care home or a family child care group home under Alaska state licensing requirements. Following an introduction that explains the difference between the two types of child care homes, the booklet considers the following topics: (1) choosing family child…

  17. A New Typology of Home-Care Helpers

    ERIC Educational Resources Information Center

    Porter, Eileen J.; Ganong, Lawrence H.; Drew, Nancy; Lanes, Tracy I.

    2004-01-01

    Purpose: The formal-informal dichotomy of home care, which has been a theoretical framework in quantitative and qualitative research, might not be descriptive of older persons' views about their home-care providers. This qualitative study explores the perspectives of older women about the characteristics of their home-care providers. Design and…

  18. Culture change in care homes: development and facilitation.

    PubMed

    Wild, Deidre; Kydd, Angela

    2016-09-29

    This article is the second of a two-part series that explores a programme of culture change in care homes. In this article, the authors describe their independent development and facilitation of a flexible learning programme for care homes, designed to meet a quality improvement request made by a care home company. The two selected care homes' staff conducted a review of their care culture, as a precursor to their creation of a new care philosophy. These activities provided a firm foundation from which the homes could, in theory, become a Remedial Enterprise Active Learning care home. Although the learning programme was not completed due to unavoidable circumstances, the staff's experiences highlight some of the challenges and successes that may be experienced when seeking to improve care homes' learning culture and practice.

  19. Home care in Europe: a systematic literature review

    PubMed Central

    2011-01-01

    Background Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. Results Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the

  20. Home care and technology: a case study.

    PubMed

    Stroulia, Eleni; Nikolaidisa, Ioanis; Liua, Lili; King, Sharla; Lessard, Lysanne

    2012-01-01

    Health care aides (HCAs) are the backbone of the home care system and provide a range of services to people who, for various reasons related to chronic conditions and aging, are not able to take care of themselves independently. The demand for HCA services will increase and the current HCA supply will likely not keep up with this increasing demand without fundamental changes in the current environment. Information and communication technology (ICT) can address some of the workflow challenges HCAs face. In this project, we conducted an ethnographic study to document and analyse HCAs' workflows and team interactions. Based on our findings, we designed an ICT tool suite, integrating easily available existing and newly developed (by our team) technologies to address these issues. Finally, we simulated the deployment of our technologies, to assess the potential impact of these technological solutions on the workflow and productivity of HCAs, their healthcare teams and client care.

  1. Misalignment between medicare policies and depression care in home health care: home health provider perspectives.

    PubMed

    Bao, Yuhua; Eggman, Ashley A; Richardson, Joshua E; Bruce, Martha L

    2014-07-01

    Semistructured interviews with nurses working for home health care agencies in five states raise serious questions about the deleterious effects of Medicare policies and procedures on depression care. The agencies have strong incentives to limit nursing time in a given payment episode and to increase volume, making it difficult to provide high-quality depression care for homebound patients. Some nurses felt forced to "abandon" many patients with depression. The authors call for incremental policy changes in several key areas.

  2. 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…

  3. Moving from the operating room to home care.

    PubMed

    Applegate, V E

    1995-01-01

    Although a change in career can be frightening, a nurse can reap many benefits in a change to home care nursing. With the health care environment changing, home care is increasing and offers a nurse a chance to refresh her enthusiasm for individual patient care and put to use her collective skills learned along the way.

  4. Antimicrobial Prophylaxis in Instrumented Spinal Fusion Surgery: A Comparative Analysis of 24-Hour and 72-Hour Dosages

    PubMed Central

    Abraham, Vineet Thomas; Ravichandran, Mirunalini; Achimuthu, Rajamani

    2016-01-01

    Study Design Prospective study. Purpose To compare the efficacy of 24-hour and 72-hour antibiotic prophylaxis in preventing surgical site infections (SSIs). Overview of Literature Antimicrobial prophylaxis in surgical practice has become a universally accepted protocol for minimizing postoperative complications related to infections. Although prophylaxis is an accepted practice, a debate exists with regard to the antibiotic type and its administration duration for various surgical procedures. Methods Our institute is a tertiary care hospital with more than 100 spinal surgeries per year for various spine disorders in the department of orthopedics. We conducted this prospective study in our department from June 2012 to January 2015. A total of 326 patients were enrolled in this study, with 156 patients in the 72-hour antibiotic prophylaxis group (group A) and 170 patients in the 24-hour group (group B). Cefazolin was the antibiotic used in both groups. Two surgeons were involved in conducting all the spinal procedures. Our study compared SSIs among patients undergoing instrumented spinal fusion. Results The overall rate of SSIs was 1.8% with no statistical difference between the two groups. Conclusions The 24-hour antimicrobial prophylaxis is as effective as the 72-hour dosage in instrumented spinal fusion surgery. PMID:27994776

  5. Returning Home in Systems of Care: Rates, Predictors, and Stability

    ERIC Educational Resources Information Center

    Farmer, Elizabeth M. Z.; Southerland, Dannia; Mustillo, Sarah A.; Burns, Barbara J.

    2009-01-01

    Recent work suggests that out-of-home placements continue to be relatively common for youth with mental health problems, even within systems of care. The current work examines rates and predictors of movement back home and stability of reunifications. During the focal period, 1,778 youths experienced out-of-home placements; 61% moved back home,…

  6. 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.…

  7. 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

  8. Optimal dose of oral omeprazole for maximal 24 hour decrease of intragastric acidity.

    PubMed Central

    Sharma, B K; Walt, R P; Pounder, R E; Gomes, M D; Wood, E C; Logan, L H

    1984-01-01

    In a series of 59 experiments in nine duodenal ulcer patients, 24 hour intragastric acidity was measured before, during, and after treatment with daily oral omeprazole. Omeprazole 10, 20, and 30 mg/day for one week caused a 37, 90, and 97% decrease of 24 hour intragastric acidity, respectively. No further decrease of acidity was observed when the dose of omeprazole was doubled to 60 mg/day, or after a second week of treatment with 30 mg/day. One week after stopping treatment with omeprazole (14 doses) there was a significant 26% decrease of 24 hour intragastric acidity, with full recovery seven weeks later. Fasting plasma gastrin concentration was significantly raised during treatment with all doses of omeprazole. Omeprazole 30 mg/day is the optimal dose for a maximal decrease of 24 hour intragastric acidity in duodenal ulcer patients. PMID:6469081

  9. 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…

  10. Retrospective Analysis of a Home Care Hospice Program.

    ERIC Educational Resources Information Center

    Brescia, Frank J.; And Others

    1985-01-01

    Presents a retrospective study of patients who died in a hospice home care program to examine quality of care and differences between patients who died at home and in the hospital. No prediction could be made of which patients could remain at home until death. (JAC)

  11. 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)

  12. Comparison of anthropometric and training characteristics between recreational male marathoners and 24-hour ultramarathoners

    PubMed Central

    Rüst, Christoph Alexander; Knechtle, Beat; Knechtle, Patrizia; Rosemann, Thomas

    2012-01-01

    Background Of the anthropometry and training variables used to predict race performance in a 24-hour ultrarun, the personal best marathon time is the strongest predictor in recreational male 24-hour ultramarathoners. This finding raises the question of whether similarities exist between male recreational 24-hour ultramarathoners and male recreational marathoners. Methods The association between age, anthropometric variables (ie, body mass, body height, body mass index, percent body fat, skeletal muscle mass, limb circumference, and skinfold thickness at the pectoral, mid axillary, triceps, subscapular, abdominal, suprailiac, front thigh, and medial calf sites), previous experience and training characteristics (ie, volume, speed, and personal best time), and race time for 79 male recreational 24-hour ultramarathoners and 126 male recreational marathoners was investigated using bivariate and multivariate analysis. Results The 24-hour ultramarathoners were older (P < 0.05), had a lower circumference at both the upper arm (P < 0.05) and thigh (P < 0.01), and a lower skinfold thickness at the pectoral, axillary, and suprailiac sites (P < 0.05) compared with the marathoners. During training, the 24-hour ultramarathoners were running for more hours per week (P < 0.001) and completed more kilometers (P < 0.001), but were running slower (P < 0.01) compared with the marathoners. In the 24-hour ultramarathoners, neither anthropometric nor training variables were associated with kilometers completed in the race (P > 0.05). In the marathoners, percent body fat (P < 0.001) and running speed during training (P < 0.0001) were related to marathon race times. Conclusion In summary, differences in anthropometric and training predictor variables do exist between male recreational 24-hour ultramarathoners and male recreational marathoners for race performance. PMID:24198595

  13. Comparison of effects of amphotericin B deoxycholate infused over 4 or 24 hours: randomised controlled trial

    PubMed Central

    Eriksson, Urs; Seifert, Burkhard; Schaffner, Andreas

    2001-01-01

    Objective To test the hypothesis that amphotericin B deoxycholate is less toxic when given by continuous infusion than by conventional rapid infusion. Design Randomised, controlled, non-blinded, single centre study. Setting University hospital providing tertiary clinical care. Patients 80 mostly neutropenic patients with refractory fever and suspected or proved invasive fungal infections. Intervention Patients were randomised to receive 0.97 mg/kg amphotericin B by continuous infusion over 24 hours or 0.95 mg/kg by rapid infusion over four hours. Main outcome measures Patients were evaluated for side effects related to infusion, nephrotoxicity, and mortality up to three months after treatment. Analysis was on an intention to treat basis. Results Patients in the continuous infusion group had fewer side effects and significantly reduced nephrotoxicity than those in the rapid infusion group. Overall mortality was higher during treatment and after three months' follow up in the rapid infusion than in the continuous infusion group. Conclusion Continuous infusions of amphotericin B reduce nephrotoxicity and side effects related to infusion without increasing mortality. PMID:11238151

  14. Data sharing between home care professionals: a feasibility study using the RAI Home Care instrument

    PubMed Central

    2014-01-01

    Background Across Ontario, home care professionals collect standardized information on each client using the Resident Assessment for Home Care (RAI-HC). However, this information is not consistently shared with those professionals who provide services in the client’s home. In this pilot study, we examined the feasibility of sharing data, from the RAI-HC, between care coordinators and service providers. Methods All participants were involved in a one-day training session on the RAI-HC. The care coordinators shared specific outputs from the RAI-HC, including the embedded health index scales, with their contracted physiotherapy and occupational therapy service providers. Two focus groups were held, one with care coordinators (n = 4) and one with contracted service providers (n = 6). They were asked for their opinions on the positive aspects of the project and areas for improvement. Results The focus groups revealed a number of positive outcomes related to the project including the use of a falls prevention brochure and an increased level of communication between professionals. The participants also cited multiple areas for improvement related to data sharing (e.g., time constraints, data being sent in a timely fashion) and to their standard practices in the community (e.g., busy workloads, difficulties in data sharing, duplication of assessments between professionals). Conclusions Home care professionals were able to share select pieces of information generated from the RAI-HC system and this project enhanced the level of communication between the two groups of professionals. However, a single information session was not adequate training for the rehabilitation professionals, who do not use the RAI-HC as part of normal practice. Better education, ongoing support and timely access to the RAI-HC data are some ways to improve the usefulness of this information for busy home care providers. PMID:24975375

  15. Home Care Nursing via Computer Networks: Justification and Design Specifications

    PubMed Central

    Brennan, Patricia Flatley

    1988-01-01

    High-tech home care includes the use of information technologies, such as computer networks, to provide direct care to patients in the home. This paper presents the justification and design of a project using a free, public access computer network to deliver home care nursing. The intervention attempts to reduce isolation and improve problem solving among home care patients and their informal caregivers. Three modules comprise the intervention: a decision module, a communications module, and an information data base. This paper describes the experimental evaluation of the project, and discusses issues in the delivery of nursing care via computers.

  16. 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.

  17. Rationing home-based nursing care: professional ethical implications.

    PubMed

    Tønnessen, Siri; Nortvedt, Per; Førde, Reidun

    2011-05-01

    The purpose of this study was to investigate nurses' decisions about priorities in home-based nursing care. Qualitative research interviews were conducted with 17 nurses in home-based care. The interviews were analyzed and interpreted according to a hermeneutic methodology. Nurses describe clinical priorities in home-based care as rationing care to mind the gap between an extensive workload and staff shortages. By organizing home-based care according to tight time schedules, the nurses' are able to provide care for as many patients as possible. Furthermore, legal norms set boundaries for clinical priority decisions, resulting in marginalized care. Hence, rationing care jeopardizes important values in the nurse-patient relationship, in particular the value of individualized and inclusive nursing care. The findings are highly relevant for clinical practice, since they have major implications for provision of nursing care. They revive debates about the protection of values and standards of care, and nurses' role and responsibility when resources are limited.

  18. Financing of pediatric home health care. Committee on Child Health Financing, Section on Home Care, American Academy of Pediatrics.

    PubMed

    2006-08-01

    In certain situations, home health care has been shown to be a cost-effective alternative to inpatient hospital care. National health expenditures reveal that pediatric home health costs totaled $5.3 billion in 2000. Medicaid is the major payer for pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenses. The most important factors affecting access to home health care are the inadequate supply of clinicians and ancillary personnel, shortages of home health nurses with pediatric expertise, inadequate payment, and restrictive insurance and managed care policies. Many children must stay in the NICU, PICU, and other pediatric wards and intermediate care areas at a much higher cost because of inadequate pediatric home health care services. The main financing problem pertaining to Medicaid is low payment to home health agencies at rates that are insufficient to provide beneficiaries access to home health services. Although home care services may be a covered benefit under private health plans, most do not cover private-duty nursing (83%), home health aides (45%), or home physical, occupational, or speech therapy (33%) and/or impose visit or monetary limits or caps. To advocate for improvements in financing of pediatric home health care, the American Academy of Pediatrics has developed several recommendations for public policy makers, federal and state Medicaid offices, private insurers, managed care plans, Title V officials, and home health care professionals. These recommendations will improve licensing, payment, coverage, and research related to pediatric home health services.

  19. 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

  20. Home health care quality conferences: promoting change through dialogue.

    PubMed

    Rudin, Danylle

    2006-01-01

    The following brief is based on the results of two conferences on home care quality hosted by the Center for Home Care Policy and Research of the Visiting Nurse Service of New York. For more information about the conference outcomes and proceedings please see: Feldman, P.H.,Peterson, L.E., Reische, L., Bruno, L., & Clark, A. (2004). Charting the course for home healthcare quality: Action steps for achieving sustainable improvement. Conference proceedings. Home Healthcare Nurse, 22(12): 841-850; and Feldman, P.H., Clark, A., & Bruno, L. (2006). Advancing the agenda for home healthcare quality: Conference proceedings and findings. Home Healthcare Nurse, 24(5): 282-290.

  1. 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;…

  2. 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

  3. Reliability and predictive validity of energy intake measures from the 24-hour dietary recalls of homebound older adults.

    PubMed

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

    2010-05-01

    Twenty-four-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 was to examine whether homebound older adults provide reliable and valid measures of total energy intake in 24-hour dietary recalls. Two hundred thirty 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 subsamples 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 energy intake was observed (r=0.59), but energy 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 energy intake (odds ratio 3.49, P=0.009), 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 is needed to better evaluate the predictive validity of energy intake measures for this population.

  4. 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

    ... Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care... solicits comments on information needed to ensure that nursing home and adult day health care facilities... approved collection. Abstract: VA pays per diem to State homes providing nursing home and adult day...

  5. 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

  6. 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.

  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.

  8. Focus on Dementia Care: Continuing Education Preferences, Challenges, and Catalysts among Rural Home Care Providers

    ERIC Educational Resources Information Center

    Kosteniuk, Julie G.; Morgan, Debra G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.

    2016-01-01

    Home care staff who provide housekeeping and personal care to individuals with dementia generally have lower levels of dementia care training compared with other health care providers. The study's purposes were to determine whether the professional role of home care staff in a predominantly rural region was associated with preferences for delivery…

  9. [Intensive care and home artificial ventilation. How do nurses experience artificial respiratory care in the home of patients?].

    PubMed

    Gödecke, Christiane; Kohlen, Helen

    2013-04-01

    In Germany, the number of patients who receive artificial respiration in their own home is increasing. One reason for long time ventilation is the rise of technical possibilities. Bringing "intensive care" to the home of people challenges original understandings of home care. While intensive care and artificial respiration are technology-oriented, home-care is social-oriented, respecting the familiar environment of the patient. An international literature review reveals that research has been done by investigating the experiences of relatives and patients but not those of nurses. The few studies with a focus on nurses relate to themes of privacy and how to set limits. In Germany, not one study could be found that dealt with the question of how nurses experience artificial respiratory care in patients' homes. Considering the involved changes of care, the question rises, how nurses experience artificial respiratory care in the home of patients. This research is explorative and allows an insight into what home care is like when technology comes in. The exploration is based on eight narrative interviews with nurses who are experiencing respiratory care for patients in their home. The findings reveal professional challenges nurses have to face when caring for patients who are dependent on technological devices. The relatives are included in the caring activities and cooperating with them is crucial.

  10. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study.

    PubMed

    Karacan, Mehmet; Işıkay, Sedat; Olgun, Haşim; Ceviz, Naci

    2010-12-01

    Some rhythm and conduction abnormalities can occur in children with acute rheumatic fever. These abnormalities have been defined based on standard electrocardiography; however, the real prevalence of these abnormalities has not been investigated previously by the evaluation of long-term electrocardiographic recordings. In this study, we evaluated the asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever by evaluating the 24-hour electrocardiography. We evaluated the standard electrocardiography and the 24-hour electrocardiography of 64 children with acute rheumatic fever. On standard electrocardiography, the frequency of the first-degree atrioventricular block was found to be 21.9%. Electrocardiography at 24 hours detected three additional and separate patients with a long PR interval. Mobitz type I block and atypical Wenckebach periodicity were determined in one patient (1.56%) on 24-hour electrocardiography. While accelerated junctional rhythm was detected in three patients on standard electrocardiography, it was present in nine patients according to 24-hour electrocardiography. Premature contractions were present in 1.7% of standard electrocardiography, but in 29.7% of 24-hour electrocardiography. Absence of carditis was found to be related to the presence of accelerated junctional rhythm (p > 0.05), and the presence of carditis was found to be related to the presence of premature contractions (p = 0.000). In conclusion, our results suggest that in children with acute rheumatic fever, the prevalence of rhythm and conduction abnormalities may be much higher than determined on standard electrocardiography. Further studies are needed to clarify whether or not these abnormalities are specific to acute rheumatic fever.

  11. Exploring new operational research opportunities within the Home Care context: the chemotherapy at home.

    PubMed

    Chahed, Salma; Marcon, Eric; Sahin, Evren; Feillet, Dominique; Dallery, Yves

    2009-06-01

    Home Care (HC) services provide complex and coordinated medical and paramedical care to patients at their homes. As health care services move into the home setting, the need for developing innovative approaches that improve the efficiency of home care organizations increases. We first conduct a literature review of investigations dealing with operation planning within the area of home care management. We then address a particular issue dealing with the planning of operations related to chemotherapy at home as it is an emergent problem in the French context. Our interest is focused on issues specific to the anti-cancer drug supply chain. We identify various models that can be developed and analyze one of them.

  12. 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,…

  13. Continual 24-hour observations of thermospheric winds made with the SOFDI instrument from Huancayo, Peru

    NASA Astrophysics Data System (ADS)

    Gerrard, Andrew; Meriwether, John W.

    The Second generation Optimized Fabry-Perot Doppler Imager (SOFDI), a state-of-the-art triple-etalon Fabry-Perot interferometer, has been sucessfully relocated to Huancayo, Peru and is making continual 24-hour observations. The 630-nm data, originating from layer-integrated OI emission with centroid heights of 250 km at night and 220 km during the day, are analyzed so as to obtain measurements of horizontal winds in the thermosphere. In this paper we report the most recent results from continuous 24-hour observations of these thermospheric parameters.

  14. [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.

  15. Experiences of technology integration in home care nursing.

    PubMed

    Johnson, K A; Valdez, R S; Casper, G R; Kossman, S P; Carayon, P; Or, C K L; Burke, L J; Brennan, P F

    2008-11-06

    The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.

  16. 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.

  17. Reducing falls in a care home

    PubMed Central

    Cooper, Rosie

    2017-01-01

    Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result. 2 A project commenced at a care home in Aberdeen with the aim of reducing the number of falls by 20% by 30st April 2016 using the model for improvement. Qualitative data was gathered to establish staff belief about falls and their level of knowledge& understanding about falls risks and how to manage these. This informed the training which was delivered and iterative testing commenced with the introduction of the Lanarkshire Falls Risk/Intervention tool – where the multifactorial nature of a resident's falls risks are explored and specific actions to manage these are identified and implemented. Failure to meet PDSA predictions about sharing risk reducing actions with staff and length of time to complete the tool prompted a focus on communication and the processes whereby the tool is completed. “Teach back” was employed to highlight communication difficulties and ultimately the introduction of Huddles out improved the flow of information about residents and informed the Falls Risk/Intervention tool. 5 PDSAs were completed and within them multiple tests of change. The improvement shift came following a root cause analysis of the nature & cause of one resident's falls and applying the tool & communication processes. The average falls rate fell from 49 per 1000 occupied bed days to 23.6 and was sustained because of the attention to the importance of communication. The aim was achieved with a 36.6% reduction in Falls rate. Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result. 2 A project commenced at a care home in Aberdeen with the aim of reducing the number of falls by 20% by 30th April 2016 using the model for improvement. Qualitative data was gathered to establish staff belief about falls and their level

  18. Reducing falls in a care home.

    PubMed

    Cooper, Rosie

    2017-01-01

    Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result. 2 A project commenced at a care home in Aberdeen with the aim of reducing the number of falls by 20% by 30st April 2016 using the model for improvement. Qualitative data was gathered to establish staff belief about falls and their level of knowledge& understanding about falls risks and how to manage these. This informed the training which was delivered and iterative testing commenced with the introduction of the Lanarkshire Falls Risk/Intervention tool - where the multifactorial nature of a resident's falls risks are explored and specific actions to manage these are identified and implemented. Failure to meet PDSA predictions about sharing risk reducing actions with staff and length of time to complete the tool prompted a focus on communication and the processes whereby the tool is completed. "Teach back" was employed to highlight communication difficulties and ultimately the introduction of Huddles out improved the flow of information about residents and informed the Falls Risk/Intervention tool. 5 PDSAs were completed and within them multiple tests of change. The improvement shift came following a root cause analysis of the nature & cause of one resident's falls and applying the tool & communication processes. The average falls rate fell from 49 per 1000 occupied bed days to 23.6 and was sustained because of the attention to the importance of communication. The aim was achieved with a 36.6% reduction in Falls rate. Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result. 2 A project commenced at a care home in Aberdeen with the aim of reducing the number of falls by 20% by 30th April 2016 using the model for improvement. Qualitative data was gathered to establish staff belief about falls and their level of

  19. Marketing considerations in home health care.

    PubMed

    Tanner, D J

    1985-12-01

    Methods for conducting a comprehensive analysis of the potential for strategic entry or expansion in the home health-care (HHC) market are discussed. By conducting a comprehensive analysis of the HHC market, hospital pharmacists can evaluate the feasibility of developing and implementing a hospital-based HHC service. A comprehensive market analysis should include an initial assessment of potential product-line offerings, development of strengths-and-weaknesses and opportunities-and-threats profiles, evaluations of competing providers of HHC and regulatory issues, and formulation of a business plan. The potential impact of program structure, operations management, product pricing, advertising and promotion, and marketing controls should also be considered. The hospital pharmacist has a unique opportunity to further the organizational objectives of the hospital by participating in the provision of HHC; a comprehensive market analysis represents a useful method of assessing the benefits and costs associated with providing integrated HHC services.

  20. Home-based chronic care. An expanded integrative model for home health professionals.

    PubMed

    Suter, Paula; Hennessey, Beth; Harrison, Gregory; Fagan, Martha; Norman, Barbara; Suter, W Newton

    2008-04-01

    The Chronic Care Model (CCM) developed by is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a "division of labor" to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.

  1. Determinants of home death in palliative home care: using the interRAI palliative care to assess end-of-life care.

    PubMed

    Brink, Peter; Frise Smith, Trevor

    2008-01-01

    Many terminally ill patients are given the choice to die at home. This study identified determinants of home death among patients receiving palliative home care. Health information was collected using the interRAI palliative care assessment tool. The sample included health information from 536 patients receiving home health care from one community care access centre in Ontario, Canada. Patients who died at home were more likely to be functionally impaired and less likely to live alone. The patients' wish to die at home and the family's ability to cope were strong determinants of home death. This study suggests that the presence of a supportive family that is able to work with the health care team to implement a plan of care is important to the patients' ability to die at home. This study highlights the need to treat the patient and the caregiver(s) as a unit of care.

  2. Innovative models of home-based palliative care.

    PubMed

    Labson, Margherita C; Sacco, Michele M; Weissman, David E; Gornet, Betsy; Stuart, Brad

    2013-01-01

    The focus of palliative care is to alleviate pain and suffering for patients, potentially while they concurrently pursue life-prolonging or curative therapy. The potential breadth of palliative care is recognized by the Medicare program, but the Medicare hospice benefit is narrowly defined and limited to care that is focused on comfort and not on cure. Any organization or setting that has been accredited or certified to provide health care may provide palliative care. Home health agencies are highly attuned to patients' need for palliative care, and often provide palliative care for patients who are ineligible for hospice or have chosen not to enroll in it. Two home health-based programs have reported improved patient satisfaction, better utilization of services, and significant cost savings with palliative care. Moving the focus of care from the hospital to the home and community can be achieved with integrated care and can be facilitated by changes in government policy.

  3. Caring for elderly people at home: the consequences to caregivers

    PubMed Central

    Grunfeld, E; Glossop, R; McDowell, I; Danbrook, C

    1997-01-01

    The emphasis on home-based care is one important aspect of health services restructuring initiatives in Canada. Fundamental to the preference for home-based care over institutional care is the expectation that family caregivers will be available in the home to support patients who would otherwise be in an institution. The authors explore the potential impact of this devolution of services from institutions to the home in 2 vulnerable patient populations--elderly patients with dementia and elderly patients with terminal illnesses. Community-based surveillance strategies are needed to determine the true health, quality-of-life and economic outcomes of these restructuring initiatives. PMID:9347781

  4. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... for day care homes. 226.12 Section 226.12 Agriculture Regulations of the Department of Agriculture... day care homes. (a) General. Sponsoring organizations for day care homes shall receive payments for... organization's: (i) Initial 50 day care homes by 42 dollars; (ii) Next 150 day care homes by 32 dollars;...

  5. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... for day care homes. 226.12 Section 226.12 Agriculture Regulations of the Department of Agriculture... day care homes. (a) General. Sponsoring organizations for day care homes shall receive payments for... organization's: (i) Initial 50 day care homes by 42 dollars; (ii) Next 150 day care homes by 32 dollars;...

  6. Expanded medical home model works for children in foster care.

    PubMed

    Jaudes, Kienberger Paula; 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 children used the health care system more effectively and cost-effective as reflected in the higher utilization rates of primary care and well-child visits and lower utilization of emergency room care for children with chronic conditions.

  7. 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…

  8. 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…

  9. 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.

  10. [Technological advances and hospital-at-home care].

    PubMed

    Tibaldi, Vittoria; Aimonino Ricauda, Nicoletta; Rocco, Maurizio; Bertone, Paola; Fanton, Giordano; Isaia, Giancarlo

    2013-05-01

    Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino.

  11. 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…

  12. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  13. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  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. 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...

  16. 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…

  17. 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)

  18. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  19. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  20. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  1. 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.

  2. 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.

  3. 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…

  4. Prevalence of Masked Hypertension: a Population-Based Survey in a Large City by Using 24-Hour Ambulatory Blood Pressure Monitoring

    PubMed Central

    Kim, Sun-Woong; Choi, Eun-Hee; Kim, Ji-Hyun; Nah, Deuk-Young; Shin, Sung-Joon; Gu, Namyi

    2016-01-01

    Background and Objectives We estimated the prevalence of hypertension and hypertension subtypes in a large semi-urban city in Korea, using 24-hour ambulatory blood pressure monitoring (ABPM) in a randomly selected sample population. Subjects and Methods A random sample (aged 20-65 years) from a city with an adult population of approximately 600000 was selected by using a list-assisted random digit dialing method. The 24-hour ABPM and conventional blood pressure measurement (CBPM) of these individuals were obtained. Results Among the 496 participants, valid 24-hour ABPM and CBPM were obtained from 462 (93%) individuals. The estimated prevalence of hypertension in Goyang was 17.54% by CBPM and 32.70% by 24-hour ABPM (p<0.01). In the age stratified analysis, both CBPM and 24-hour ABPM showed increased prevalence of hypertension with age. The estimated prevalence of masked hypertension was 16.22% and that of white-coat hypertension was 1.08%. Men had a higher prevalence of masked hypertension than women (20.79% vs. 11.86%, p=0.0295). The estimated prevalence of masked hypertension was 17.5%, 20.58%, 24.34%, and 13.29% in the age categories of 30s, 40s, 50s, and 60s, respectively. The estimated prevalence of masked uncontrolled hypertension was 26.79% in patients with hypertension who were taking antihypertensive medications. Conclusion The estimated prevalence of hypertension by 24-hour ABPM was higher than that by CBPM, revealing high prevalence of masked hypertension. The high prevalence of masked hypertension supports the adoption of ABPM in the national population survey and clinical practice to improve public health and reduce health care costs. PMID:27721860

  5. 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

  6. 24 Hours of Sleep, Sedentary Behavior, and Physical Activity with Nine Wearable Devices

    PubMed Central

    Rosenberger, Mary E.; Buman, Matthew P.; Haskell, William L.; McConnell, Michael V.; Carstensen, Laura L.

    2015-01-01

    Getting enough sleep, exercising and limiting sedentary activities can greatly contribute to disease prevention and overall health and longevity. Measuring the full 24-hour activity cycle - sleep, sedentary behavior (SED), light intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) - may now be feasible using small wearable devices. PURPOSE This study compares nine devices for accuracy in 24-hour activity measurement. METHODS Adults (N=40, 47% male) wore nine devices for 24-hours: Actigraph GT3X+, activPAL, Fitbit One, GENEactiv, Jawbone Up, LUMOback, Nike Fuelband, Omron pedometer, and Z-Machine. Comparisons (to standards) were made for total sleep time (Z-machine), time spent in SED (activPAL), LPA (GT3x+), MVPA (GT3x+), and steps (Omron). Analysis included mean absolute percent error, equivalence testing, and Bland-Altman plots. RESULTS Error rates ranged from 8.1–16.9% for sleep; 9.5–65.8% for SED; 19.7–28.0% for LPA; 51.8–92% for MVPA; and 14.1–29.9% for steps. Equivalence testing indicated only two comparisons were significantly equivalent to standards: the LUMOback for sedentary behavior and the GT3X+ for sleep. Bland-Altman plots indicated GT3X+ had the closest measurement for sleep, LUMOback for sedentary behavior, GENEactiv for LPA, Fitbit for MVPA and GT3X+ for steps. CONCLUSIONS Currently, no device accurately captures activity data across the entire 24-hour day, but the future of activity measurement should aim for accurate 24-hour measurement as a goal. Researchers should continue to select measurement devices based on their primary outcomes of interest. PMID:26484953

  7. Role of environmental cleanliness and decontamination in care homes.

    PubMed

    Cousins, Gary

    2016-01-06

    While it is widely accepted that the environment has an important role in transmission of healthcare-associated infections, there has been a paucity of empirical investigation in this area to date, and the majority of published literature relates to acute settings. People living in care homes come into contact with a communally used environment and communally used equipment daily. Equipment may include hoists, hoist slings, clinical monitoring equipment, commodes and shower chairs. In care homes, primary responsibility for decontamination lies with the healthcare team, most of whom are not nurses. The challenge for nurses working in care homes is their accountability for the provision of safe and effective care.

  8. 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....

  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.

  10. The personal significance of home: habitus and the experience of receiving long-term home care.

    PubMed

    Angus, Jan; Kontos, Pia; Dyck, Isabel; McKeever, Patricia; Poland, Blake

    2005-03-01

    The physical, symbolic and experiential aspects of receiving long-term care are examined in this paper using Bourdieu's concepts of habitus and field. We draw on data from an ethnographic study of home care in 16 homes in urban, rural and remote locations in Ontario, Canada. Across all cases, data about domestic and caregiving routines were gathered through observation, interviews with clients and/or the primary family caregiver, interviews with service providers and videotaped tours of the home. Based on the analysis of these data, we argue that a transposition of logics and practices occurred when the domestic and health care fields were superimposed within the spaces of the home. Although all of the care recipients and their family caregivers indicated a strong preference for home care over institutional care, their experiences and practices within their homes were disrupted and reconfigured by the insertion of logics emanating from the healthcare field. These changes were manifested in three main themes: the politics of aesthetics; the maintenance of order and cleanliness; and transcending the limitations of the home. In each of these dimensions, it became apparent that care recipients engaged in improvisatory social practices that reflected their ambiguous and changing habitus or social location. The material spaces of their homes signified, or prompted, altered or changing social placement.

  11. 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)…

  12. [Terminal patient home care: the family caregivers perspective].

    PubMed

    Oliveira, Stefanie Griebeler; Quintana, Alberto Manuel; Denardin-Budó, Maria de Lourdes; de Moraes, Natália de Andrade; Lüdtke, Manoela Fonseca; Cassel, Paula Argemi

    2012-09-01

    This study was aimed at getting to know the relationships built among patients, family caregivers and the health care team, during home care,from the perspective of the family caregiver It is a qualitative study with 11 family caregivers of terminal patients, registered on a home care service of a university hospital in the South of Brazil. Data collection was carried out through narrative interviews that were recorded transcribed and analyzed through content analysis. Three categories were built from data analysis: relationships among the family caregiver, the patient and the health care team; awareness of the patient's terminal condition. the caregiver's perspective; and situation in which patients are unaware of their terminal condition. They approach how the home care relationships are established among the caregivers, such as health care professionals and family caregivers, and the people who are taken care of such as the patients, highlighting the importance of communication in such care related context.

  13. Complexity and contradiction: home care in a multicultural area.

    PubMed

    Skott, Carola; Lundgren, Solveig M

    2009-09-01

    The aim of this study was to explore the meaning of experience for home-care nurses in a multicultural area of Sweden. Interviews and group discussions with a team of five home-care nurses were interpreted in accordance with a hermeneutical perspective. The meaning was expressed in connection with the complexities of place, and space for care. Contradictions developed from diversities of perspectives incorporated in this particular multicultural area. Nurses saw themselves as mediators and allowed complexity to be considered in order to manage care. They took on responsibility of creating a 'space of care', while the organizational structures of home care were perceived as something outside the care praxis. Making contradictions evident renders an intermediary caring strategy feasible.

  14. [Coordinating home assistance and nursing care for global patient management].

    PubMed

    Cerf, Dominique

    Enabling patients to remain in their home is only possible when the different services, both from within and outside the hospital are able to communicate and when the recommended actions are properly coordinated. Entrusting the coordination of the care to the Spasad (polyvalent service for home assistance and nursing care) enables the expectations of the patients and family carers to be analysed. This allows the team to put in place the appropriate actions both in terms of assistance and nursing care.

  15. [Coordinating home assistance and nursing care for global patient management].

    PubMed

    Cerf, Dominique

    2016-01-01

    Enabling patients to remain in their home is only possible when the different services, both from within and outside the hospital are able to communicate and when the recommended actions are properly coordinated. Entrusting the coordination of the care to the Spasad (polyvalent service for home assistance and nursing care) enables the expectations of the patients and family carers to be analysed. This allows the team to put in place the appropriate actions both in terms of assistance and nursing care.

  16. Factors of Good Collaboration in Home-Based End-of-Life Care: A Questionnaire Survey of Japanese Home Care Nurses, Home Helpers, and Care Managers.

    PubMed

    Yamamoto-Mitani, Noriko; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Takemura, Yukie; Suzuki, Miho

    2015-01-01

    Good interprofessional work (IPW) is essential to provide quality home-based end-of-life (EOL) care. The purpose of this study was to explore the factors of "good collaboration," as evaluated separately by home care nurses (HNs), home helpers (HHs), and care managers (CMs). The relationship was examined between their evaluation of good collaboration and their recent actual experience of interprofessional collaborative work for a home-based EOL case. The questionnaire was returned nationwide by 378 HNs, 305 HHs, and 476 CMs, and data were collected on 177 EOL cases from HNs, 84 cases from HHs, and 123 cases from CMs. Evaluation of good collaboration by HNs was associated with working with a CM with whom they had multiple collaborative experiences, the client being independent for their toileting until just before dying, and sharing information regarding the client's EOL decision with an HH 1 month before dying. Evaluation of good collaboration by HHs was associated with working at an agency that collaborated with fewer CM agencies and working at an agency that allowed staff to visit dying clients. Evaluation of good collaboration by CMs was associated only with the client being dependent for toileting. Our results highlighted the characteristics of how each professional seeks to collaborate depending on their preparedness, contexts, and resultant expectations toward other professionals when entering the IPW for home-based EOL care. To promote good IPW for home-based EOL care further, professionals need to understand these differences among ourselves and try to meet others' expectations.

  17. A declaration of healthy dependence: the case of home care.

    PubMed

    Palm, Elin

    2014-12-01

    Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a cost-effective future care that better can accommodate the needs of an aging population and promote care recipients' independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated.

  18. Care pathways as boundary objects between primary and secondary care: Experiences from Norwegian home care services.

    PubMed

    Håland, Erna; Røsstad, Tove; Osmundsen, Tonje C

    2015-11-01

    The need for integration of healthcare services and collaboration across organisational boundaries is highlighted as a major challenge within healthcare in many countries. Care pathways are often presented as a solution to this challenge. In this article, we study a project of developing, introducing and using a care pathway across healthcare levels focusing on older home-dwelling patients in need of home care services after hospital discharge. In so doing, we use the concept of boundary object, as described by Star and Griesemer, to explore how care pathways can act as tools for translation between specialist healthcare services and home care services. Based on interviews with participants in the project, we find that response to existing needs, local tailoring, involvement and commitment are all crucial for the care pathway to function as a boundary object in this setting. Furthermore, the care pathway, as we argue, can be used to push boundaries just as much as it can be used as a tool for bridging across them, thus potentially contributing to a more equal relationship between specialist healthcare services and home care services.

  19. 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

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

    PubMed

    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.

  1. "Could We Hold Hands?" Older Lesbian and Gay Couples' Perceptions of Long-Term Care Homes and Home Care.

    PubMed

    Furlotte, Charles; Gladstone, James W; Cosby, Robert F; Fitzgerald, Kerri-Ann

    2016-12-01

    This qualitative study describes expectations, concerns, and needs regarding long-term care (LTC) homes and home care services of 12 older lesbian and gay couples living in Canada. Our findings reflect four major themes: discrimination, identity, expenditure of energy, and nuanced care. Discrimination involved concerns about covert discrimination; loss of social buffers as one ages; and diminished ability to advocate for oneself and one's partner. Identity involved anticipated risk over disclosing one's sexual identity; the importance of being identified within a coupled relationship; and the importance of access to reference groups of other gay seniors. We conclude that partners were burdened by the emotional effort expended to hide parts of their identity, assess their environments for discrimination, and to placate others. Nuanced care involved a mutual level of comfort experienced by participants and their health care providers. These themes inform understandings of LTC homes and home care services for lesbian and gay older couples.

  2. 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.

  3. Exercising in the Fasted State Reduced 24-Hour Energy Intake in Active Male Adults

    PubMed Central

    Deitrick, Ronald W.; Hillman, Angela R.

    2016-01-01

    The effect of fasting prior to morning exercise on 24-hour energy intake was examined using a randomized, counterbalanced design. Participants (12 active, white males, 20.8 ± 3.0 years old, VO2max: 59.1 ± 5.7 mL/kg/min) fasted (NoBK) or received breakfast (BK) and then ran for 60 minutes at 60%  VO2max. All food was weighed and measured for 24 hours. Measures of blood glucose and hunger were collected at 5 time points. Respiratory quotient (RQ) was measured during exercise. Generalized linear mixed models and paired sample t-tests examined differences between the conditions. Total 24-hour (BK: 19172 ± 4542 kJ versus NoBK: 15312 ± 4513 kJ; p < 0.001) and evening (BK: 12265 ± 4278 kJ versus NoBK: 10833 ± 4065; p = 0.039) energy intake and RQ (BK: 0.90 ± 0.03 versus NoBK: 0.86 ± 0.03; p < 0.001) were significantly higher in BK than NoBK. Blood glucose was significantly higher in BK than NoBK before exercise (5.2 ± 0.7 versus 4.5 ± 0.6 mmol/L; p = 0.025). Hunger was significantly lower for BK than NoBK before exercise, after exercise, and before lunch. Blood glucose and hunger were not associated with energy intake. Fasting before morning exercise decreased 24-hour energy intake and increased fat oxidation during exercise. Completing exercise in the morning in the fasted state may have implications for weight management. PMID:27738523

  4. Circadian polymorphisms in night owls, in bipolars, and in non-24-hour sleep cycles.

    PubMed

    Kripke, Daniel F; 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

    2014-10-01

    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.

  5. Iodine Excretion in 24-hour Urine Collection and Its Dietary Determinants in Healthy Japanese Adults

    PubMed Central

    Katagiri, Ryoko; Asakura, Keiko; Uechi, Ken; Masayasu, Shizuko; Sasaki, Satoshi

    2016-01-01

    Background Since seaweed is a common component of the Japanese diet, iodine intake in Japanese is expected to be high. However, urinary iodine excretion, measured using 24-hour urine samples, and its dietary determinants are not known. Methods Apparently healthy adults aged 20 to 69 years living in 20 areas throughout Japan were recruited in February and March, 2013. Urinary iodine excretion was evaluated using 24-hour urine collected from 713 subjects (362 men and 351 women), and the difference among age groups was assessed. The association between dietary intake of food groups and urinary iodine excretion was assessed among 358 subjects who completed a semi-weighed 4-day diet record (DR) and urine collection. The correlations between iodine intake and iodine excretion were also evaluated, and correlation coefficients were calculated for iodine intake in the DR of the overlapping day or the DR 1 day before and after urine collection. Results Median iodine excretion in 24-hour urine was 365 µg, and excretion was significantly higher in older subjects. Iodine intake estimated by the DRs was significantly correlated with urinary iodine excretion when DRs and urine collection were obtained on the same day (r = 0.37). After adjustment for confounding factors, iodine excretion was significantly associated with intakes of kelp and soup stock from kelp and fish. Conclusions Although multiple measurements for urinary iodine are required to confirm our results, this study showed the current iodine status of healthy Japanese adults. The results suggest that kelp and fish are the main contributors to Japanese iodine status measured by 24-hour urine. PMID:27374137

  6. Gender disparities in German home-care arrangements.

    PubMed

    Dorin, Lena; Krupa, Elzbieta; Metzing, Sabine; Büscher, Andreas

    2016-03-01

    An ageing population correlates with rising needs for long-term care (LTC). Support programmes should consider the specific needs of the various subgroups of care dependents and family caregivers. The objective of this study was to analyse the gender-specific disparities in home-care arrangements in Germany, and for this purpose, survey and insurance claims data were used. A survey of 2545 insured care recipients with high-level care needs was conducted in 2012 with the Barmer GEK, a major German statutory healthcare insurance. Insurance claims data were provided for a follow-up, focussing on the group aged 60 years and older. For statistical comparison, chi-squared test and t-tests were used, and a p-value < 0.05 was considered statistically significant. Most care recipients are female, and they are on average 2 years older than males. Men receive family care mostly from their wives, whereas widows frequently live alone and receive care from daughters, sons, other relatives, neighbours and friends, as well as from professional nursing services. Furthermore, women more often anticipate the need for (further) professional assistance and move in with a relative or to an assisted living facility or a nursing home in good time. The desired rate for relocation to a nursing home was higher than the anticipated, and during the 6-month follow-up, the actual rate of relocations was in between both. In summary, the caring situation of men and women is different. Care-receiving men are most often cared for by their wives. Widowed women need a social network and their children in order to remain in their own home. To provide better home-care arrangements for women in this situation, the family and social networks need a stronger focus in politics and research. To stabilise the home-care situation of men with high-level care needs, their wives need more support.

  7. 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

  8. Home care technology through an ability expectation lens.

    PubMed

    Wolbring, Gregor; Lashewicz, Bonnie

    2014-06-20

    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

  9. 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

  10. [24-hour energy metabolism in the human: circadian rhythm, relation to body weight and nutrition].

    PubMed

    Steiniger, J

    1985-04-15

    In 7 men with normal weight and 9 man with overweight and healthy metabolism the resting and fasting energy expenditure was indirectly calorimetrically pursued in the open system over 24 hours. The total energy expenditure over 24 hours revealed an ascertained dependence on body-weight and nutrition. The persons with overweight had a higher absolute energy expenditure, however, the activity of the energy metabolism of the body mass free from fat and the active body mass, respectively, decreased with increasing overweight. The resting and fasting energy expenditure showed in all measured parameters (oxygen consumption, respiratory quotient and nitrogen excretion in the urine) an ascertained daily periodicity (circadian rhythm), which was widely independent of body weight. Only the average daily level C0 (rhythm adjusted level) of the resting and fasting energy expenditure was positively correlated with the body weight and the food energy intake. A negative energy balance (reduction 1.2 MJ/d over 28 days) influenced only the total energy and substrate balance over 24 hours and the daily average level, respectively. The circadian conditions remained unchanged (Chossat's phenomenon). The variability in daily rhythm of the energy expenditure of nearly 25% of the daily average should be taken into consideration in the judgment of exogenically stimulated changes in the energy metabolism.

  11. Nursing Effort and Quality of Care for Nursing Home Residents

    ERIC Educational Resources Information Center

    Arling, Greg; Kane, Robert L.; Mueller, Christine; Bershadsky, Julie; Degenholtz, Howard B.

    2007-01-01

    Purpose: The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes. Design and Methods: Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado,…

  12. 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…

  13. Caring for Depression in Older Home Health Patients.

    PubMed

    Bruce, Martha L

    2015-11-01

    Depression is common in older home health patients and increases their risk of adverse outcomes. Depression screening is required by Medicare's Outcome and Assessment Information Set. The Depression Care for Patients at Home (CAREPATH) was developed as a feasible strategy for home health nurses to manage depression in their patients. The protocol builds on nurses' existing clinical skills and is designed to fit within routine home visits. Major components include ongoing clinical assessment, care coordination, medication management, education, and goal setting. In a randomized trial, Depression CAREPATH patients had greater improvement in depressive symptoms compared to usual care. The difference between groups was significant at 3 months, growing larger and more clinically meaningful over 1 year. The intervention had no impact on patient length of stay, number of home visits, or duration of visits. Thus, nurses can play a pivotal role in the long-term course and outcomes of patients with depression.

  14. Validation of triple pass 24-hour dietary recall in Ugandan children by simultaneous weighed food assessment

    PubMed Central

    Olupot-Olupot, Peter; Engoru, Charles; Ssenyondo, Tonny; Nteziyaremye, Julius; Amorut, Denis; Nakuya, Margaret; Arimi, Margaret; Frost, Gary; Maitland, Kathryn

    2016-01-01

    Background Undernutrition remains highly prevalent in African children, highlighting the need for accurately assessing dietary intake. In order to do so, the assessment method must be validated in the target population. A triple pass 24 hour dietary recall with volumetric portion size estimation has been described but not previously validated in African children. This study aimed to establish the relative validity of 24-hour dietary recalls of daily food consumption in healthy African children living in Mbale and Soroti, eastern Uganda compared to simultaneous weighed food records. Methods Quantitative assessment of daily food consumption by weighed food records followed by two independent assessments using triple pass 24-hour dietary recall on the following day. In conjunction with household measures and standard food sizes, volumes of liquid, dry rice, or play dough were used to aid portion size estimation. Inter-assessor agreement, and agreement with weighed food records was conducted primarily by Bland-Altman analysis and secondly by intraclass correlation coefficients and quartile cross-classification. Results 19 healthy children aged 6 months to 12 years were included in the study. Bland-Altman analysis showed 24-hour recall only marginally under-estimated energy (mean difference of 149kJ or 2.8%; limits of agreement -1618 to 1321kJ), protein (2.9g or 9.4%; -12.6 to 6.7g), and iron (0.43mg or 8.3%; -3.1 to 2.3mg). Quartile cross-classification was correct in 79% of cases for energy intake, and 89% for both protein and iron. The intraclass correlation coefficient between the separate dietary recalls for energy was 0.801 (95% CI, 0.429-0.933), indicating acceptable inter-observer agreement. Conclusions Dietary assessment using 24-hour dietary recall with volumetric portion size estimation resulted in similar and acceptable estimates of dietary intake compared with weighed food records and thus is considered a valid method for daily dietary intake assessment of

  15. Static stretching can impair explosive performance for at least 24 hours.

    PubMed

    Haddad, Monoem; Dridi, Amir; Chtara, Moktar; Chaouachi, Anis; Wong, Del P; Behm, David; Chamari, Karim

    2014-01-01

    The aim of this study was to compare the effects of static vs. dynamic stretching (DS) on explosive performances and repeated sprint ability (RSA) after a 24-hour delay. Sixteen young male soccer players performed 15 minutes of static stretching (SS), DS, or a no-stretch control condition (CC) 24 hours before performing explosive performances and RSA tests. This was a within-subject repeated measures study with SS, DS, and CC being counterbalanced. Stretching protocols included 2 sets of 7 minutes 30 seconds (2 repetitions of 30 seconds with a 15-second passive recovery) for 5 muscle groups (quadriceps, hamstring, calves, adductors, and hip flexors). Twenty-four hours later (without any kind of stretching in warm-up), the players were tested for the 30-m sprint test (with 10- and 20-m lap times), 5 jump test (5JT), and RSA test. Significant differences were observed between CC, SS, and DS with 5JT (F = 9.99, p < 0.00, effect size [ES] = 0.40), 10-m sprint time (F = 46.52, p < 0.00, ES = 0.76), 20-m sprint time (F = 18.44, p < 0.000, ES = 0.55), and 30-m sprint time (F = 34.25, p < 0.000, ES = 0.70). The significantly better performance (p < 0.05) was observed after DS as compared with that after CC and SS in 5JT, and sprint times for 10, 20, and 30 m. In contrast, significantly worse performance (p < 0.05) was observed after SS as compared with that after CC in 5JT, and sprint times for 10, 20, and 30 m. With RSA, no significant difference was observed between different stretching protocols in the total time (F = 1.55, p > 0.05), average time (F = 1.53, p > 0.05), and fastest time (F = 2.30, p > 0.05), except for the decline index (F = 3.54, p < 0.04, ES = 0.19). Therefore, the SS of the lower limbs and hip muscles had a negative effect on explosive performances up to 24 hours poststretching with no major effects on the RSA. Conversely, the DS of the same muscle groups are highly recommended 24 hours before performing sprint and long-jump performances. In

  16. 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.…

  17. 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)

  18. 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

  19. Congressman Greg Walden speaks out in support of home care.

    PubMed

    Kincheloe, Jeff

    2005-05-01

    Support for the mission of home care and hospice from Congress continues to expand as more members of the House and Senate take time out of their busy schedules to visit with a home care or hospice patient. Take the case of Congressman Greg Walden (R-OR) who is currently in his fourth term representing the people of Oregon's Second Congressional District, which includes twenty counties in central, southern and eastern Oregon. He is a passionate advocate for home care and hospice who as chair of the Congressional Rural Health Care Coalition, is a key figure in the fight to restore the 5% rural add on for home health services to rural patients.

  20. Home care business management software not just for scheduling.

    PubMed

    Morey, Rick

    2012-10-01

    Rule number one for running a successful, profitable home care company: It is essential to have an efficient, cost-effective administrative operation. A hard fact of the home care industry is that the location of an agency, to a large extent, dictates the billing rates as well as caregiver pay. Therefore, agency profitability is primarily dependent on how efficiently the company is run. Software, used in the right way, helps agencies become more productive andmore profitable.

  1. 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

  2. Integrated Working for Enhanced Health Care in English Nursing Homes

    PubMed Central

    McNall, Anne; Thompson, Juliana; Hodgson, Philip; Shaw, Lynne; Cowie, Daniel

    2016-01-01

    Abstract Background The increasingly complex nature of care home residents’ health status means that this population requires significant multidisciplinary team input from health services. To address this, a multisector and multiprofessional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. Study Aims To explore the views and experiences of practitioners, social care officers, and carers involved in the enhanced health care in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of health care to older residents. Methods A qualitative constructivist methodology was adopted. The study had two stages. Stage 1 explored the experiences of the programme enhanced healthcare workforce through group, dyad, and individual interviews with 45 participants. Stage 2 involved two workshops with 28 participants to develop Stage 1 findings (data were collected during February–March 2016). Thematic and content analysis were applied. Findings The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organizational and professional boundaries that support effective decision making and problem solving. Clinical Relevance Understanding of the processes and outcomes of a model of integrated health care between public and independent sector care home services for older people. PMID:28094909

  3. 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

  4. Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults.

    PubMed

    Robison, Julie; Shugrue, Noreen; Porter, Martha; Fortinsky, Richard H; Curry, Leslie A

    2012-01-01

    A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.

  5. Marketing home health care medical services: the physician's view.

    PubMed

    Ryan, E J; Phelps, R A

    1993-01-01

    The authors surveyed physicians serving the Jackson, Mississippi home health care market. They identified problems and studied physician perceptions regarding services provided by home health care agencies, private duty nursing agencies, and durable medical equipment suppliers. Respondents perceived home health care as providing: (1) increased patient satisfaction, (2) greater patient convenience, (3) earlier discharge, and (4) lowered patient costs. They least liked: (1) lack of control and involvement in the patient caring process, (2) paperwork, (3) quality control potential, and the possibility that patient costs could increase. Two sets of implications for health care marketers are presented that involve both national and regional levels. Overall results indicate that a growing and profitable market segment exists and is being served in an effective and socially responsible manner.

  6. [Neonatal palliative care at home: Contribution of the regional pediatric palliative care team].

    PubMed

    Cojean, N; Strub, C; Kuhn, P; Calvel, L

    2017-02-01

    The "patients' rights and end-of-life care" act, known as the Leonetti law, has allowed implementation of palliative care in neonatology as an alternative to unreasonable therapeutic interventions. A palliative care project can be offered to newborns suffering from intractable diseases. It must be focused on the newborn's quality of life and comfort and on family support. Palliative care for newborns can be provided in the delivery room, in the neonatal unit, and also at home. Going home is possible but requires medical support. Here we describe the potential benefits of the intervention of a regional team of pediatric palliative care for newborns, both in the hospital and at home. Two clinical situations of palliative care at home started in the neonatal period and the neonatal unit are presented. They are completed by a retrospective national survey focusing on the type of support to newborns in palliative care in 2014, which was conducted in 22 French regional pediatric palliative care teams. It shows that 26 newborns benefited from this support at home in 2014. Sixteen infants were born after a pregnancy with a palliative care birth plan and ten entered palliative care after a decision to limit life-sustaining treatments. Twelve of them returned home before the 20th day of life. Sixteen infants died, six of them at home. The regional pediatric palliative care team first receives in-hospital interventions: providing support for ethical reflection in the development of the infant's life project, meeting with the child and its family, helping organize the care pathway to return home. When the child is at home, the regional pediatric palliative care team can support the caregiver involved, provide home visits to continue the clinical monitoring of the infant, and accompany the family. The follow-up of the bereavement and the analysis of the practices with caregivers are also part of its tasks.

  7. 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

  8. 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.

  9. Heterogeneity of Prognostic Studies of 24-Hour Blood Pressure Variability: Systematic Review and Meta-Analysis

    PubMed Central

    Taylor, Kathryn S.; Heneghan, Carl J.; Stevens, Richard J.; Adams, Emily C.; Nunan, David; Ward, Alison

    2015-01-01

    In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2–7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods. PMID:25984791

  10. Heterogeneity of prognostic studies of 24-hour blood pressure variability: systematic review and meta-analysis.

    PubMed

    Taylor, Kathryn S; Heneghan, Carl J; Stevens, Richard J; Adams, Emily C; Nunan, David; Ward, Alison

    2015-01-01

    In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2-7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods.

  11. A Home-Based Palliative Care Consult Service for Veterans.

    PubMed

    Golden, Adam G; Antoni, Charles; Gammonley, Denise

    2016-11-01

    We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians.

  12. Lack of effect of a 24-hour infusion of iloprost in intermittent claudication.

    PubMed

    Hay, C R; Waller, P C; Carter, C; Cameron, H A; Parnell, L; Ramsay, L E; Preston, F E; Greaves, M

    1987-04-15

    24 hour infusion of iloprost was compared with placebo infusion in 19 patients with stable intermittent claudication using a double blind, balanced crossover design. Despite significant inhibition of platelet aggregation to ADP and collagen (p less than 0.001) and the typical cardiovascular and gastrointestinal side effects, there was no significant effect on treadmill exercise times at any time up to 6 weeks after infusion. The 95% confidence limits indicated that an improvement of more than 25% was unlikely to occur. No significant changes in B thromboglobulin, platelet aggregate ratio, bleeding time, whole blood viscosity and euglobulin clot lysis time were demonstrated.

  13. [The changes in mental working capacity of operators during 24-hour shift work conditions].

    PubMed

    Kal'nysh, V V; Shvets', A V; Ieshchenko, O I

    2011-01-01

    Psychophysiological peculiarities of influence of a 24-hour shift work on the efficiency of operators have been discussed. It was shown that servicemen operators develop significant fatigue as a result of 24 hrs duty services. The informative psychophysiological characteristics which can be reliable indicators of fatigue level are highlighted. Individual psychophysiological indicators of fatigue level, according to different mechanisms of its development, have been proposed. The hypothesis about the existence of several compensatory mechanisms for maintenance of long duty operators' working capacity has been formulated.

  14. 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.

  15. Preliminary Data on a Care Coordination Program for Home Care Recipients.

    PubMed

    Dean, Katie M; Hatfield, Laura A; Jena, Anupam B; Cristman, David; Flair, Michael; Kator, Kylie; Nudd, Geoffrey; Grabowski, David C

    2016-09-01

    Home care recipients are often hospitalized for potentially avoidable reasons. A pilot program (Intervention in Home Care to Improve Health Outcomes (In-Home)) was designed to help home care providers identify acute clinical changes in condition and then manage the condition in the home and thereby avoid a costly hospitalization. Caregivers answer simple questions about the care recipient's condition during a telephone-based "clock-out" at the end of each shift. Responses are electronically captured in the agency management software that caregivers use to "clock-in," manage care, and "clock-out" on every shift. These are transmitted to the agency's care manager, who follows up on the change in condition and escalates appropriately. A description of the In-Home model is presented, and pilot data from 22 home care offices are reported. In the pilot, caregivers reported a change in condition after 2% of all shifts, representing an average of 1.9 changes per care recipient in a 6-month period. Changes in behavior and skin condition were the most frequently recorded domains. Interviews with participating caregivers and care managers suggested positive attitudes regarding the intervention; challenges included resistance to change on the part of home care staff and difficulties in applying a uniform intervention to individuals with varying needs in home care offices with varying capacities. In an ongoing randomized trial, the success of the overall program will be measured primarily according to the potential reduction in avoidable hospitalizations of home care recipients and the effect this potential reduction has on spending and healthcare outcomes.

  16. Personal resources supporting living at home as described by older home care clients.

    PubMed

    Eloranta, Sini; Routasalo, Pirkko; Arve, Seija

    2008-08-01

    This study describes the personal resources of older (> or = 75 years) home care clients in Finland and their perceptions of factors that enhance and constrain their ability to live independently at home. The data were collected by unstructured interviews with 21 older home care clients. Inductive content analysis were used to analyse the data. The resources of older people consisted of a sense of control over one's life and a determination to remain active. Factors enhancing older people's resources were their involvement in leisure activities and social networks, factors undermining their resources were conditions on living imposed by outsiders, declining health and loneliness. The results show that home care professionals do not yet have sufficient skills and abilities to identify and support older people's existing resources. As well as having access to necessary resources, it is also crucial that older people know how to use them.

  17. 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…

  18. 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…

  19. Children's Use of Retreats in Family Child Care Homes

    ERIC Educational Resources Information Center

    Weinberger, Nanci

    2006-01-01

    The use of retreat spaces by 65 children in 9 family child care homes was assessed in this study. Family child care providers used daily diaries to collect information about children's retreat frequency and associated behavior. The findings revealed that nearly half of the children used informal, readily available retreats during the research…

  20. Risk of aspiration in care home residents and associated factors.

    PubMed

    van der Maarel-Wierink, Claar D; van der Putten, Gert-Jan; De Visschere, Luc M J; Bronkhorst, Ewald M; de Baat, Cees; Schols, Jos M G A

    2015-02-01

    Pneumonia is a prevalent cause of death in care home residents. Dysphagia is a significant risk factor of aspiration pneumonia. The purpose of the current study was to screen for risk of aspiration in care home residents in the Netherlands and assess potential risk factors of aspiration. Five experienced speech-language therapists assessed 203 care home residents (115 primarily physically disabled, 88 primarily cognitively impaired) 60 and older in the first week after admission to a care home. In 43 (21.2%) residents, speech-language therapists assessed risk of aspiration and found no significant difference between physically disabled (26.1%) and cognitively impaired (14.8%) residents. After multivariate logistic regression analysis, the final prediction model for risk of aspiration showed Parkinson's disease as a significant factor (odds ratio = 5.11; 95% confidence interval [1.49, 17.52]) . The authors therefore conclude that risk of aspiration is a relevant care problem among Dutch care home residents and requires further assessment.

  1. Home care for the disabled elderly: predictors and expected costs.

    PubMed Central

    Coughlin, T A; McBride, T D; Perozek, M; Liu, K

    1992-01-01

    While interest in publicly funded home care for the disabled elderly is keen, basic policy issues need to be addressed before an appropriate program can be adopted and financed. This article presents findings from a study in which the cost implications of anticipated behavioral responses (for example, caregiver substitution) are estimated. Using simulation techniques, the results demonstrate that anticipated behavioral responses would likely add between $1.8 and $2.7 billion (1990 dollars) to the costs of a public home care program. Results from a variety of cost simulations are presented. The data base for the study was the 1982 National Long-Term Care Survey. PMID:1399652

  2. 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.

  3. 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

  4. 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.

  5. 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

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

    PubMed

    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/m(2), 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.

  7. Validity of 24-hour dietary recall interviews conducted among volunteers in an adult working community.

    PubMed

    Kahn, H A; Whelton, P K; Appel, L J; Kumanyika, S K; Meneses, J L; Hebert, P R; Woods, M

    1995-11-01

    There is considerable uncertainty regarding the validity of dietary data collected from free-living populations. Nevertheless, few attempts have been made to validate dietary assessment instruments. To address this issue, we compared average daily protein intake estimated from 24-hour dietary recall interviews to protein intake estimated from urinary nitrogen excretion in 24-hour samples. Among 244 community-dwelling adults who volunteered for a hypertension study, men (n = 139) overreported dietary protein intake by 12 to 19%. In contrast, women (n = 105) reported a dietary protein intake almost exactly in agreement with estimates based on urinary nitrogen levels. Thin men reported about one-third more protein intake than was reflected in their urinary nitrogen measurements. Our results suggest that the accuracy of dietary recall estimates may vary across subgroups of the population. Additional information from sufficiently large validation studies would be helpful in determining the role of dietary assessment instruments which are already in wide use in epidemiologic research. Until such information is obtained, doubts will remain regarding the validity of inferences drawn from nutritional epidemiologic studies.

  8. [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.

  9. HoCaMA: Home Care Hybrid Multiagent Architecture

    NASA Astrophysics Data System (ADS)

    Fraile, Juan A.; Bajo, Javier; Abraham, Ajith; Corchado, Juan M.

    Home Care is one of the main objectives of Ambient Intelligence. Nowadays, the disabled and elderly population, which represents a significant part of our society, requires novel solutions for providing home care in an effective way. In this chapter, we present HoCaMA, a hybrid multiagent architecture that facilitates remote monitoring and care services for disabled patients at their homes. HoCaMA combines multiagent systems and Web services to facilitate the communication and integration with multiple health care systems. In addition, HoCaMA focuses on the design of reactive agents capable of interacting with different sensors present in the environment, and incorporates a system of alerts through SMS and MMS mobile technologies. Finally, it uses Radio Frequency IDentification and JavaCard technologies to provide advanced location and identification systems, as well as automatic access control facilities. HoCaMA has been implemented in a real environment and the results obtained are presented within this chapter.

  10. 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

  11. [A study of endogenous-exogenous factors in urinary incontinence and home care nursing of the elderly at home].

    PubMed

    Kamei, T F; Simanouchi, S; Hayashi, M

    1996-01-01

    social activity, etc. 4) Exogenous factors involved elderly caregiver persons, residual care fatigue sensation, inconvenient toilet and other housing condition, etc. 5) Endogenous-exogenous compound factors in possible urinary incontinence involved paralysis, contrature, social activity, start of visiting for morbid state observational nursing, guidance and utilization of social services for YO group, suggesting strong factor involving the care rather than physical problems of the subject concerned for elder group. From the above, suggestions for the subject concerned were made as follows; 1) start of visiting aiming at the prevention and improvement of urinary incontinence in early stage of onset of cerebrovascular disease (especially for males) or dementia (especially for females) and 2) promotion of rehabilitation for tension provocation of pelvic muscular group and enlargement of ADL and walking distance, and suggestions for caregiver were made as follows; 1) giving appropriate advice for excretory nursing at home and 2) assessment of the relationship with the subject concerned. From the viewpoint of housing environment, reconstruction of such a toilet as is easily usable by both an elderly person and its nursing person and from the viewpoint of regional system, necessary preparation of 24-hour approach to diminution of nocturnal excretory nursing burden was suggested.

  12. The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

    PubMed Central

    Rabiner, D J; Stearns, S C; Mutran, E

    1994-01-01

    OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS. The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS. This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use. PMID:8002352

  13. 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…

  14. Introducing Psychiatric Care into Nursing Homes.

    ERIC Educational Resources Information Center

    Sakauye, Kenneth M.; Camp, Cameron J.

    1992-01-01

    Consultation-liaison psychiatry program in teaching nursing home helped implement six guiding principles, including make patient human to the staff; assume no behavior is random; look for depression or psychosis as source of problems; reduce medications and medication doses; create more homelike environment; and use conditions in which learning…

  15. Impact of a formulary on personal care homes in Manitoba.

    PubMed Central

    Yakabowich, M R; Keeley, G; Montgomery, P R

    1994-01-01

    OBJECTIVE: To assess the impact of a formulary on drug expenditures and prescribing trends in personal care homes (nursing homes). DESIGN: Quasi-experimental analysis of a drug prescription database before and after implementation of the formulary. SETTING: Personal care homes in Manitoba. PATIENTS: Residents occupying the 6848 beds of the 88 personal care homes that did not already have a formulary. INTERVENTION: Formulary, introduced Apr. 1, 1987. MAIN OUTCOME MEASURES: Drug expenditures from Apr. 1, 1985, to Mar. 31, 1990; proportion of residents receiving a prescription by drug class and rate of prescriptions of nonformulary drugs in the year before and 2 years after the formulary was introduced. MAIN RESULTS: The total drug expenditures per bed remained constant during the first year after the formulary was implemented, even though the annual drug inflation rate was 9.8% on average during the study period. Expenditures 2 and 3 years after implementation rose by 9.4% and 5.8% respectively. Those for specific agents and drug classes targeted as being inappropriate for long-term care decreased greatly because of reduced prescribing. Expenditures for some other drug classes increased mainly because newer, more expensive agents were used. The mean drug expenditure per bed varied widely between homes; neither size nor location were found to correlate with drug expenditure, but adherence to the formulary did predict personal care homes with decreased expenditures. CONCLUSIONS: A formulary in personal care homes can improve therapeutic management. The impact on cost containment was not as strong after the first year, although expenditures remained less than the rate of inflation for drug costs. PMID:8174030

  16. 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

  17. [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.

  18. 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…

  19. The emotional climate of care-giving in home-care services.

    PubMed

    Olsson, E; Ingvad, B

    2001-11-01

    The emotional aspects of the care-giving relationship in home-care services are studied, starting from the home-care recipients' and the home-care workers' perception of the emotional climate. Their experiences of the care-giving relationship and the influence from different aspects of the care-giving situation and social processes in the work organisation are explored. Two hundred and twenty-two recipients and their home-care workers in three typical Swedish municipalities were studied. The emotional climate is described with the help of a scale of 85 adjectives. Results show that home-care workers are more likely to experience the climate with a higher degree of emotionality. There is symmetry between the parties in the perception of a negative climate. However, if one party perceives the climate as close the other party is more likely to perceive it as rational or instrumental. The organisational processes, especially the group climate of the work team, principally influence the home-care recipients' perceptions. The workers' perceptions are principally influenced by age and gender of the recipients and the workers' own age. The emotional climate is constructed in a process between the parties, depending on their responses to each other. Tendencies to perceive a specific climate are strengthened or weakened by context variables and this in turn changes the care-giving interaction.

  20. Cardiovascular Outcomes in Patients with Normal and Abnormal 24-Hour Ambulatory Blood Pressure Monitoring

    PubMed Central

    Iqbal, P.; Stevenson, Louise

    2011-01-01

    Introduction. 24-hour ambulatory blood pressure monitoring (ABPM) plays an important role in assessing cardiovascular prognosis, through presence or absence of ABPM-related prognostic features. Objectives. To study relationship between 24-hour ABPM and cardiovascular outcomes in patients from Chesterfield Royal Hospital. Material and Methods. Over 12 months from the 1st of August 2002, 1187 individuals had 24-hour ABPM performed. Cardiovascular outcomes were studied in a subset (297) of the original cohort, made up by every 4th consecutive subject. The following ABPM-related prognostic features were studied—high day time systolic and diastolic BP (≥135, ≥85 mmHg), high night time systolic and diastolic BP (≥120 mmHg, ≥75 mmHg), absence of nocturnal dip (≤10% fall in night time SBP), high early morning SBP (≥140 mmHg), and morning surge (≥20/15 mmHg). The cardiovascular outcomes studied in the fourth table included fatal and nonfatal MI, new diagnosis of angina, acute coronary syndrome, sudden cardiac death, cardiac arrhythmias, acute LVF, cerbrovascular events, peripheral vascular disease, abdominal aortic aneurysm, and CKD stage 3 or above. Results. Over a followup period of 2015 ± 116 days (1720–2305 days) 82 cardiovascular events occurred in 61 subjects. Cardiac arrhythmias were the most common CV outcome (34 events) followed by cerebrovascular events (15). Statistically significant associations found were between cerebrovascular events and absent nocturnal dip ≤ 10% (P = .05) and high day time DBP (P = .029), peripheral vascular disease and morning surge ≥ 20/15 mmHg (P = .014), cardiac arrhythmias and high day time and night time DBP (P = .009 and .033, resp.). Conclusion. Significant associations were found between cerebrovascular events and absent nocturnal dip ≤ 10% and high day time DBP, peripheral vascular disease and morning surge ≥ 20/15 mmHg, cardiac arrhythmias and high day time and night time DBP. PMID

  1. 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

  2. Estimating 24-hour urinary sodium excretion from casual urinary sodium concentrations in Western populations: the INTERSALT study.

    PubMed

    Brown, Ian J; Dyer, Alan R; Chan, Queenie; Cogswell, Mary E; Ueshima, Hirotsugu; Stamler, Jeremiah; Elliott, Paul

    2013-06-01

    High intakes of dietary sodium are associated with elevated blood pressure levels and an increased risk of cardiovascular disease. National and international guidelines recommend reduced sodium intake in the general population, which necessitates population-wide surveillance. We assessed the utility of casual (spot) urine specimens in estimating 24-hour urinary sodium excretion as a marker of sodium intake in the International Cooperative Study on Salt, Other Factors, and Blood Pressure. There were 5,693 participants recruited in 1984-1987 at the ages of 20-59 years from 29 North American and European samples. Participants were randomly assigned to test or validation data sets. Equations derived from casual urinary sodium concentration and other variables in the test data were applied to the validation data set. Correlations between observed and estimated 24-hour sodium excretion were 0.50 for individual men and 0.51 for individual women; the values were 0.79 and 0.71, respectively, for population samples. Bias in mean values (observed minus estimated) was small; for men and women, the values were -1.6 mmol per 24 hours and 2.3 mmol per 24 hours, respectively, at the individual level and -1.8 mmol per 24 hours and 2.2 mmol per 24 hours, respectively, at the population level. Proportions of individuals with urinary 24-hour sodium excretion above the recommended levels were slightly overestimated by the models. Casual urine specimens may be a useful, low-burden, low-cost alternative to 24-hour urine collections for estimation of population sodium intakes; ongoing calibration with study-specific 24-hour urinary collections is recommended to increase validity.

  3. [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.

  4. [Home care to the elderly who had stroke].

    PubMed

    Pedreira, Larissa Chaves; Lopes, Regina Lúcia Mendonça

    2010-01-01

    The purpose was to Identify the knowledge production about the stroke in elderly under home care. Bibliographic research whose data were collected though the abstracts from 1997 to 2007, contained in LILACS and SciELO databases. The following key words were used: home assistance, aged people and cerebrovascular accident. Fifty-two references were found in the LILACS database, nine in the SciELO Brazil, and three in the SciELO Cuba. Most of the researches were carried out in 2000. Regarding the method, qualitative method predominance were observed, and central theme is related to the care giver, as well as to the clinical and epidemiologic aspects of the disease. It was observed that this knowledge is still established in Brazil, and the themes related to the person submitted to home care and violence to the aged are still little explored.

  5. 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.…

  6. 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.

  7. New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms.

    PubMed Central

    Ewing, D J; Neilson, J M; Travis, P

    1984-01-01

    Cardiac parasympathetic activity was assessed using 24 hour electrocardiographic recordings by measuring the incidence of larger changes in successive RR intervals, which in normal subjects occur frequently but irregularly. In 25 normal subjects the mean number of times per hour in which the change in successive RR interval was greater than 50 ms was 150-250 during waking and 350-450 during sleeping. By contrast, 30 diabetics with medically denervated hearts (12 with cardiovascular reflex evidence of parasympathetic damage and 18 with additional sympathetic damage) and six cardiac transplant patients with surgically denervated hearts had extremely low counts. Additionally, of 20 diabetics with normal cardiovascular reflexes, about half had abnormally low counts, suggesting that this method is better than currently available reflex tests in detecting early cardiac parasympathetic damage. This technique provides a valid and sensitive way of monitoring cardiac parasympathetic activity over prolonged periods. PMID:6383446

  8. 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.

  9. Low correlation between visit-to-visit variability and 24-hour variability of blood pressure

    PubMed Central

    Muntner, Paul; Shimbo, Daichi; Diaz, Keith M.; Newman, Jonathan; Sloan, Richard P.; Schwartz, Joseph E.

    2013-01-01

    Visit-to-visit variability (VVV) of clinic systolic blood pressure (SBP) has been associated with cardiovascular disease risk. Given the need for obtaining blood pressure (BP) at multiple visits to calculate VVV, substituting BP variability from ambulatory blood pressure monitoring (ABPM) may be a practical alternative. We assessed the correlation between VVV of BP and BP variability from ABPM using data from 146 untreated, mostly normotensive participants (mean age 47.9 years) in a substudy of the ongoing Masked Hypertension Study. VVV of SBP and diastolic blood pressure (DBP) was estimated by the standard deviation (SDvvv) and average real variability (ARVvvv) from 6 study visits over a median of 216 days. ABPM data were used to calculate the day-night SD (SDdn) and the ARV of SBP and DBP over 24 hours (ARV24). For SBP, the mean SDvvv and SDdn were 6.3 (SD=2.5) and 8.8 (SD=1.8) mmHg, respectively, and mean ARVvvv and ARV24 were 7.2 (SD=3.2) and 8.4 (SD=2.1) mmHg, respectively. The Spearman correlation coefficient between SDvvv and SDdn of SBP was rs=0.25 and between ARVvvv and ARV24 was rs=0.17. Participants in the highest quartile of SDdn of SBP were 1.66 (95% CI: 0.93 – 2.75) times more likely to be in the highest quartile of SDvvv of SBP. The observed-to-expected ratio between the highest quartiles of ARVvvv and ARV24 of SBP was 0.89 (95% CI: 0.41 – 1.69). The correlations for SDvvv and SDdn and ARVvvv and ARV24 of DBP were minimal. These data suggest VVV and 24-hour variability are weakly correlated and not interchangeable. PMID:23784506

  10. Mice increased target biting behaviors 24 hours after co-administration of alcohol and fluoxetine.

    PubMed

    Mamiya, Ping Chao; Matray-Devoti, Judith; Fisher, Hans; Wagner, George C

    2017-02-10

    Increased alcohol consumption has been linked to social isolation. Individuals showed heightened aggression following social isolation. Animals treated with alcohol following social separation showed higher aggression and lower serotonin transmission. Although reduced serotonin transmission in the brain may be related to alcohol induced heightened aggression, it remains unclear whether there are specific brain regions where changes in serotonin transmission are critical for animal aggression following alcohol treatment. In the present study, we isolated mice for 4 - 6 weeks and injected them with alcohol, fluoxetine and alcohol with fluoxetine. We studied their aggression by using two types of behavioral paradigms: isolation-induced attack behavior towards a naïve mouse in a neutral cage, or shock-induced target biting aggression. We observed that alcohol administered at 500 mg/kg significantly increased animal attack behaviors towards naïve mice 30 minutes after injections. This dose of alcohol co-administered with a low dose of fluoxetine (2 mg/kg) further increased the attack behaviors, but with higher doses of fluoxetine decreased the attack behaviors. Alcohol administered at a dose of 1,000 mg/kg significantly decreased the shock-induced target biting rates 24 hours after injections. Interestingly, we observed a significant increase in target biting rates when alcohol was co-administered with fluoxetine at a dose of 16 mg/kg 24 hours after injections. We also observed the same heightened target biting rates when animals were injected with fluoxetine alone. This heightened biting attack engendered by the fluoxetine (alone or in combination with the alcohol) occurred at a time when brain serotonin activity was reduced by these drugs in the frontal lobe and hypothalamus. These observations indicate that heightened biting attack behavior may be associated with reduced serotonergic activity in brain regions regulating aggression.

  11. 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

    2016-01-01

    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.

  12. 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.

  13. Estimation of 24-hour urinary sodium excretion using spot urine samples.

    PubMed

    Rhee, Moo-Yong; Kim, Ji-Hyun; Shin, Sung-Joon; Gu, Namyi; Nah, Deuk-Young; Hong, Kyung-Soon; Cho, Eun-Joo; Sung, Ki-Chul

    2014-06-20

    The present study evaluated the reliability of equations using spot urine (SU) samples in the estimation of 24-hour urine sodium excretion (24-HUNa). Equations estimating 24-HUNa from SU samples were derived from first-morning SU of 101 participants (52.4 ± 11.1 years, range 24-70 years). Equations developed by us and other investigators were validated with SU samples from a separate group of participants (n = 224, 51.0 ± 10.9 years, range 24-70 years). Linear, quadratic, and cubic equations were derived from first-morning SU samples because these samples had a sodium/creatinine ratio having the highest correlation coefficient for 24-HUNa/creatinine ratio (r = 0.728, p < 0.001). In the validation group, the estimated 24-HUNa showed significant correlations with measured 24-HUNa values. The estimated 24-HUNa by the linear, quadratic, and cubic equations developed from our study were not significantly different from measured 24-HUNa, while estimated 24-HUNa by previously developed equations were significantly different from measured 24-HUNa values. The limits of agreement between measured and estimated 24-HUNa by six equations exceeded 100 mmol/24-hour in the Bland-Altman analysis. All equations showed a tendency of under- or over-estimation of 24-HUNa, depending on the level of measured 24-HUNa. Estimation of 24-HUNa from single SU by equations as tested in the present study was found to be inadequate for the estimation of an individual's 24-HUNa.

  14. Dietary restraint and disinhibition do not affect accuracy of 24-hour recall in a multiethnic population.

    PubMed

    Ard, Jamy D; Desmond, Renee Ann; Allison, David B; Conway, Joan Marie

    2006-03-01

    Some psychological predictors of eating behaviors have been shown to affect usefulness of methods for dietary assessment. Therefore, this study was conducted to determine the association of dietary restraint and disinhibition with dietary recall accuracy for total energy, fat, carbohydrate, and protein. In a cross-sectional study, data were obtained from 79 male and 71 female non-Hispanic whites and African-American volunteers. Participants selected and consumed all foods for a 1-day period under observation and actual intake was determined. The following day, each participant completed a telephone 24-hour recall using the US Department of Agriculture Multiple-Pass method to obtain recalled intake. The Eating Inventory, which measures dietary restraint and disinhibition, was administered prior to eating any food in the study. Repeated measures analyses of variance were used to determine if dietary restraint or disinhibition were independent predictors of recall accuracy. The mean (+/-standard deviation) age and body mass index of the participants was 43+/-12 years and 29+/-5.5 (calculated as kg/m2), respectively. On average, men overreported intake of energy by 265 kcal and women by 250 kcal; both groups also overreported intake of protein, carbohydrate, and fat. When controlling for body mass index, sex, and race, restraint was a significant independent predictor of energy intake (P=0.004) and negatively correlated with energy intake (r=-0.23, P<0.001). Unlike intake of carbohydrate or protein, fat intake was significantly and negatively associated with dietary restraint (P<0.001; r=-0.3). Dietary restraint did not affect accuracy of recall of intake of energy, fat, carbohydrate, or protein, but was significantly associated with intake of energy and fat. Disinhibition was not related to intake or accuracy. Dietetics professionals should consider dietary restraint a possible reason for a lower than expected estimate of energy intake when using 24-hour recalls.

  15. Patient-centered care or cultural competence: negotiating palliative care at home for Chinese Canadian immigrants.

    PubMed

    Nielsen, Lisa Seto; Angus, Jan E; Howell, Doris; Husain, Amna; Gastaldo, Denise

    2015-06-01

    The literature about Chinese attitudes toward death and dying contains frequent references to strong taboos against open discussion about death; consequently, there is an assumption that dying at home is not the preferred option. This focused ethnographic study examined the palliative home care experiences of 4 Chinese immigrants with terminal cancer, their family caregivers, and home care nurses and key informant interviews with 11 health care providers. Three main themes emerged: (1) the many facets of taboo; (2) discursive tensions between patient-centered care and cultural competence; and (3) rethinking language barriers. Thus, training on cultural competence needs to move away from models that portray cultural beliefs as shared, fixed patterns, and take into account the complicated reality of everyday care provision at end of life in the home.

  16. Encounters in Home-Based Nursing Care - Registered Nurses’ Experiences

    PubMed Central

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin

    2013-01-01

    The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses’ experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care. PMID:23847697

  17. At-home oral care for adults with developmental disabilities

    PubMed Central

    Minihan, Paula M.; Morgan, John P.; Park, Angel; Yantsides, Konstantina E.; Nobles, Carrie J.; Finkelman, Matthew D.; Stark, Paul C.; Must, Aviva

    2015-01-01

    Background Little is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance. Methods A convenience sample of 808 caregivers (84.5 percent paid, 15.5 percent family members) who accompanied adults with DDs (20 years or older) to appointments at a specialized statewide dental care system completed computer-assisted personal interview surveys. The authors used these data to investigate caregivers’ at-home oral care experiences and to explore differences between caregivers who were paid and those who were family members. Results Caregivers reported that a high proportion (85 percent) of dentate adults with DDs received assistance with tooth cleaning. They also reported a high prevalence of dental problems, and low adherence to brushing (79 percent) and flossing (22 percent) recommendations. More caregivers reported that they felt confident assisting with brushing than with flossing (85 percent versus 54 percent). Family members and paid caregivers differed with respect to confidence and training. Conclusions At-home oral care, particularly flossing, presents substantial challenges for adults with DDs. Solutions must be tailored to address the different experiences and distinct needs of the family members and paid caregivers who assist these adults. Practical Implications Caregivers play an important role in providing at-home oral care, and they must be included in efforts to improve oral health outcomes for people with DDs. PMID:25270700

  18. 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

  19. 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

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. Attempt Quit Smoking 24+ Hours Maps and Data of Model-Based Small Area Estimates - Small Area Estimates

    Cancer.gov

    Attempt Quit Smoking 24+ Hours is defined as a person 18 years of age or older who must have reported smoking at least 100 cigarettes in his/her life, and now does not smoke at all but it has been less than 365 days since completely stopped smoking cigarettes, or now smoke everyday or some days but reported that have made attempt of quitting for more than 24 hours in the past 12 months.

  6. A system for intelligent home care ECG upload and priorisation.

    PubMed

    D'Angelo, Lorenzo T; Tarita, Eugeniu; Zywietz, Tosja K; Lueth, Tim C

    2010-01-01

    In this contribution, a system for internet based, automated home care ECG upload and priorisation is presented for the first time. It unifies the advantages of existing telemonitoring ECG systems adding functionalities such as automated priorisation and usability for home care. Chronic cardiac diseases are a big group in the geriatric field. Most of them can be easily diagnosed with help of an electrocardiogram. A frequent or long-term ECG analysis allows early diagnosis of e.g. a cardiac infarction. Nevertheless, patients often aren't willing to visit a doctor for prophylactic purposes. Possible solutions of this problem are home care devices, which are used to investigate patients at home without the presence of a doctor on site. As the diffusion of such systems leads to a huge amount of data which has to be managed and evaluated, the presented approach focuses on an easy to use software for ECG upload from home, a web based management application and an algorithm for ECG preanalysis and priorisation.

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

    PubMed

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

    2016-03-01

    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.

  8. 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.

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... day care homes. 226.13 Section 226.13 Agriculture Regulations of the Department of Agriculture... CARE FOOD PROGRAM Payment Provisions § 226.13 Food service payments to sponsoring organizations for day... children and eligible enrolled children of day care home providers, at approved day care homes. (b)...

  15. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... day care homes. 226.13 Section 226.13 Agriculture Regulations of the Department of Agriculture... CARE FOOD PROGRAM Payment Provisions § 226.13 Food service payments to sponsoring organizations for day... children and eligible enrolled children of day care home providers, at approved day care homes. (b)...

  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. 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

  18. 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

  19. 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…

  20. 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

  1. Using scenarios to capture work processes in shared home care.

    PubMed

    Hägglund, Maria; Scandurra, Isabella; Koch, Sabine

    2007-01-01

    Shared home care is increasingly common, and in order to develop ICT that support such complex cooperative work it is crucial obtain an understanding of the work routines, information demands, and other central preconditions at the clinical level before the development is initiated. Scenarios are proposed as a technique that can be useful for capturing work processes in shared home care and experiences from the Old@Home project are presented. The scenarios are useful not only in the initial phases of the development project but throughout the development process, improving the accessibility of end user requirements and usability issues for the design team, and as a basis for use cases and further design.

  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. Teaching Principles of Geriatrics Through a Home Health Care Rotation.

    ERIC Educational Resources Information Center

    Francisco, George E., Jr.

    1983-01-01

    A one week rotation in home health care for the aged, included in a required clinical clerkship, provided students with exposure to medical, social, and economic influences on the elderly and provided the patient with nondispensing pharmaceutical services. Improved communication skills and knowledge of geriatric drugs and diseases resulted. (MSE)

  4. 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…

  5. Use of Informal In-Home Care by Rural Elders.

    ERIC Educational Resources Information Center

    Newhouse, Janette K.; McAuley, William J.

    1987-01-01

    Examined use of in-home services by older rural people who received assistance exclusively from informal sources. Results suggest that informal caregiver is essential in community-based care for rural elderly. Having a car, distance to friend, economic resources, physical health, and performance in daily living activities related to use of more…

  6. 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.

  7. Virtual Visits in Home Health Care for Older Adults

    PubMed Central

    Husebø, Anne Marie Lunde

    2014-01-01

    Background. This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits. Design. An integrative literature review. Method. Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience. Results. Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found. Conclusions. The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home. PMID:25506616

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

    PubMed

    Burns, J

    1995-06-05

    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.

  9. Needs for Psychosocial Support in Home Care Hospice Patients.

    ERIC Educational Resources Information Center

    Gotay, Carolyn Cook

    There is little research documenting the psychosocial support needs of hospice patients and their families. To assess hospice patients' and families' use of and perceptions of need for support, 77 patients and their families were interviewed during home care for terminal illness (Group 1), and 50 family members (84% spouses) were interviewed 1…

  10. 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

  11. 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

  12. 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

  13. Nursing Home Levels of Care: Problems and Alternatives

    PubMed Central

    Bishop, Christine E.; Plough, Alonzo L.; Willemain, Thomas R.

    1980-01-01

    Providers and recipients of nursing home care under Medicaid are currently classified into two levels of care to facilitate appropriate placement, care, and reimbursement. The inherent imprecision of the two level system leads to problems of increased cost to Medicaid, lowered quality of care, and inadequate access to care for Medicaid recipients. However, a more refined system is likely to encounter difficulties in carrying out the functions performed by the broad two-level system, including assessment of residents, prescription of needed services, and implementation of service plans. The service type-service intensity classification proposed here can work in combination with a three-part reimbursement rate to encourage more accurate matching of resident needs, services, and Medicaid payment, while avoiding disruption of care. PMID:10309329

  14. Low mean impedance in 24-hour tracings and esophagitis in children: a strong connection.

    PubMed

    Salvatore, S; Salvatoni, A; Ummarino, D; Ghanma, A; Van der Pol, R; Rongen, A; Fuoti, M; Meneghin, F; Benninga, M Alexander; Vandenplas, Y

    2016-01-01

    Esophageal multiple intraluminal impedance baseline is an additional impedance parameter that was recently related to esophageal integrity. The aim of this study was to assess the relationship between mean esophageal impedance value and endoscopic findings in a large group of children. Children with symptoms of gastroesophageal reflux submitted to both endoscopy and impedance were included. Esophagitis was graded according to the Los Angeles classification. Mean impedance value was automatically calculated over 24-hour tracings. Data were adjusted for age through z-score transformation using percentiles normalized by the LMS (Lambda for the skew, Mu for the median, and Sigma for the generalized coefficient of variation) method. Nonparametric Mann-Whitney and Kruskal-Wallis tests, multiple, and stepwise regression were used. P-value <0.05 was considered as statistically significant. A total of 298 impedance tracings were analyzed. Endoscopic and histological esophagitis were detected in 30 and 29% patients, respectively. Median baseline z-score was significantly decreased both in proximal (P = 0.02) and distal (P = 0.01) esophagus in patients with endoscopic (but not histological) esophagitis. Patients with more severe esophagitis showed the lowest z-score. Bolus exposure index and the number of reflux episodes were the variables that were significantly associated with the baseline z-score. Impedance z-score is significantly decreased in infants and children with endoscopic esophagitis. Severity of esophagitis, bolus exposure index, and number of reflux episodes are factors influencing mean esophageal impedance.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. What and how much do we eat? 24-hour dietary recall method.

    PubMed

    Salvador Castell, Gemma; Serra-Majem, Lluis; Ribas-Barba, Lourdes

    2015-02-26

    Diet, along with lifestyle factors, is an important determinant of the health status of an individual and of a community. Dietary assessment at the population level provides us with key information on the frequency and distribution of possible inadequate diets and/or nutritional status. It is also useful as input into the elaboration of food and nutrition policies aiming to improve dietary habits and the health status of a community. This article reviews the characteristics, advantages and limitations of the 24-hour dietary recall method (24hDR), which is one of the most widely used tools in nutrition epidemiology to identify food, energy and nutrient intake in national nutrition surveys, cross-sectional studies, clinical trials and cohort studies as well as in the evaluation of individual dietary intake and Total Diet assessment. To reduce the key factors associated with bias, the importance of previously trained interviewers is highlighted, as well as the role of support materials and the contribution of novel technologies.

  1. 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.

  2. 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.

  3. A 24-hour study to investigate persistent chemical exposures associated with clandestine methamphetamine laboratories.

    PubMed

    VanDyke, Mike; Erb, Nicola; Arbuckle, Shawn; Martyny, John

    2009-02-01

    The clandestine manufacture of methamphetamine continues to be a concern across the United States. Although the exposures associated with the actual production process have been evaluated, the persistence of those exposures in a residential setting have not been investigated. This study was designed to document the contamination associated with two red phosphorous methamphetamine "cooks" conducted in a residence and the associated exposures up to 24 hours after the cook. The two cooks were conducted on the first day of the study, and exposures associated with different occupant activity levels were measured the following day. Airborne methamphetamine levels during the cook ranged from 520 microg/m(3) to 760 microg/m(3). On Day 2, airborne levels of methamphetamine ranged from 70 microg/m(3) to 210 microg/m(3) and increased with moderate to high activity levels within the residence. The majority of the methamphetamine measured during both days had a particle size of less than 1 mum, suggesting that the methamphetamine is formed as a condensation aerosol and is readily resuspended from contaminated surfaces. Significant methamphetamine contamination was found in the carpeting and likely was associated with the elevated levels of methamphetamine during activity. Levels of hydrogen chloride and iodine were also detected on Day 2 of the project although at very low levels. The study concluded that exposures may still present a significant inhalation exposure well after the actual cook.

  4. Pneumonia in nursing homes and long-term care facilities.

    PubMed

    Loeb, Mark B

    2005-12-01

    This article reviews the epidemiology of pneumonia in residents of nursing homes and other long-term care facilities (LTCFs). Streptococcus pneumoniae is the most important cause of pneumonia in residents of nursing homes and LTCFs. Factors suggestive of aspiration are the most important risk factors for pneumonia in this population. The clinical presentation of pneumonia among long-term care facility residents is challenging; residents tend to be older and more debilitated than their elderly community-dwelling counterparts. Data on optimal antimicrobial therapy in this setting is sparse. Functional status is an important predictor of outcome in this population. There are key management issues, such as site of care, which remain unresolved. Immunization with influenza and pneumococcal vaccines remains the mainstay of prevention.

  5. [Home care rehabilitation and physiotherapy in knee prosthesis].

    PubMed

    López-Liria, R; Vega-Ramírez, Fa; Catalán-Matamoros, D; Padilla Góngora, D; Martínez-Cortés, Mc; Mesa-Ruiz, A

    2012-01-01

    This review analyzes the existing studies on home care rehabilitation and physiotherapy in patients with a knee prosthesis intervention, identifying and synthesising the results of the interventions measured in terms of muscular strength, function, extension of the joint, walking, patient's quality of life and cost of the service, compared with other alternative treatments. Nine databases have been analysed: IME, ENFISPO, CUIDEN PLUS, PUBMED, EMBASE, CINAHL, PEDro, COCHRANE library Plus and TRIP DATA BASE where 18 studies met the criteria for inclusion with information on 4,996 patients. Home care rehabilitation varies from one place to another and between studies (forms of care, application, duration, variable measures); but the idea is supported that this is as effective and acceptable as that received in an outpatients' department. It accelerates the attainment of functional achievements in the short and medium term, entailing very brief hospital stays and a reduction in costs.

  6. 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.

  7. Black-White Disparities in Care in Nursing Homes

    PubMed Central

    Grabowski, David C.; McGuire, Thomas G.

    2009-01-01

    Nursing homes serve many severely ill poor people, including large numbers of racial/ethnic minority residents. Previous research indicates that blacks tend to receive care from lower quality nursing homes (Grabowski, 2004). Using the Institute of Medicine (IOM) definition of racial-ethnic disparities, this study decomposes nursing home disparities into within and across facility components. Using detailed person-level nursing home data, we find meaningful black-white disparities for one of the four risk-adjusted quality measures, with both within and across nursing home components of the disparity. The IOM approach, which recognizes mediation through payer status and education, has a small effect on measured disparities in this setting. Although we did not find disparities across the majority of quality measures and alternate disparity definitions, this approach can be applied to other health care services in an effort to disentangle the role of across and within facility variation and the role of potential mediators on racial/ethnic disparities. PMID:20160968

  8. Day Care Homes: A Pennsylvania Profile. Center for Human Services Development Report No. 18.

    ERIC Educational Resources Information Center

    Peters, Donald L.

    This report presents a preliminary profile of home day care in Pennsylvania. Information was gathered through extensive questionnaires and home observations which occurred during site visits to a geographically-representative sample of 162 licensed or approved day care homes. In the profile, comparisons are made between 146 homes which are…

  9. 78 FR 53506 - Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... AFFAIRS Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction... comments on the information collection required to obtain patient perspective on satisfaction with the CCHT... forms of information technology. Titles: Care Coordination Home Telehealth (CCHT) Patient...

  10. Mobile computing and the quality of home care nursing practice.

    PubMed

    Paré, Guy; Sicotte, Claude; Moreault, Marie-Pierre; Poba-Nzaou, Placide; Nahas, Georgette; Templier, Mathieu

    2011-01-01

    We investigated the effects of the introduction of mobile computing on the quality of home care nursing practice in Québec. The software, which structured and organized the nursing activities in patients' homes, was installed sequentially in nine community health centres. The completeness of the nursing notes was compared in 77 paper records (pre-implementation) and 73 electronic records (post-implementation). Overall, the introduction of the software was associated with an improvement in the completeness of the nursing notes. All 137 nurse users were asked to complete a structured questionnaire. A total of 101 completed questionnaires were returned (74% response rate). Overall, the nurses reported a very high level of satisfaction with the quality of clinical information collected. A total of 57 semi-structured interviews were conducted and most nurses believed that the new software represented a user-friendly tool with a clear and understandable structure. A postal questionnaire was sent to approximately 1240 patients. A total of 223 patients returned the questionnaire (approximately 18% response rate). Overall, patients felt that the use of mobile computing during home visits allowed nurses to manage their health condition better and, hence, provide superior care services. The use of mobile computing had positive and significant effects on the quality of care provided by home nurses.

  11. Lack of ear care knowledge in nursing homes

    PubMed Central

    Solheim, Jorunn; Shiryaeva, Olga; Kvaerner, Kari J

    2016-01-01

    Background Rising life expectancy means an increase in the number of elderly people with hearing loss in the population. Many elderly people live in nursing homes, with varying care needs. A substantial proportion of these people will need help with their hearing aids and other hearing devices. Objective The objective of the study has been to assess the knowledge, experience, skills, competence, and need for information of staff at nursing homes in relation to residents’ hearing loss and hearing aids. Materials and methods One hundred and ninety-five employees at seven nursing homes participated in the study. The main approach was a descriptive study, using questionnaires. Results The main findings are that 73% of informants found that many residents need help with their hearing aids. Only one-tenth report that they know enough about the residents’ hearing aids. Almost four out of five informants find that the residents become socially isolated as a result of hearing loss. Seventy-eight percent agree to some extent that more residents would benefit from hearing aids. Conclusion Staff at nursing homes have insufficient knowledge about hearing loss and hearing aids. Increased focus on the elderly with hearing impairment in nursing homes is needed. Contact between nursing homes and audiological specialists should be improved to best followup hearing loss and hearing aids. PMID:27757038

  12. Deficiencies In Care At Nursing Homes And Racial & Ethnic Disparities Across Homes Declined, 2006–11

    PubMed Central

    Li, Yue; Harrington, Charlene; Temkin-Greener, Helena; Kai, You; Cai, Xueya; Cen, Xi; Mukamel, Dana B.

    2015-01-01

    Despite the increased use of nursing homes by minority residents, nursing home care remains highly segregated. Compared to whites, racial/ethnic minorities tend to be cared for in facilities with limited clinical and financial resources, low nurse staffing levels, and a relatively high number of care deficiency citations. We assessed the trends from 2006 to 2011 in those citations and in disparities across facilities with four different concentrations of racial/ethnic minority residents. We found that the number of health care–related deficiencies and the percentage of facilities with serious deficiencies decreased over time for all four facility groups. From 2006 to 2011, the average annual number of health care–related deficiencies declined from 7.4 to 6.8 for facilities with low minority concentrations (< 5 percent) and from 10.6 to 9.4 for facilities with high minority concentrations (≥ 35 percent). In multivariable analyses, across-site disparities in health care-related deficiencies and in life-safety deficiencies narrowed over time. We also found that increasing the Medicaid payment rate might help improve both overall quality and disparities, but state case-mix payment approaches might worsen both. These results suggest the need to reevaluate quality improvement and cost containment efforts to better foster quality and equity of nursing home care. PMID:26153308

  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.

  14. 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

  15. 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.

  16. No Enhancement of 24-Hour Visuomotor Skill Retention by Post-Practice Caffeine Administration

    PubMed Central

    Hussain, Sara J.; Cole, Kelly J.

    2015-01-01

    Caffeine is widely consumed throughout the world and appears to indirectly facilitate learning and memory through effects on attention and motivation. Animal work indicates that post-training caffeine administration augments inhibitory avoidance memory, spatial memory, and object memory. In humans, post-training caffeine administration enhances the ability to discern between familiar images and new, similar images. However, the effect of post-training caffeine administration on motor memory has not been examined. Therefore, we tested two groups of low caffeine consumers (average weekly consumption ≤500 mg) in a double-blind, placebo-controlled study involving acquisition of a continuous isometric visuomotor tracking skill. On Day 1, subjects completed 5 blocks (150 repetitions) of training on the continuous isometric visuomotor skill and subsequently ingested either 200 mg of caffeine or placebo. On day 2, subjects completed an additional 5 blocks of training. Day 1 mean performance and performance variability were both similar between groups, suggesting that both groups acquired the motor skill similarly. For mean performance on Day 2, patterns of re-learning, mean performance learning magnitudes, mean performance learning rates, and mean performance retention magnitudes were all similar between groups. For performance variability on Day 2, there was a small trend towards increased variability in the caffeine group during re-learning, but performance variability learning magnitudes and performance variability retention magnitudes did not differ between groups. Because motor skill acquisition can also be conceptualized as a reduction in performance variability, these results suggest that there may be a small negative effect of post-practice caffeine administration on memory of a newly-learned visuomotor skill. Overall, we found no evidence to suggest that post-training caffeine administration enhances 24-hour retention of a newly-learned continuous visuomotor

  17. No Enhancement of 24-Hour Visuomotor Skill Retention by Post-Practice Caffeine Administration.

    PubMed

    Hussain, Sara J; Cole, Kelly J

    2015-01-01

    Caffeine is widely consumed throughout the world and appears to indirectly facilitate learning and memory through effects on attention and motivation. Animal work indicates that post-training caffeine administration augments inhibitory avoidance memory, spatial memory, and object memory. In humans, post-training caffeine administration enhances the ability to discern between familiar images and new, similar images. However, the effect of post-training caffeine administration on motor memory has not been examined. Therefore, we tested two groups of low caffeine consumers (average weekly consumption ≤500 mg) in a double-blind, placebo-controlled study involving acquisition of a continuous isometric visuomotor tracking skill. On Day 1, subjects completed 5 blocks (150 repetitions) of training on the continuous isometric visuomotor skill and subsequently ingested either 200 mg of caffeine or placebo. On day 2, subjects completed an additional 5 blocks of training. Day 1 mean performance and performance variability were both similar between groups, suggesting that both groups acquired the motor skill similarly. For mean performance on Day 2, patterns of re-learning, mean performance learning magnitudes, mean performance learning rates, and mean performance retention magnitudes were all similar between groups. For performance variability on Day 2, there was a small trend towards increased variability in the caffeine group during re-learning, but performance variability learning magnitudes and performance variability retention magnitudes did not differ between groups. Because motor skill acquisition can also be conceptualized as a reduction in performance variability, these results suggest that there may be a small negative effect of post-practice caffeine administration on memory of a newly-learned visuomotor skill. Overall, we found no evidence to suggest that post-training caffeine administration enhances 24-hour retention of a newly-learned continuous visuomotor

  18. Trends in Child Protection and Out-of-Home Care

    PubMed Central

    Szilagyi, Moira A.; Franke, Todd M.; Albertin, Christina S.; Blumkin, Aaron K.; Szilagyi, Peter G.

    2013-01-01

    BACKGROUND: Over the past decades, increased knowledge about childhood abuse and trauma have prompted changes in child welfare policy, and practice that may have affected the out-of-home (OOH) care population. However, little is known about recent national trends in child maltreatment, OOH placement, or characteristics of children in OOH care. The objective of this study was to examine trends in child maltreatment and characteristics of children in OOH care. METHODS: We analyzed 2 federal administrative databases to identify and characterize US children who were maltreated (National Child Abuse and Neglect Data System) or in OOH care (Adoption and Foster Care Analysis and Reporting System). We assessed trends between 2000 and 2010. RESULTS: The number of suspected maltreatment cases increased 17% from 2000 to 2010, yet the number of substantiated cases decreased 7% and the number of children in OOH care decreased 25%. Despite the decrease in OOH placements, we found a 19% increase in the number of children who entered OOH care because of maltreatment (vs other causes), a 36% increase in the number of children with multiple (vs single) types of maltreatment, and a 60% increase in the number of children in OOH care identified as emotionally disturbed. CONCLUSIONS: From 2000 to 2010, fewer suspected cases of maltreatment were substantiated, despite increased investigations, and fewer maltreated children were placed in OOH care. These changes may have led to a smaller but more complex OOH care population with substantial previous trauma and emotional problems. PMID:24062369

  19. 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…

  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…

  1. The Center for Health Care Law: the legal muscle of home care and hospice.

    PubMed

    Dombi, Bill

    2006-10-01

    The Center for Health Care Law is a unique offering for a trade association. Operating as a law firm within NAHC, the Center has strengthened NAHC's advocacy efforts on all fronts. The law provides a useful structure and a rational system for behavior, provided that the law is understood. The Center brings the necessary understanding of the law to home care and hospice.

  2. 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…

  3. 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…

  4. Accidental Injuries among Children in Day Care Centers and Family Day Care Homes.

    ERIC Educational Resources Information Center

    Snow, Charles W.; And Others

    For this study, information was obtained about accidential injuries among children in day care centers (DCC) and family day care homes (DCH) in North Carolina. An Accident Survey Questionnaire was used to report injuries that required treatment by a staff member, doctor, or nurse. Results of data analyses showed that: (1) falls were the leading…

  5. [Nursing care according to Virginia Henderson in the at home care field].

    PubMed

    Coll, Margarita; Besora, Inma; Icart, Teresa; Vall, Asunción Ferré; Manito, Isabel; Ondiviela, Angeles; Pulpon, Anna

    2007-03-01

    The authors determine if applying the nurse process, by adopting Virginia Henderson's conceptual model, is more effective and provides any added value in terms of quality care and security or professional satisfaction in comparison to the application of other methods which do not adopt Henderson's model in the field of at home care.

  6. Caring from Home: Addressing Barriers to Family Child Care Expansion.

    ERIC Educational Resources Information Center

    Citizens' Committee for Children of New York, NY.

    This study involved focus groups with New York City family day care providers to determine difficulties they experienced in three areas: economic barriers, payment and regulatory barriers, and barriers to workforce development. Overall, providers had difficulty making wages that allowed them to provide for themselves and their families. They…

  7. The Impact of Using Different Methods to Assess Completeness of 24-Hour Urine Collection on Estimating Dietary Sodium.

    PubMed

    Wielgosz, Andreas; Robinson, Christopher; Mao, Yang; Jiang, Ying; Campbell, Norm R C; Muthuri, Stella; Morrison, Howard

    2016-06-01

    The standard for population-based surveillance of dietary sodium intake is 24-hour urine testing; however, this may be affected by incomplete urine collection. The impact of different indirect methods of assessing completeness of collection on estimated sodium ingestion has not been established. The authors enlisted 507 participants from an existing community study in 2009 to collect 24-hour urine samples. Several methods of assessing completeness of urine collection were tested. Mean sodium intake varied between 3648 mg/24 h and 7210 mg/24 h depending on the method used. Excluding urine samples collected for longer or shorter than 24 hours increased the estimated urine sodium excretion, even when corrections for the variation in timed collections were applied. Until an accurate method of indirectly assessing completeness of urine collection is identified, the gold standard of administering para-aminobenzoic acid is recommended. Efforts to ensure participants collect complete urine samples are also warranted.

  8. Non-24-hour sleep–wake syndrome improved by low-dose valproic acid: a case report

    PubMed Central

    Kurita, Masatake; Moriya, Takahiro; Nishino, Satoshi; Hirata, Eishin; Hirasawa, Noriyasu; Okubo, Yoshiro; Sato, Tadahiro

    2016-01-01

    A woman was diagnosed with non-24-hour sleep–wake syndrome and depressive symptoms. Her depressive symptoms did not respond to standard doses of several antidepressants or mood stabilizers. Furthermore, her sleep–wake cycle remained non-entrained despite treatment with a melatonin-related drug, vitamin B12, and phototherapy. Ultimately, her sleep–wake rhythm was restored to a 24-hour pattern with a low dose of valproic acid, and her depressive symptoms tended to improve as a result of synchronization without antidepressants. Low-dose valproic acid appears to be one of the effective means of entraining circadian rhythms in patients with non-24-hour sleep–wake syndrome, which in turn likely improves associated depressive symptoms. PMID:28008257

  9. Competition and quality in home health care markets.

    PubMed

    Jung, Kyoungrae; Polsky, Daniel

    2014-03-01

    Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition.

  10. The role of the pharmacist in home health care.

    PubMed

    McAllister, J C

    1985-04-01

    Home infusion services, a new facet of home health care (HHC) delivery, have created many new opportunities for hospital pharmacists to participate more actively in patient care. These opportunities can create new roles for the pharmacist as an educator, clinician, and administrator. Early efforts must be made to educate hospital administrators, physicians, and other allied health personnel regarding the advantages and disadvantages of providing HHC--from the perspective of both patients and institutions. The pharmacist can also collect data to assist in determining the extent to which the institution should participate in HHC delivery, and should coordinate the hospital's efforts to initiate home infusion services. Pharmacists should play an active role in screening, selecting, and training patients for HHC before discharge. The input of pharmacists in drug product selection and assistance in product compounding can ensure optimal patient outcomes and minimize costs. Clinical monitoring activities conducted by the pharmacist can include telephone interviews with patients at home and assessment of clinical progress during scheduled return visits to the clinic.

  11. 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

  12. 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

  13. Forgotten resources of older home care clients: focus group study in Finland.

    PubMed

    Turjamaa, Riitta; Hartikainen, Sirpa; Pietilä, Anna-Maija

    2013-09-01

    In this qualitative focus group study, the resources available to older home-dwelling people, particularly incoming and existing home care clients, are described from the viewpoint of home care professionals (n = 32). The data were analyzed using inductive content analysis. There were three categories of older people requiring resources from the viewpoint of interviewers: home-dwelling people, incoming home care clients, and existing home care clients. Based on the analysis, the resources of older home-dwelling people were categorized in terms of support, meaningful life, everyday activities, and environment. Incoming home care client resources were support, out-of-home activities, in-home activities, and environment. Existing client resources were described in terms of support, everyday activities, and environment. Home care professionals described the resources of the older home-dwelling people in diverse ways, but those of the perspective of existing clients were reduced. The biggest difference was in everyday activities. Psychological and social resources, including meaningful life and social relationships, seemed to be forgotten. All available resources must be taken into account, especially in the everyday home care services for existing home care clients.

  14. Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?

    PubMed Central

    Kemper, Peter; Weaver, France; Short, Pamela Farley; Shea, Dennis; Kang, Hyojin

    2008-01-01

    Objective To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n = 6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. PMID:18199190

  15. Interchangeability between 24-hour collection and single spot urines for vanillylmandelic and homovanillic acid levels in the diagnosis of neuroblastoma.

    PubMed

    Cangemi, Giuliana; Barco, Sebastiano; Reggiardo, Giorgio; Viscardi, Elisabetta; Di Cataldo, Andrea; Garaventa, Alberto; Melioli, Giovanni; Conte, Massimo

    2013-12-01

    The determination of the two urinary catecholamine metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) is of crucial importance for the diagnosis and follow-up of neuroblastoma (NB). The standard practice for their measurement requires the use of 24-hour collections that are time consuming and difficult to obtain. In this article, we directly demonstrate that 24-hour collections and single spot urines are interchangeable for the determination of HVA and VMA expressed as ratio on creatinine concentration. This study can be useful for a faster management of NB at onset.

  16. 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.

  17. [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.

  18. '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.

  19. 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

  20. Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form.

    PubMed

    Alharbi, Ziyad; Piatkowski, Andrzej; Dembinski, Rolf; Reckort, Sven; Grieb, Gerrit; Kauczok, Jens; Pallua, Norbert

    2012-05-14

    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.

  1. Home telehealth for children with special health-care needs.

    PubMed

    Cady, Rhonda; Kelly, Anne; Finkelstein, Stanley

    2008-01-01

    The U Special Kids (USK) programme at the University of Minnesota provides intensive care coordination and case management services to children with complex special health-care needs. We conducted a one-year pilot study to evaluate the feasibility of videoconferencing between the USK office and family homes. To ensure easy installation, families were provided with prepackaged equipment and software. However, the families had different Internet providers, different modems and/or routers and different firewall software, which required case-by-case resolution during home visits by the project coordinator. Five families participated in 3-5 videoconferencing sessions with a USK nurse. All connections with urban families had clear audio and video, whereas connections with rural families had clear audio, but unclear video. All of the scheduled virtual visits were rated by nurses as providing information that was similar to a telephone call. However, the unscheduled virtual visits were rated by the nurses as providing more information than a telephone call, suggesting that home-based videoconferencing may be useful in the management of children with complex special health-care needs.

  2. 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

  3. 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.

  4. Uncovering the Meaning of Home Care Using an Arts-Based and Qualitative Approach.

    PubMed

    Fraser, Kimberly; Archibald, Mandy; Nissen, Catherine

    2014-09-01

    The need for home care is increasing in Canada, yet little is known about the home care experience of clients and their families. Uncovering the meaning of the home care experience is an important step towards developing understanding and public awareness. We explored the experiences of home care using arts-based methods and individual interviews with 11 participants (one client and 10 family caregivers). Participants discussed the numerous ways formal home care and family caregiving affected their lives, how they coped with these effects, their experiences in hospitals or assisted living facilities, and aspects of the home care experience they liked or disliked. Participants agreed that home care facilitated a better quality of life for families and clients, although they acknowledged some challenges with it. The artistic outputs produced by participants facilitated interview dialogue and fostered understanding of key themes within the research team.

  5. Social security income and the utilization of home care: Evidence from the social security notch.

    PubMed

    Tsai, Yuping

    2015-09-01

    This paper exploits Social Security law changes to identify the effect of Social Security income on the use of formal and informal home care by the elderly. Results from an instrumental variables estimation strategy show that as retirement income increases, elderly individuals increase their use of formal home care and become less likely to rely on informal home care provided to them by their children. This negative effect on informal home care is most likely driven by male children withdrawing from their caregiving roles. The empirical results also suggest that higher Social Security benefits would encourage the use of formal home care by those who would not have otherwise used any type of home care and would also encourage the use of both types of home care services among elderly individuals.

  6. [A Study on problems associated with a patient's death during home care, based on the duration of home care and patient's age-why terminal home care is difficult for a patient's family].

    PubMed

    Ohara, Hiroo; Okabe, Hiromi; Tsuchiya, Kumiko; Kikuchi, Kana

    2012-12-01

    When a patient receives home care, an important factor is how the family accepts the patient's death. In this study, we observed that the number of long-term in-home terminal care cases increased, as well as the number of short-term in-home care cases. Moreover, the number of cancer cases among the young population is also increasing. Consequently, how to acceptance of a patient's death varies among their family. When tending to patients, suitable support from the medical staff is required. Additionally, various options need to be provided for terminal care.

  7. Preventing crises in palliative care in the home. Role of family physicians and nurses.

    PubMed Central

    Howarth, G.; Willison, K. B.

    1995-01-01

    With the current shift to community care, the need for palliative care in the home involving the family physician has increased. Potential causes of crises in the home care of the dying are identified. Strategies to prevent crises are suggested that rely on a team's providing comprehensive and anticipatory care. PMID:7539653

  8. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ...-day period was $2,537.40 in FY 2010. The average Medicare reimbursement level for skilled home care....74 less per day from VA for a 60-day episode of care. On average, each of the 8400 providers cares... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care by Non-VA...

  9. 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

    ... AGENCY 40 CFR Part 81 Additional Air Quality Designations for the 2006 24-Hour Fine Particle National Ambient Air Quality Standards AGENCY: Environmental Protection Agency (EPA). ACTION: Supplemental... particle (PM 2.5 ) national ambient air quality standards (NAAQS) air quality designations for the...

  10. 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.

  11. 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

  12. Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing.

    PubMed

    Amin, Raouf; Somers, Virend K; McConnell, Keith; Willging, Paul; Myer, Charles; Sherman, Marc; McPhail, Gary; Morgenthal, Ashley; Fenchel, Matthew; Bean, Judy; Kimball, Thomas; Daniels, Stephen

    2008-01-01

    Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index <5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity.

  13. Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea.

    PubMed

    Wilcox, I; Grunstein, R R; Hedner, J A; Doyle, J; Collins, F L; Fletcher, P J; Kelly, D T; Sullivan, C E

    1993-09-01

    Ambulatory blood pressure (BP) was measured noninvasively (Oxford Medilog ABP) at 15-minute intervals for 24 hours before and after 8 weeks of treatment with nasal continuous positive airway pressure (nCPAP) in 19 men with obstructive sleep apnea (OSA). We included both normotensive and hypertensive patients, but hypertensives were studied after withdrawal of antihypertensive drugs. Ambulatory BP before and after treatment was compared using patients as their own controls. Treatment with nCPAP was successfully established in 14 of the 19 patients (74%). Blood pressure fell significantly in patients who were successfully treated: 24-hour mean BP (systolic/diastolic) decreased from 141 +/- 18/89 +/- 11 mm Hg to 134 +/- 19/85 +/- 13 mm Hg (p < 0.05). The reduction in 24-hour mean systolic BP occurred during both day and night, but a significant fall in mean diastolic BP was only observed during the day. The mean blood pressure fell in both normotensive and hypertensive patients. Patients who were inadequately treated with nCPAP had no reduction in mean 24-hour BP. Effective treatment of sleep apnea with nCPAP was associated with a significant fall in both systolic and diastolic BP independent of changes in body weight or alcohol consumption, suggesting that sleep apnea was an independent factor contributing to elevated nighttime and daytime BP in these patients.

  14. Correlations of beta-aminoisobutyric acid in 8 hour and 24 hour urinary samples determined by dual column gas chromatography.

    PubMed

    Sjölin, K E; Nyholm, K K

    1980-05-01

    The correlations of beta-aminoisobutyric acid values in 8 hour and 24 hour urinary samples from 23 healthy persons were determined. beta-AIB in the 8 hour urinary samples was measured by gas chromatography and the 24 hour excretion was calculated from the results of three 8 hour determinations. Simultaneous determinations of urinary creatinine were performed by Jaffe's reaction. Based on the 8 hour values of urinary beta-AIB the results demonstrated a constant excretion of beta-aminoisobutyric acid within the 24 hour periods in both low and high excretors. The precision in distinguishing low and high 24 hour excretors of beta-AIB by using 8 hour values was 91%. If 8 hour values of beta-AIB were related to creatinine the same precision for this calculated ratio was 96.5%. However, for high excretors of beta-AIB, failures were 24.5% by using the 8 hour excretion of beta-AIB as indicator, but only 6.5% by using the ratio.

  15. Urinary saturation and risk factors for calcium oxalate stone disease based on spot and 24-hour urine specimens.

    PubMed

    Ogawa, Yoshihide; Yonou, Hiroyuki; Hokama, Sanehiro; Oda, Masami; Morozumi, Makoto; Sugaya, Kimio

    2003-09-01

    In 222 random spot urine specimens, the calcium concentration and calcium oxalate saturation [DG(CaOx)] were significantly higher among stone formers than among non-stone formers, while the citrate and creatinine-corrected citrate concentrations were lower. In 188 24-hour urine specimens, magnesium excretion was lower among stone formers than non-stone formers, while the creatinine-corrected calcium concentration and DG(CaOx) were higher. Among stone formers, there was no gender difference in the urinary concentrations of calcium, oxalate, citrate, magnesium, and DG(CaOx), but the creatinine-corrected calcium, citrate, and magnesium concentrations were higher in women, as well as 24-hour citrate excretion. The levels of calcium and oxalate have a major influence on DG(CaOx), while citrate and magnesium levels have a minor influence. DG(CaOx) was correlated with calcium and oxalate excretion, as well as with the creatinine-corrected calcium and oxalate concentrations. Approximately 5% of 24-hour urine specimens showed critical supersaturation, 80% showed metastable supersaturation, and 15% were unsaturated. Hypercalciuria or hyperoxaluria was fairly common (30% and 40%) in critically supersaturated urine, while it was less common (22.4% and 8.6%) in metastably supersaturated urine and was not detected in unsaturated urine. Hypocitraturia and/or hypomagnesiuria was more common (63.8-80%) at any saturation. The urinary calcium, oxalate, and citrate concentrations, as well as the creatinine-corrected calcium, oxalate, citrate, and magnesium concentrations and DG(CaOx), showed a significant correlation between 57 paired early morning spot urine and 24-hour urine specimens. The creatinine-corrected calcium and citrate concentrations of the early morning urine specimens were significantly correlated with the levels of calcium and citrate excretion in the paired 24-hour urine specimens. In conclusion, no parameter other than urinary saturation gives more than a vague

  16. 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

  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.

  18. Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff.

    PubMed

    Solimeo, Samantha L; Ono, Sarah S; Stewart, Kenda R; Lampman, Michelle A; Rosenthal, Gary E; Stewart, Greg L

    2017-03-01

    International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority.

  19. 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.

  20. Mothers With Physical Disability: Child Care Adaptations at Home

    PubMed Central

    Smith, Diane L.; Iezzoni, Lisa I.

    2016-01-01

    OBJECTIVE. This study describes how women with physical disability experience caregiving for a new infant and how they adapt their home environment and care tasks. METHOD. In 2013, we conducted 2-hr telephone interviews with 22 women with significant physical disability who had delivered babies within the previous 10 yr. The semistructured, open-ended interview protocol addressed wide-ranging pregnancy-related topics. NVivo was used to sort the texts for content analysis. RESULTS. Night care, bathing, and carrying the baby were identified as the biggest challenges. Typical adaptations (with and without occupational therapy consultation) included use of a wrap for carrying the infant, furniture adaptations for mothers using wheelchairs, and assistance from caregivers. CONCLUSION. Women with physical disability can be fully capable of caring for an infant and can find ways to adapt their environment. Further research may determine the role of occupation therapy. PMID:27767945

  1. 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

  2. Effects of para-aminobenzoic acid (PABA) form and administration mode on PABA recovery in 24-hour urine collections.

    PubMed

    Sharma, Rashmi S; Joy, Raechel C; Boushey, Carol J; Ferruzzi, Mario G; Leonov, Alexei P; McCrory, Megan A

    2014-03-01

    Para-aminobenzoic acid (PABA) has long been used as an objective measure to assess completeness of 24-hour urine collections. However, pharmaceutical-grade PABA for human ingestion is not available in the United States. An alternative, the potassium salt of PABA, aminobenzoate potassium, can be obtained for clinical use, although it has not yet been validated in this role. Both PABA and aminobenzoate potassium can be directly ingested in their tablet or capsule forms or added to food before consumption. Our aim was to investigate the effect of form (PABA vs aminobenzoate potassium) and administration mode (directly ingested as a tablet/capsule vs added to food) on urinary PABA recovery levels. Twenty healthy participants underwent 3 test days separated by two 24-hour wash-out periods. Three test conditions, one on each test day, were investigated in randomized order: PABA tablet, aminobenzoate potassium capsule, and PABA or aminobenzoate potassium in food. Ingestion of each dose was supervised and participants performed the 24-hour urine collections while free-living. The 24-hour urine collections were analyzed for PABA recovery (%R) levels using a colorimetric assay. Recoveries 85% to 110% were deemed complete and those >110% were reanalyzed by high pressure liquid chromatography and mass spectrometry. Only complete collections (>85%R) were included in analyses. The recovery for the PABA tablet, aminobenzoate potassium capsule, and PABA/aminobenzoate potassium in food were similar at 98.8%R±2.0%R, 95.1%R±2.3%R, and 93.2%R±2.1%R, respectively, and did not differ significantly. These results suggest that aminobenzoate potassium may be used as an alternative to PABA for assessing the completeness of 24-hour urine collections and to track compliance with consuming provided diets in community-dwelling studies.

  3. Prediction of destination at discharge from a comprehensive rehabilitation hospital using the home care score

    PubMed Central

    Matsugi, Akiyoshi; Tani, Keisuke; Yoshioka, Nami; Yamashita, Akira; Mori, Nobuhiko; Oku, Kosuke; Murakami, Yoshikazu; Nomura, Shohei; Tamaru, Yoshiki; Nagano, Kiyoshi

    2016-01-01

    [Purpose] This study investigated whether it is possible to predict return to home at discharge from a rehabilitation hospital in Japan using the home care score of patients with cerebrovascular or osteoarticular disease and low activities of daily living at admission. [Subjects and Methods] The home care score and functional independent measurement were determined for 226 patients at admission and at discharge from five hospitals, and receiver operating characteristic analyses were conducted. [Results] The home care score cutoff point for the prediction of return to home at admission and at discharge was 11, and the area under the curve was more than 0.8. The area under the curve of the home care score was 0.77 for patients with low activities of daily living and within this group, the probability of return to home was approximately 50%, as predicted by the functional independent measurement. The home care score increased after receiving intervention at a rehabilitation hospital. [Conclusion] The home care score is useful for the prediction of return to home from a rehabilitation hospital, although prediction using the functional independent measurement is difficult for patients with low activities of daily living. Moreover, comprehensive interventions provided by the rehabilitation hospitals improve the ability to provide home care of the patient’s family, which is assessed by the home care score. PMID:27821925

  4. Strategies to recruit difficult-to-reach home health care nurses for research.

    PubMed

    Samia, Linda W; Ellenbecker, Carol Hall

    2011-08-01

    Strategies to access a stratified random sample of New England home health care agencies and nurses are described. The combined strategies resulted in a sample of 123 home health care agencies and 2,459 home healthcare nurses from the six New England states. The results will inform researchers aiming to achieve data representativeness and clinicians critiquing the rigor of evidence.

  5. Americans Needing Home Care, United States. Data from the National Health Survey.

    ERIC Educational Resources Information Center

    Feller, Barbara A.

    1986-01-01

    This report presents information from the Home Care Supplement to the National Health Interview Survey (NHIS) on the types of help needed by adults with chronic health problems who live outside of institutions. Home care items discussed include: (1) assistance in basic physical activities; (2) assistance in home management activities; (3) adults…

  6. 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,…

  7. Connecting Veterans at Risk for Suicide to Care Through the HOME Program.

    PubMed

    Matarazzo, Bridget B; Farro, Samantha A; Billera, Melodi; Forster, Jeri E; Kemp, Janet E; Brenner, Lisa A

    2017-02-02

    The Home-Based Mental Health Evaluation (HOME) program, which engages veterans in care following psychiatric hospitalization, was evaluated. Thirty-four veterans who participated in the HOME program were compared to 34 veterans from a matched archival control group on treatment engagement and implementation outcomes. Veterans who participated in the HOME program were significantly more likely to engage in care, engaged in care more quickly, and attended significantly more individual mental health appointments. Veterans reported high levels of satisfaction. Results suggest that the HOME program is effective at engaging veterans in care during the high-risk period of time following psychiatric hospitalization.

  8. Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes.

    PubMed

    Vivancos, R; Trainor, E; Oyinloye, A; Keenan, A

    2012-10-01

    We assess the effect of key care quality indicators on viral gastroenteritis outbreaks and control in care homes using mandatory inspection data collected by a non-departmental public body. Outbreak occurrence was associated with care home size but not with overall quality or individual environmental standards. Care home size, hygiene and infection control standard scores were inversely associated with attack rate in residents, whereas delayed reporting to the local public health agency was associated with higher attack rates.

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  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.

  15. Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients?

    PubMed

    Ryvicker, Miriam; McDonald, Margaret V; Trachtenberg, Melissa; Peng, Timothy R; Sridharan, Sridevi; Feldman, Penny H

    2013-01-01

    The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting.

  16. Association between pneumonia and oral care in nursing home residents.

    PubMed

    El-Solh, Ali A

    2011-06-01

    Pneumonia remains the leading cause of death in nursing home residents. The accumulation of dental plaque and colonization of oral surfaces and dentures with respiratory pathogens serves as a reservoir for recurrent lower respiratory tract infections. Control of gingivitis and dental plaques has been effective in reducing the rate of pneumonia but the provision of dental care for institutionalized elderly is inadequate, with treatment often sought only when patients experience pain or denture problems. Direct mechanical cleaning is thwarted by the lack of adequate training of nursing staff and residents' uncooperativeness. Chlorhexidine-based interventions are advocated as alternative methods for managing the oral health of frail older people; however, efficacy is yet to be demonstrated in randomized controlled trials. Development and maintenance of an oral hygiene program is a critical step in the prevention of pneumonia. While resources may be limited in long-term-care facilities, incorporating oral care in daily routine practice helps to reduce systemic diseases and to promote overall quality of life in nursing home residents.

  17. Webinar Presentation: Phthalates in our Diet and in our Homes: Personal Care Products

    EPA Pesticide Factsheets

    This presentation, Phthalates in our Diet and in our Homes: Personal Care Products, was given at the NIEHS/EPA Children's Centers 2015 Webinar Series: Phthalates in the Diet and in our Homes held on June 10, 2015.

  18. Noncontingent reinforcement of disruptive behaviors in personal care home settings.

    PubMed

    Yury, Craig A

    2013-06-01

    The purpose of this case study was to examine the potential of using noncontingent reinforcement (NCR) to reduce the frequency of disruptive behaviors of three elderly persons in personal care home (PCH) settings. Assessment indicated that participants were engaging in the disruptive behaviors to obtain social attention from PCH staff. Social attention, up to 1 min of staff making eye contact with the participant and directing positive verbal statements toward the participant, was given on a fixed time interval (from morning through early evening) beginning every 20 min and fading to every 30 min. Results indicate that NCR reduced the frequency of the disruptive behaviors.

  19. 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.

  20. 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

  1. 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.

  2. 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…

  3. 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

  4. 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

    ... 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 Service...-risk afterschool care centers, and adult day care centers; the food service payment rates for meals...

  5. 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...

  6. 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

    ... 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 Service...-risk afterschool care centers, and adult day care centers; the food service payment rates for meals...

  7. 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

  8. Saving our backs: safe patient handling and mobility for home care.

    PubMed

    Beauvais, Audrey; Frost, Lenore

    2014-01-01

    Predicted work-related injuries for nurses and home healthcare workers are on the rise given the many risk factors in the home environment and the escalating demands for home healthcare workers in the United States. Fortunately, safe patient handling and mobility programs can dramatically decrease injuries. Despite strides being made to promote safe patient handling and mobility programs in acute care, more can be done to establish such initiatives in the home care setting.

  9. Sensor network infrastructure for a home care monitoring system.

    PubMed

    Palumbo, Filippo; Ullberg, Jonas; Stimec, Ales; Furfari, Francesco; Karlsson, Lars; Coradeschi, Silvia

    2014-02-25

    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.

  10. 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

  11. Teaching home care electronic documentation skills to undergraduate nursing students.

    PubMed

    Nokes, Kathleen M; Aponte, Judith; Nickitas, Donna M; Mahon, Pamela Y; Rodgers, Betsy; Reyes, Nancy; Chaya, Joan; Dornbaum, Martin

    2012-01-01

    Although there is general consensus that nursing students need knowledge and significant skill to document clinical findings electronically, nursing faculty face many barriers in ensuring that undergraduate students can practice on electronic health record systems (EHRS). External funding supported the development of an educational innovation through a partnership between a home care agency staff and nursing faculty. Modules were developed to teach EHRS skills using a case study of a homebound person requiring wound care and the Medicare-required OASIS documentation system. This article describes the development and implementation of the module for an upper-level baccalaureate nursing program located in New York City. Nursing faculty are being challenged to develop creative and economical solutions to expose nursing students to EHRSs in nonclinical settings.

  12. Providing effective and preferred care closer to home: a realist review of intermediate care.

    PubMed

    Pearson, Mark; Hunt, Harriet; Cooper, Chris; Shepperd, Sasha; Pawson, Ray; Anderson, Rob

    2015-11-01

    Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision-making and care co-ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between

  13. 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…

  14. 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…

  15. 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…

  16. 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…

  17. 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…

  18. 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…

  19. 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…

  20. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers... services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect home health and hospice care providers who do...

  1. 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.

  2. Study on Operation Optimization of Pumping Station's 24 Hours Operation under Influences of Tides and Peak-Valley Electricity Prices

    NASA Astrophysics Data System (ADS)

    Yi, Gong; Jilin, Cheng; Lihua, Zhang; Rentian, Zhang

    2010-06-01

    According to different processes of tides and peak-valley electricity prices, this paper determines the optimal start up time in pumping station's 24 hours operation between the rating state and adjusting blade angle state respectively based on the optimization objective function and optimization model for single-unit pump's 24 hours operation taking JiangDu No.4 Pumping Station for example. In the meantime, this paper proposes the following regularities between optimal start up time of pumping station and the process of tides and peak-valley electricity prices each day within a month: (1) In the rating and adjusting blade angle state, the optimal start up time in pumping station's 24 hours operation which depends on the tide generation at the same day varies with the process of tides. There are mainly two kinds of optimal start up time which include the time at tide generation and 12 hours after it. (2) In the rating state, the optimal start up time on each day in a month exhibits a rule of symmetry from 29 to 28 of next month in the lunar calendar. The time of tide generation usually exists in the period of peak electricity price or the valley one. The higher electricity price corresponds to the higher minimum cost of water pumping at unit, which means that the minimum cost of water pumping at unit depends on the peak-valley electricity price at the time of tide generation on the same day. (3) In the adjusting blade angle state, the minimum cost of water pumping at unit in pumping station's 24 hour operation depends on the process of peak-valley electricity prices. And in the adjusting blade angle state, 4.85%˜5.37% of the minimum cost of water pumping at unit will be saved than that of in the rating state.

  3. 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

  4. Associations Between Family Ratings on Experience With Care and Clinical Quality-of-Care Measures for Nursing Home Residents.

    PubMed

    Li, Yue; Li, Qinghua; Tang, Yi

    2016-02-01

    Several states are currently collecting and publicly reporting nursing home resident and/or family member ratings of experience with care in an attempt to improve person-centered care in nursing homes. Using the 2008 Maryland nursing home family survey reports and other data, this study performed both facility- and resident-level analyses, and estimated the relationships between family ratings of care and several long-term care quality measures (pressure ulcers, overall and potentially avoidable hospitalizations, and mortality) after adjustment for resident characteristics. We found that better family evaluations of overall and specific aspects of care may be associated with reduced rates of risk-adjusted measures at the facility level (range of correlation coefficients: -.01 to -.31). Associations of overall experience ratings tended to persist after further adjustment for common nursing home characteristics such as nurse staffing levels. We conclude that family ratings of nursing home care complement other types of performance measures such as risk-adjusted outcomes.

  5. [Creating a good relationship between hospital and clinic for the support of end-of-life home care patients-usefulness of questionnaires to indicate the capacity of home care-supporting clinics for palliative care].

    PubMed

    Takahashi, Osamu; Kato, Toshihiko; Shimizu, Kazuko; Chiba, Yasuko; Ishiguro, Motoko; Iwadare, Midori

    2012-12-01

    We have been practicing palliative care for terminal cancer patients at outpatient sections, patient wards, by home care, and by visiting nursing stations for the last 4 years. After the establishment of our palliative care unit in June 2011, it became difficult for us to provide sufficient home care support by ourselves, because of the increasing number of the patients and their widespread locations. It is therefore necessary to cooperate with regional medical clinics in order to support the patients who need home care even after their condition deteriorates. To determine the extent to which the home care-supporting clinics perform palliative care, we used an original questionnaire. Twenty-five clinics agreed to the publication of their names as our cooperating clinics. The number of patients who received palliative care at home from home care clinics after visiting our hospital increased from 8% to 14%, and the rate of patients who died at home also increased from 10% to 13%. Information about cooperating with home care clinics is very important and the improvement of palliative care skills necessary for home care doctors to continue their support for End-Of-Life cancer patients. Furthermore, the hospital should offer a strict and timely backup when the condition of patients treated at home suddenly deteriorates.

  6. 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.

  7. Vanilmandelic acid and homovanillic acid levels in patients with neural crest tumor: 24-hour urine collection versus random sample.

    PubMed

    Gregianin, L J; McGill, A C; Pinheiro, C M; Brunetto, A L

    1997-01-01

    Neuroblastoma is the most common solid tumor in childhood and is the most frequent neural crest tumor (NCT). More than 90% of the patients excrete high levels of vanilmandelic acid (VMA) and homovanillic acid (HVA) in the urine. Original biochemical methods for measuring these two metabolites of catecholamines employed a collection of urine for 24 hours to avoid errors related to circadian cycle variations. More recently, attempts have been made to replace the 24-hour collections by random samples (RSs). This has practical advantages particularly for young children. The objective of this study is to assess whether urinary VMA related to urinary creatinine levels can be determined reliably by the method of Pisano et al. from RSs in patients with NCT. The determination of the consumption of VMA in urine stored for prolonged periods of time was also studied. We found a good correlation between the values of metabolites of catecholamines in RSs compared with 24-hour urine collections. There was consumption of VMA in urine samples after storage. We conclude that determination of VMA in RSs of urine by Pisano's method may identify NCT production of catecholamines and that the consumption of these catecholamines is an important factor to consider in the interpretation of values obtained with stored urine specimens.

  8. 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

  9. Characterization of Acinetobacter baumannii from intensive care units and home care patients in Palermo, Italy.

    PubMed

    Mammina, C; Bonura, C; Aleo, A; Calà, C; Caputo, G; Cataldo, M C; Di Benedetto, A; Distefano, S; Fasciana, T; Labisi, M; Sodano, C; Palma, D M; Giammanco, A

    2011-11-01

    In this study 45 isolates of Acinetobacter baumannii identified from patients in intensive care units of three different hospitals and from pressure ulcers in home care patients in Palermo, Italy, during a 3-month period in 2010, were characterized. All isolates were resistant to at least three classes of antibiotics, but susceptible to colistin and tygecycline. Forty isolates were non-susceptible to carbapenems. Eighteen and two isolates, respectively, carried the bla(OXA-23-like) and the bla(OXA-58-like) genes. One strain carried the VIM-4 gene. Six major rep-PCR subtype clusters were defined, including isolates from different hospitals or home care patients. The sequence type/pulsed field gel electrophoresis group ST2/A included 33 isolates, and ST78/B the remaining 12. ST2 clone proved to be predominant, but a frequent involvement of the ST78 clone was evident.

  10. Care of newborn in the community and at home

    PubMed Central

    Neogi, S B; Sharma, J; Chauhan, M; Khanna, R; Chokshi, M; Srivastava, R; Prabhakar, P K; Khera, A; Kumar, R; Zodpey, S; Paul, V K

    2016-01-01

    India has contributed immensely toward generating evidence on two key domains of newborn care: Home Based Newborn Care (HBNC) and community mobilization. In a model developed in Gadchiroli (Maharashtra) in the 1990s, a package of Interventions delivered by community health workers during home visits led to a marked decline in neonatal deaths. On the basis of this experience, the national HBNC program centered around Accredited Social Health Activists (ASHAs) was introduced in 2011, and is now the main community-level program in newborn health. Earlier in 2004, the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program was rolled out with inclusion of home visits by Anganwadi Worker as an integral component. IMNCI has been implemented in 505 districts in 27 states and 4 union territories. A mix of Anganwadi Workers, ASHAs, auxiliary nursing midwives (ANMs) was trained. The rapid roll out of IMNCI program resulted in improving quality of newborn care at the ground field. However, since 2012 the Ministry of Health and Family Welfare decided to limit the IMNCI program to ANMs only and leaving the Anganwadi component to the stewardship of the Integrated Child Development Services. ASHAs, the frontline workers for HBNC, receive four rounds of training using two modules. There are a total of over 900 000 ASHAs per link workers in the country, out of which, only 14% have completed the fourth round of training. The pace of uptake of the HBNC program has been slow. Of the annual rural birth cohort of over 17 million, about 4 million newborns have been visited by ASHA during the financial year 2013–2014 and out of this 120 000 neonates have been identified as sick and referred to health facilities for higher level of neonatal care. Supportive supervision remains a challenge, the role of ANMs in supervision needs more clarity and there are issues surrounding quality of training and the supply of HBNC kits. The program has low visibility in many states

  11. Care coordination in long-term home- and community-based care.

    PubMed

    Johansson, Barbara; Harkey, Jane

    2014-09-01

    This article examines the role of care coordination, when fulfilled by a professional board-certified case manager, in successful long-term home- and community-based care (HCBC). A facet of care coordination, as also discussed, is a robust assessment of the individual by the professional case manager, who devises and implements a comprehensive care plan to address the clinical, psychosocial, and environmental needs of the individual as part of a person-centered, evidenced-based approach. To be successful, long-term HCBC starts with a robust assessment of the individual by a professional board-certified case manager. The case manager uses specific tools that incorporate qualitative measurements to address factors such as medical/clinical needs, (e.g., diagnoses, chronic conditions, and/or health risks); mental/behavioral health (e.g., geriatric depression screening); medication/pharmacology (e.g., review and reconciliation of prescribed and over the counter medications and supplements) and the individual's ability to self-administer; home safety; and presence of a family/support system and their ability and willingness to provide care. Based on these findings, the case manager puts in place a comprehensive care plan, working with a well-coordinated multidisciplinary team, including informal supports, physicians, registered nurses, occupational therapists, pharmacists, social workers, nutritionists, and other allied health professionals. From the beginning, the rigor of care coordination is essential to the how successfully individuals and their families/support systems realize their goal of long-term HCBC.

  12. Residential Care Supply, Nursing Home Licensing, and Case Mix in Four States

    PubMed Central

    Swan, James; Newcomer, Robert

    2000-01-01

    Simulation analyses quantify admission and continuing physical and cognitive impairment patient case-mix changes under two scenarios: with increases in residential care supply and with all nursing homes licensed only as skilled care facilities. Findings raise caution about the assumed interplay between residential care supply and nursing home use. The proportion of nursing home patients with only physical and cognitive impairment likely to be affected by current and emerging long-term care (LTC) policy was well under 25 percent of the nursing home population in each of the four study States. States varied in LTC supply and utilization controls. PMID:11481756

  13. [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.

  14. Association of target organ damage with 24-hour systolic and diastolic blood pressure levels and hypertension subtypes in untreated Chinese.

    PubMed

    Wei, Fang-Fei; Li, Yan; Zhang, Lu; Xu, Ting-Yan; Ding, Feng-Hua; Staessen, Jan A; Wang, Ji-Guang

    2014-02-01

    The association of target organ damage with 24-hour systolic and diastolic blood pressure levels and ambulatory hypertension subtypes has not yet been examined in untreated Chinese patients. We measured left ventricular mass index by echocardiography (n=619), the urinary albumin:creatinine ratio (n=1047), and aortic pulse wave velocity by tonometry (n=1013) in 1047 untreated subjects (mean age, 50.6 years; 48.9% women). Normotension was a 24-hour systolic/diastolic blood pressure <130/<80 mm Hg. Hypertension subtypes were isolated diastolic hypertension and mixed systolic plus diastolic hypertension. We assessed associations of interest by multivariable-adjusted linear models. Using normotension as reference, mixed hypertension was associated with higher (P≤0.003) left ventricular mass index (+4.31 g/m(2)), urinary albumin:creatinine ratio (+1.63 mg/mmol), and pulse wave velocity (+0.76 m/s); and isolated diastolic hypertension was associated with similar left ventricular mass index and pulse wave velocity (P≥0.39), but higher urinary albumin:creatinine ratio (+1.24 mg/mmol; P=0.002). In younger participants (<55 years), the mutually independent effect sizes associated with 1 SD increases in 24-hour systolic/diastolic blood pressure were +3.31/-0.36 g/m(2) (P=0.009/0.79) for left ventricular mass index, +1.15/+1.14 mg/mmol (P=0.02/0.04) for the urinary albumin:creatinine ratio, and +0.54/-0.05 m/s (P<0.001/0.54) for pulse wave velocity. In older participants, these estimates were +3.58/+0.30 g/m(2) (P=0.045/0.88), +1.23/+1.05 mg/mmol (P=0.002/0.54), and +0.76/-0.49 m/s (P<0.001/<0.001), respectively. In conclusion, 24-hour systolic blood pressure and mixed hypertension are major determinants of target organ damage irrespective of age and target organ, whereas 24-hour diastolic blood pressure and isolated diastolic hypertension only relate to the urinary albumin:creatinine ratio below middle age.

  15. 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

  16. 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.

  17. 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…

  18. 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

  19. 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

  20. 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

  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. Stability, precision, and near-24-hour period of the human circadian pacemaker

    NASA Technical Reports Server (NTRS)

    Czeisler, C. A.; Duffy, J. F.; Shanahan, T. L.; Brown, E. N.; Mitchell, J. F.; Rimmer, D. W.; Ronda, J. M.; Silva, E. J.; Allan, J. S.; Emens, J. S.; Dijk, D. J.; Kronauer, R. E.

    1999-01-01

    Regulation of circadian period in humans was thought to differ from that of other species, with the period of the activity rhythm reported to range from 13 to 65 hours (median 25.2 hours) and the period of the body temperature rhythm reported to average 25 hours in adulthood, and to shorten with age. However, those observations were based on studies of humans exposed to light levels sufficient to confound circadian period estimation. Precise estimation of the periods of the endogenous circadian rhythms of melatonin, core body temperature, and cortisol in healthy young and older individuals living in carefully controlled lighting conditions has now revealed that the intrinsic period of the human circadian pacemaker averages 24.18 hours in both age groups, with a tight distribution consistent with other species. These findings have important implications for understanding the pathophysiology of disrupted sleep in older people.

  3. 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.

  4. 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…

  5. A warning detector for urinary incontinence for home health care.

    PubMed

    Tamura, T; Nakajima, K; Matsushita, T; Fujimoto, T; Shimooki, S; Nakano, T

    1995-01-01

    A telemetry system for monitoring urinary incontinence has been developed using two principles, temperature and impedance changes of a diaper. The system is composed of a pair of sensors, a transmitter, and a receiver. Temperature changes are monitored using thermistors, one in the center of the diaper and the other attached to the abdomen, and the temperature differences between them after urinary incontinence is detected. For the impedance method, two electroconductive cloths as electrodes placed in the diaper are used as sensors. Urine acts as a conductor to produce a current between the sensors. Clinical evaluation showed that both methods operate well; 13 of 17 incontinence episodes were detected using the temperature method and 32 of 35 with the impedance method. The misdetections were caused by faulty sensor arrangement for temperature measurement and by detection of exudates by the conductive sensors. These monitors may be used for the care of elderly people who use diapers for home health care, to save care time and help maintain hygiene.

  6. Registered Nurse Staffing Mix and Quality of Care in Nursing Homes: A Longitudinal Analysis

    ERIC Educational Resources Information Center

    Kim, Hongsoo; Harrington, Charlene; Greene, William H.

    2009-01-01

    Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…

  7. Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions.

    PubMed

    Garcia, Theresa J; Harrison, Tracie C; Goodwin, James S

    2016-04-01

    Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged.

  8. 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 ...

  9. Michigan: Healthy Homes-Healthy Business Project (A Former EPA CARE Project)

    EPA Pesticide Factsheets

    The Healthy Homes-Healthy Business project is a recipient of a Level II CARE cooperative agreement. The communities of focus for this CARE level II project are the adjacent neighborhoods of Southwest Detroit and South Dearborn.

  10. Testing the bed-blocking hypothesis: does nursing and care home supply reduce delayed hospital discharges?

    PubMed

    Gaughan, James; Gravelle, Hugh; Siciliani, Luigi

    2015-03-01

    Hospital bed-blocking occurs when hospital patients are ready to be discharged to a nursing home, but no place is available, so that hospital care acts as a more costly substitute for long-term care. We investigate the extent to which greater supply of nursing home beds or lower prices can reduce hospital bed-blocking using a new Local Authority (LA) level administrative data from England on hospital delayed discharges in 2009-2013. The results suggest that delayed discharges respond to the availability of care home beds, but the effect is modest: an increase in care home beds by 10% (250 additional beds per LA) would reduce social care delayed discharges by about 6-9%. We also find strong evidence of spillover effects across LAs: more care home beds or fewer patients aged over 65 years in nearby LAs are associated with fewer delayed discharges.

  11. Practice paper of the American Dietetic Association: Home care--opportunities for food and nutrition professionals.

    PubMed

    Fuhrman, M Patricia; Galvin, Theresa A; Ireton-Jones, Carol S; Thorpe, Jennifer

    2009-06-01

    Home care continues to expand. With this growth are opportunities for registered dietitians (RDs) to demonstrate the vital role that they play not only in providing optimal nutrition care, but also in contributing to each patient's quality of life. Home care nutrition services range from individual patient counseling to managing and monitoring parenteral nutrition. RDs' knowledge of nutrition, reimbursement, and new technologies position them to improve care and control costs. Current roles and responsibilities along with emerging areas of professional growth give RDs a multitude of options to provide and expand their services and value in home care.

  12. In search of financial viability: hospital-based v. freestanding home care.

    PubMed

    Laff, Pat; Steding, Pam

    2005-03-01

    In the continually changing and perpetually unpredictable nature of Medicare and Medicaid reimbursement, many hospitals and health care systems are rethinking their relationships with their affiliated home care and hospice programs. As the books of many of these programs show an increasing amount of red ink, many hospitals are spinning off their home care and hospice services into independent entities with their own individual operating structures. This article provides insight into one health care system's transitioning of its home care services into a freestanding entity.

  13. Successful in vitro antigen-dependent activation of 24-hour-old peripheral blood lymphocytes.

    PubMed

    Owen, J A; Muirhead, K; Jensen, C; Jonak, Z L

    1996-03-28

    We describe a simple, rapid and reproducible in vitro culture system in which human peripheral blood lymphocytes (PBLs), donated 24 h prior to initiation of culture can be stimulated to produce antigen-specific antibodies. Peripheral blood lymphocytes purified by Ficoll-Hypaque centrifugation were passed over a G10 Sephadex column and then activated in vitro in the presence of 0.003% staphylococcus Cowan A, 2.8 x 10(-6) M indomethacin and appropriate concentrations of tetanus toxoid antigen. After the first 24 h in culture, a five-fold concentrated supernatant from an allogeneic mixed lymphocyte culture was added. The cell surface phenotypes of the PBLs were analyzed by flow cytometry at the initiation and termination of culture, in order to provide a comprehensive characterization of the cellular composition of a successful in vitro stimulation system. Our results clearly show that the majority of peripheral blood B cells can be induced to an activated stage (blast transformation) and interleukin 2 (IL-2) receptor expression, following very simple manipulations of the lymphoid population. Tetanus toxoid-specific antibody production can be readily generated in this cell population. In contrast, T cells were not activated to express IL-2 receptors and reach blast transformation, and did not show appreciable proliferation. Our system provides a population of B cells producing antibodies of desired specificity which could be utilized for the generation of human hybridomas or could serve as a donor population for antibody engineering via the combinatorial library approach. Careful light scattering and cell surface phenotypic analyses of the cells entering, proliferating and differentiating in these cultures enabled several novel observations to be made.

  14. [Promotion of home shifts for terminal cancer patients through intervention of visitor palliative care team].

    PubMed

    Shiraishi, Ko; Chigira, Mayumi; Tsuyuki, Naoko; Hozaki, Kyoko; Murotsu, Keizo; Umeki, Mikiko; Harada, Naohiro; Hirata, Satomi; Otsuka, Yuko; Hara, Hiroko

    2013-12-01

    It has been recommended that terminal cancer patients be shifted from the hospital to their homes. In our hospital, a visitor palliative care team was started for the purpose of the early introduction of palliative care, and home shifts were promoted. The results of home shifts by the visitor palliative care team from 2008 to 2012 were examined. Home shifts were possible for 27 cases out of 108 cases intervened. In 12 cases, there were at-home deaths, and the median at-home period was 55 days. In the group that could not be shifted, the at-home death rate and application rate of nursing care insurance were low. Additionally, the length of stay (median) for patients who died in hospitalization was 8 days for the group that could be shifted and 17 days for the group that could not be shifted. It was felt that effective communication with local health care facilities is important for a successful home shift. Early and adequate preparations for the treatment and care of terminal cancer patients undergoing home shift are important, and in this regard, a review of the current provisions of nursing care insurance is necessary.

  15. Effects of Fibrinogen Concentrate on Thrombin Generation, Thromboelastometry Parameters, and Laboratory Coagulation Testing in a 24-Hour Porcine Trauma Model

    PubMed Central

    Zentai, Christian; Solomon, Cristina; van der Meijden, Paola E. J.; Spronk, Henri M. H.; Schnabel, Jonas; Rossaint, Rolf

    2015-01-01

    Introduction: In a 24-hour porcine model of liver injury, we showed that fibrinogen supplementation does not downregulate endogenous fibrinogen synthesis. Here we report data from the same study showing the impact of fibrinogen on coagulation variables. Materials and Methods: Coagulopathy was induced in 20 German land race pigs by hemodilution and blunt liver injury. Animals randomly received fibrinogen concentrate (100 mg/kg) or saline. Coagulation parameters were assessed and thromboelastometry (ROTEM) was performed. Results: Fibrinogen concentrate significantly reduced the prolongations of EXTEM clotting time, EXTEM clot formation time, and prothrombin time induced by hemodilution and liver injury. A decrease in clot strength was also ameliorated. Endogenous thrombin potential was significantly higher in the fibrinogen group than in the control group, 20 minutes (353 ± 24 vs 289 ± 22 nmol/L·min; P < .05) and 100 minutes (315 ± 40 vs 263 ± 38 nmol/L·min; P < .05) after the start of infusion. However, no significant between-group differences were seen in other thrombin generation parameters or in d-dimer or thrombin–antithrombin levels. Fibrinogen–platelet binding was reduced following liver injury, with no significant differences between groups. No significant between-group differences were observed in any parameter at ∼12 and ∼24 hours. Conclusion: This study suggests that, in trauma, fibrinogen supplementation may shorten some measurements of the speed of coagulation initiation and produce a short-lived increase in endogenous thrombin potential, potentially through increased clotting substrate availability. Approximately 12 and 24 hours after starting fibrinogen concentrate/saline infusion, all parameters measured in this study were comparable in the 2 study groups. PMID:25948634

  16. Extent and Determinants of Thermogenic Responses to 24 Hours of Fasting, Energy Balance, and Five Different Overfeeding Diets in Humans

    PubMed Central

    Pannacciulli, Nicola; Bonfiglio, Susan; Pacak, Karel; Krakoff, Jonathan

    2013-01-01

    Context: Individual variation in the ability to convert excess calories to heat and the effects of dietary macronutrient composition are unclear. Objective: Stability and determinants of the energy expenditure (EE) response to overconsumption were assessed. Design, Setting, and Participants: Twenty subjects (75% male) with normal glucose regulation were evaluated during 24 hours each of energy balance, fasting, and 5 different diets with 200% energy requirements in a clinical research unit. Interventions: Five 1-day overfeeding diets were given in random order: high carbohydrate (75%) and low protein (3%); high carbohydrate and normal protein (20%); high fat (46%) and low protein; high fat (60%) and normal protein; and balanced (50% carbohydrates, 20% protein). Main Outcome Measures: The 24-hour EE, sleeping EE, and thermic effect of food (TEF) during each diet were measured with a metabolic chamber. Appetitive hormones were measured before and after the diets. Results: The EE response to overfeeding exhibited good intraindividual reproducibility. Similar increases above eucaloric feeding in 24-hour EE (mean 10.7 ± 5.7%, P < .001; range 2.9–18.8%) and sleeping EE (14.4 ± 11.3%, P < .001; range 1.0–45.1%) occurred when overfeeding diets containing 20% protein, despite differences in fat and carbohydrate content, but the EE response during overfeeding diets containing 3% protein was attenuated. The percent body fat negatively correlated with TEF during normal protein overfeeding (r = −0.53, P < .01). Fasting peptide YY negatively correlated with TEF (r = −0.56, P < .01) and the increase in sleeping EE (r = −0.54, P < .01) during overfeeding. Conclusions: There is an intrinsic EE response to overfeeding that negatively associates with adiposity, although it represents a small percentage of consumed calories. PMID:23666976

  17. A disease management program for heart failure: collaboration between a home care agency and a care management organization.

    PubMed

    Gorski, Lisa A; Johnson, Kathy

    2003-01-01

    This article describes a collaborative approach to manage patients with heart failure between a home care agency and a care management agency. The resulting disease management program used a combination of home visits and phone contact. Care management plans emphasized patient education on increasing adherence to medical and diet regimens, and recognizing early symptoms of exacerbation that could lead to rehospitalization. Clinician activities and patient outcomes are described.

  18. Aldosterone-to-Renin Ratio Is Associated With Reduced 24-Hour Heart Rate Variability and QTc Prolongation in Hypertensive Patients.

    PubMed

    Grübler, Martin R; Kienreich, Katharina; Gaksch, Martin; Verheyen, Nicolas; Hartaigh, Bríain Ó; Fahrleitner-Pammer, Astrid; März, Winfried; Schmid, Johannes; Oberreither, Eva-Maria; Wetzel, Julia; Catena, Cristiana; Sechi, Leonardo A; Pieske, Burkert; Tomaschitz, Andreas; Pilz, Stefan

    2016-02-01

    Aldosterone is considered to exert direct effects on the myocardium and the sympathetic nervous system. Both QT time and heart rate (HR) variability (HRV) are considered to be markers of arrhythmic risk and autonomous dysregulation. In this study, we investigated the associations between aldosterone, QT time, and HRV in patients with arterial hypertension.We recruited 477 hypertensive patients (age: 60.2 ± 10.2 years; 52.3% females) with a mean systolic/diastolic 24-hour ambulatory blood pressure monitoring (ABPM) value of 128 ± 12.8/77.1 ± 9.2 mmHg and with a median of 2 (IQR: 1-3) antihypertensive agents. Patients were recruited from the outpatient clinic at the Department of Internal Medicine of the Medical University of Graz, Austria. Blood samples, 24-hour HRV derived from 24-hour blood pressure monitoring (ABPM) and ECG's were obtained. Plasma aldosterone and plasma renin concentrations were measured by means of a radioimmunoassay. Twenty-four-hour urine specimens were collected in parallel with ABPM.Mean QTc was 423.3 ± 42.0 milliseconds for males and 434.7 ± 38.3 milliseconds for females. Mean 24H-HR and 24H-HRV was 71.9 ± 9.8 and 10.0 ± 3.6 bpm, respectively. In linear regression analyses adjusted for age, sex, body mass index, ABPM, and current medication, aldosterone to active renin ratio (AARR) was significantly associated with the QTc interval, a marker for cardiac repolarization abnormalities (mean = 426 ± 42.4 milliseconds; β-coefficient = 0.121; P = 0.03) as well as with the 24-hour heart rate variability a surrogate for autonomic dysfunction (median = 9.67 [IQR = 7.38-12.22 bpm]; β-coefficient = -0.133; P = 0.01).In hypertensive patients, AARR is significantly related to QTc prolongation as well as HRV. Further studies investigating the effects of mineralocorticoid receptor blocker and aldosterone synthase inhibitors on QTc and HRV are warranted.

  19. The transition of care from hospital to home for patients with hypertension.

    PubMed

    Franklin, Mary M; McCoy, Mary Anne

    2017-02-12

    Approximately 50% to 75% of hospital patients have hypertension. At the time of discharge, patients experience a transition of care as they move from the hospital to home. This article describes the transition of care from the hospital to home for patients with hypertension and discusses practice implications for NPs.

  20. Embodied Germ Cell at Work: Building an Expansive Concept of Physical Mobility in Home Care

    ERIC Educational Resources Information Center

    Engestrom, Yrjo; Nummijoki, Jaana; Sannino, Annalisa

    2012-01-01

    This article presents a process of collective formation of a new concept of mobility between home care workers and their elderly clients, who are at risk of losing physical mobility and functional capacity. A new tool called mobility agreement was introduced to facilitate the inclusion of regular mobility exercises in home care visits and in the…

  1. Services Avaliable for Nursing Care of the Sick at Home. Public Health Service Publication, No. 1265.

    ERIC Educational Resources Information Center

    1966

    The survey of agencies providing home care conducted on January 1, 1966 by the Division of Nursing showed that almost 70 percent of the population of the United States and essentially all of the population in the territories lived in areas where some type of organized home care nursing services was available. Since 1959, the number of large cities…

  2. Frameworks for Understanding Challenging Behaviour in Out-of-Home Care

    ERIC Educational Resources Information Center

    McLean, Sara; Kettler, Lisa; Delfabbro, Paul; Riggs, Damien

    2012-01-01

    Background: Challenging and disruptive behaviour is commonly reported among children placed in the out-of-home care sector. Little is known about how stakeholders in this sector understand or manage challenging behaviour. Method: Ninety-two stakeholders in the South Australian out-of-home care sector were interviewed about their approach to…

  3. Creating a Child Care Center in a Nursing Home and Implementing an Intergenerational Program.

    ERIC Educational Resources Information Center

    Foster, Karen B.

    The success of the Champaign County Nursing Home Child Care Center (CCNHCCC) in Illinois provides a model for the establishment of child care centers in nursing homes. Needs assessment, financial support, licensing, staff hiring and training are all important factors that need to addressed in the start up and running of such a program. The…

  4. Randomized Controlled Trial of Problem-Solving Therapy for Minor Depression in Home Care

    ERIC Educational Resources Information Center

    Gellis, Zvi D.; McGinty, Jean; Tierney, Lynda; Jordan, Cindy; Burton, Jean; Misener, Elizabeth

    2008-01-01

    Objective: Data are presented from a pilot research program initiated to develop, refine, and test the outcomes of problem-solving therapy that targets the needs of older adults with minor depression in home care settings. Method: A pilot randomized clinical trial compares the impact of problem-solving therapy for home care to treatment as usual…

  5. International Collaboration for Home Care Education, Part I: Creating the Partnership.

    ERIC Educational Resources Information Center

    Lee, HaeOk; And Others

    1997-01-01

    The Case Western Reserve University School of Nursing collaborated with Yonsei University College of Nursing in Korea in a three-week summer home care nursing program for Korean nurses. Participants gained clinical experience in U.S. home-care nursing. (SK)

  6. [Home support for a child receiving palliative care provided by a self-employed nurse].

    PubMed

    Diamantidis-Zinchiri, Catherine

    2011-01-01

    Complex and demanding, paediatric palliative care at home is beginning to develop. How can a self-employed nurse, by definition isolated, care for a child approaching the end of life and his/her family at home? What resources and tools does the nurse have to provide this support?

  7. Effects of Home Care on the Quality of Circumstances of the Elderly.

    ERIC Educational Resources Information Center

    Caro, Francis G.; Blank, Arthur E.

    Home care has not consistently proven to prevent institutionalization, reduce mortality rates, reduce hospital use, or improve functional status and morale; and indeed, these objectives may be unreasonable. Rather, the purpose of home care should be to meet immediate needs of recipients which they can no longer meet themselves. Publicly-funded…

  8. The Automated Self-Administered 24-Hour Dietary Recall for Children, 2012 version, for youth aged 9 to 11 Years: A validation study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Our objective was to validate the 2012 version of the Automated Self-Administered 24-Hour Dietary Recall for Children (ASA24-Kids-2012), a self-administered web-based 24-hour dietary recall (24hDR) instrument, among children aged 9 to 11 years, in two sites using a quasiexperimental design. In one s...

  9. Trials and tribulations: a small pilot telehealth home care program for medicare patients.

    PubMed

    Walsh, Maureen; Coleman, John R

    2005-01-01

    This article describes a home care agency's experience initiating the technology of a telehealth program for a selected view of its home care patients. The goal of the telehealth program was to improve patient outcomes by augmenting patients' regularly scheduled in-home skilled nursing visits with video-conferencing encounters. Patient selection, costs, projected savings, patient satisfaction, and the technical, clinical, and patient problems with the telehealth system are discussed.

  10. Patterns of maltreatment and diagnosis across levels of care in group homes.

    PubMed

    Pane Seifert, Heather T; Farmer, Elizabeth M Z; Wagner, H Ryan; Maultsby, Linda T; Burns, Barbara J

    2015-04-01

    Patterns of Axis I psychiatric diagnosis and maltreatment history were explored among youth in group homes, including match of clinical need to level or restrictiveness of care. Data on demographics, diagnoses, maltreatment, and group home level of care (Level I, II, or III homes, representing lower to higher intensity of supervision and treatment) were obtained from 523 youth who participated in a quasi-experimental study of group homes. Three quarters of youth had a diagnosis and two-thirds of youth had a maltreatment history. Youth in higher level homes had more diagnoses and higher rates of all disorders except adjustment disorders. Youth in Level I homes had a history of more maltreatment types, particularly high rates of neglect. Sexual abuse, physical abuse, and emotional abuse were most common among youth in higher level homes. Regardless of diagnosis history, comparable proportions of youth had a maltreatment history, and similar patterns were found across levels of care. Together, findings indicate that group homes with varying degrees of restrictiveness serve youth with different psychiatric diagnosis and maltreatment histories. Youth triaged to higher level homes had more diagnoses, while youth placed in the least restrictive homes had a history of more maltreatment subtypes. Further, distinct patterns of diagnosis types and maltreatment subtypes were seen across homes. Implications include the importance of assessing unique clinical needs of youth to promote an appropriate match to level of care and treatment plan.

  11. Filipino Health Care Aides and the Nursing Home Labour Market in Winnipeg.

    PubMed

    Novek, Sheila

    2013-12-01

    Canada’s nursing homes have become increasingly dependent on immigrant health care aides. More than any other ethnic group, Filipino women are over-represented among health care aides in the Canadian health care system. This qualitative study explored the employment experiences of Filipino health care aides in nursing homes from their own perspectives as well as those of policy stakeholders. Fourteen in-depth interviews were conducted with Filipino health care aides and long-term-care policy stakeholders in Winnipeg, Manitoba. The results indicated that migrant social networks act as pathways linking immigrant women with employment opportunities in nursing homes. The composition of the labour force is also shaped by management strategies and labour market accommodations that respond to, and reinforce, these social networks. These findings have implications for workforce planning and the quality of care provision in nursing homes.

  12. Second-hand smoke exposure: responses from home care and therapeutic group home nurses: a call to action.

    PubMed

    L'Heureux, Juliana

    2009-02-01

    Home care visiting nurses and those working in a therapeutic group home expressed concerns about their inadvertent exposure to secondhand smoke when caring for patients who live where cigarettes or tobacco products are used. The American Lung Association Fact Sheet on Secondhand Smoke Exposure cites the Environmental Protection Agency (EPA) classification of secondhand smoke as a cause of human cancer. Secondhand smoke causes approximately 3,400 lung cancer deaths and 22,700 to 69,600 heart disease deaths among adult nonsmokers in the United States each year (American Lung Association, 2009). For this study, home care nurses and those working in a therapeutic group home for the mentally ill in Augusta, Maine, were interviewed. This report describes their exposure and how secondhand smoke can be eliminated with minimal disruption to patient care. The interviewed nurses discussed the repeated exposures they experienced while caring for multiple smoking patients in residences that included apartment buildings and group homes and while transporting patients with private automobiles in which the use of cigarettes, cigarillos, cigars, pipes, and tobacco products can be common. Concerns about secondhand smoke exposures frequently focused on the unpleasant smoke odor retained on clothes and nursing equipment when people smoke during a patient visit. Protective actions also were reported. Strategies for action are discussed.

  13. Same agency, different teams: perspectives from home and inpatient hospice care.

    PubMed

    Lysaght Hurley, Susan; Barg, Frances K; Strumpf, Neville; Ersek, Mary

    2015-07-01

    Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States.

  14. Questionnaire survey on current status of home care and support for patients with hematological diseases.

    PubMed

    Adachi, Akiko; Tsukada, Yuiko; Kondo, Sakiko; Asakura, Keiko; Matsuki, Eri; Kawagoe, Shohei; Hashiguchi, Saori; Nonaka, Hiroshi; Takeda, Junzo; Okamoto, Shinichiro

    2014-11-01

    In order to survey the current status of home care and support for patients with hematological diseases, questionnaires were sent to 3,591 hospitals and home care facilities in Tokyo and surrounding prefectures. The first survey showed that 81.7% of medical staff members at hospitals reported that they had experience with home care and support, but only 24.9% of home care facility staff members had such experience. The second questionnaire, surveying 1,202 personnel, identified four factors hampering successful establishment of home care and support networks for hematological diseases. These included insufficient familial support for patients, difficulty making end of life decisions by family members and patients, limited access to transfusion support, and financial problems.

  15. Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System

    PubMed Central

    Armstrong, Joshua J.; Sims-Gould, Joanie

    2016-01-01

    Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial. PMID:27904234

  16. Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System.

    PubMed

    Armstrong, Joshua J; Sims-Gould, Joanie; Stolee, Paul

    2016-01-01

    Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial.

  17. Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health

    PubMed Central

    Lindley, Lisa C.; Mixer, Sandra J.; Mack, Jennifer W.

    2016-01-01

    Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs. PMID:27383451

  18. Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health.

    PubMed

    Lindley, Lisa C; Mixer, Sandra J; Mack, Jennifer W

    2016-01-01

    Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.

  19. Determination of and correlation between urine protein excretion and urine protein-to-creatinine ratio values during a 24-hour period in healthy horses and ponies.

    PubMed

    Uberti, Benjamin; Eberle, D Bernard; Pressler, Barrak M; Moore, George E; Sojka, Janice E

    2009-12-01

    OBJECTIVE-To determine whether urine protein-to-creatinine (UP:C) ratio assessment provides an estimate of urine protein excretion (UPE) over a 24-hour period in horses and ponies, establish a preliminary UP:C ratio reference range, and determine UP:C ratio variation over time in healthy equids. ANIMALS-11 female horses and 6 female ponies. PROCEDURES-Urine was collected from all equids at 4-hour intervals for 24 hours. Total 24-hour UPE (mg of protein/kg of body weight) and UP:C ratio were determined; these variables were also assessed in aliquots of urine collected at 4-hour intervals. On 2 additional days, urine samples were also obtained from 6 horses (1 sample/horse/d) to determine day-to-day variation in UP:C ratio. Correlation between 4-hour or 24-hour UPE and UP:C ratio values was assessed. Reference ranges for 24-hour UPE, 24-hour UP:C ratio, and 4-hour UP:C ratios were calculated as central 95th percentiles of observed values. RESULTS-Mean 24-hour UPE (4.28 +/- 2.99 mg/kg) and 24-hour UP:C ratio (0.0 to 0.37) had excellent correlation (R = 0.826; P < 0.001) in both horses and ponies; analysis of 4-hour data also revealed good correlation (R = 0.782; P < 0.001) with these variables. Calculated UPE and UP:C ratio reference ranges were similar to established ranges in other species. Day-to-day variability in UP:C ratio was minimal, and all results were within the reference range calculated by use of the 24-hour urine samples. CONCLUSIONS AND CLINICAL RELEVANCE-Assessment of the UP:C ratio appears to be a reliable method for estimating 24-hour UPE in horses and ponies.

  20. Enhanced carotid-cardiac baroreflex response and elimination of orthostatic hypotension 24 hours after acute exercise in paraplegics

    NASA Technical Reports Server (NTRS)

    Engelke, K. A.; Shea, J. D.; Doerr, D. F.; Convertino, V. A.

    1992-01-01

    To test the hypothesis that an acute bout of maximal exercise can ameliorate orthostatic hypotension consequent to prolonged wheelchair confinement, we evaluated heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure responses during 15 minutes of 70 degrees head-up tilt (HUT) in 10 paraplegic subjects 24 hours after arm crank exercise designed to elicit maximal effort, and during a control (no exercise) conditions. Additionally, the carotid baroreceptor stimulus-cardiac response relationship was determined by measurement of R-R interval during external application of graded pressures to the carotid sinuses. One week separated the treatment conditions. The maximum slope of the carotid-cardiac baroreflex response was increased (p = 0.049) by exercise (6.2 +/- 1.7 msec/mmHg) compared to control (3.3 +/- 0.6). During control HUT, HR increased from 61 +/- 1 to 90 +/- 7 bpm (p = 0.001) while SBP decreased from 118 +/- 5 to 106 +/- 9 mmHg (p = 0.025). During HUT 24 hours after exercise, HR increased from 60 +/- 2 to 90 +/- 4 bpm (p = 0.001), but the reduction in SBP was essentially eliminated (116 +/- 5 to 113 +/- 5 mmHg).

  1. Family Day Care as Observed in Licensed Homes in Montgomery County, Maryland.

    ERIC Educational Resources Information Center

    Allen, Rebecca Blundell

    A questionnaire was administered to 19 licensed day-care mothers in Montgomery County, Maryland. This report presents what was found in observations of the family day care homes, and points out the relative merits and disadvantages of family day care and group day care. The sections of the report are: I. Introduction; II. The Needs of Children;…

  2. Client expectations and satisfaction of quality in home care services. A consumer perspective.

    PubMed

    Samuelsson, G; Wister, A

    2000-12-01

    This study examines clients' expectations of quality in home care services and their perceived satisfaction with services among a random sample of 76 home care recipients in Vancouver, Canada. The researchers conducted face-to-face interviews that applied Multiattribute Utility Technology, a procedure that organizes several quality attributes of "ideal" home care into a tree structure to compare their relative importance and ranking from the clients' perspective. Participants also were asked to state their satisfaction or dissatisfaction with the services received in these domains. Among the five main quality attributes identified, the subjects ranked suitability of the home helper and its subset, personal competence, as the most important indicators of quality, followed by continuity in service. In addition, clients tended to have a high level of satisfaction with regard to the attributes of overall home care services. The highest level of satisfaction was reported for elements of personal dispositions of home care staff. The lowest level of satisfaction involved the time/availability components of the service. Finally, comparisons between client expectations and satisfaction of received home care services showed the highest discrepancy for the attributes of influence and time/availability and the greatest congruence for personal attributes of the staff. The results are discussed in terms of their implications for the delivery of home care services.

  3. Practice improvement as a result of an end of life care programme for care homes.

    PubMed

    Springett, Angela

    2017-03-31

    This article explores practice outcomes from a Six Steps+ programme for end of life care (EoLC) delivered in care homes in the south of England. The education programme aims to increase staff's knowledge, skills and confidence to counter-balance their anxiety about EoLC. The Six Steps+ programme promotes a culture of high quality, compassionate, person-centred and dignified holistic care to meet the needs of residents who may have increasing complex requirements throughout their last year or more of life. Through integrated working and a reduction in avoidable hospital admissions, residents are enabled to die in their place of choice where possible. Case studies show that participating in the Six Steps+ programme increases care home staff's knowledge, skills and confidence and enhances the quality of EoLC for residents. With the cost of the education and support required essentially covered by six avoided hospital admissions throughout the one-year course, the Six Steps+ programme is an attractive and cost-effective approach to improving EoLC.

  4. Old-age homes and services: old and new approaches to aged care.

    PubMed

    Liebig, Phoebe S

    2003-01-01

    Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve nonaged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.

  5. 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... currently approved collection. Abstract: VA pays per diem to State homes providing nursing home and adult day health services care to Veterans. VA requires facilities providing nursing home and adult...

  6. 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

    ... 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 Correction In notice document 2011... page 43255, the table labeled ``Administrative Reimbursement Rates for Sponsoring Organizations of...

  7. Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents

    ERIC Educational Resources Information Center

    Kane, Robert L.; Flood, Shannon; Bershadsky, Boris; Keckhafer, Gail

    2004-01-01

    Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will…

  8. A Comparison of Helping, Sharing, Comforting, Honesty, and Civic Awareness for Home Care, Day Care, and Preschool Children.

    ERIC Educational Resources Information Center

    Austin, Ann M. Berghout; And Others

    In a study designed to determine whether experience in day care or preschool affects children's knowledge and enactment of prosocial behaviors, 59 children in day care, preschool, and home care were pre- and post-tested concerning: (1) their understanding of helping, sharing, comforting, honesty, and civic awareness; (2) their definitions of…

  9. Urine 24-hour volume

    MedlinePlus

    ... in a day, such as: Creatinine Sodium Potassium Nitrogen Protein This test may also be done if ... disease Potassium urine test Sodium urine test Urea nitrogen urine test Urination - excessive amount Urine output - decreased ...

  10. 24-hour urine protein

    MedlinePlus

    ... your doctor may be able to order a test that is done on just one urine sample (protein-to-creatinine ratio). Normal Results The normal value is less than 100 milligrams per day or less than 10 milligrams per deciliter ... of these tests. Normal value ranges may vary slightly among different ...

  11. [Medical care support intervention to the patient and family who has chosen a terminal care at home - an influence of satisfactory experience on the culture of terminal care].

    PubMed

    Sugimoto, Kaoru; Ishikawa, Mariko; Kouketsu, Nobuko; Ozaki, Mitsuyo; Tomita, Ikue; Hong, Youngjae; Miura, Hisayuki; Nishikawa, Mitsunori; Yokoe, Yuriko; Nakashima, Kazumitsu

    2010-12-01

    The National Center for Geriatrics and Gerontology in Japan implemented a home medical care support system for aged patients in April 2009. In this study, we report a case of terminal care system where a medical care intervention was carried out by a close coordination of visiting nurses and other staffs with a "at-home terminal care" brochure on hand, and we discussed how this system was brought forward satisfactory and how it affected this culture.

  12. Creating positive experiences for people living with dementia in care homes.

    PubMed

    Callaghan, Margaret; Ritchie, Louise

    2017-01-31

    The global incidence of dementia is set to increase. It is estimated that two thirds of people with dementia live in care homes. To ensure good care experiences for these people, it is essential that the factors which create positive care home environments are understood. This article presents findings from a literature review of factors influencing care home experiences for people with dementia. The main findings were that organisational culture and workforce development are important factors in creating positive care home experiences for people with dementia. Although the evidence is limited, a person-centred approach based on research evidence is essential if the workforce is to gain the necessary knowledge and skills to provide positive experiences of care for residents with dementia.

  13. Does investor-ownership of nursing homes compromise the quality of care?

    PubMed

    Harrington, Charlene; Woolhandler, Steffie; Mullan, Joseph; Carrillo, Helen; Himmelstein, David U

    2002-01-01

    Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

  14. The redefinition of the familialist home care model in France: the complex formalization of care through cash payment.

    PubMed

    Le Bihan, Blanche

    2012-05-01

    This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities.

  15. [Organization of the health system from the perspective of home care professionals].

    PubMed

    Andrade, Angélica Mônica; Brito, Maria José Menezes; Silva, Kênia Lara; Montenegro, Lívia Cozer; Caçador, Beatriz Santana; Freitas, Letícia Fernanda de Cota

    2013-06-01

    The aim of this qualitative case study is to analyze how the health system is organized from the perspective of homecare professionals. Data was collected by means of semi-structured interviews with seven professionals that provide home healthcare services. Content analysis revealed the following empirical categories: Perception of home care professionals in relation to their work and the health system; Difficulties in articulating the Home Care Program with other services of the health system; and, Opportunities to articulate the various health services with the Home Care Program. Results indicate that the work conducted in the Home Care Program significantly interfaces with other health service programs, and is considered important to implement principles of the National Health Service.

  16. Hospice Care

    MedlinePlus

    ... loved one. Hospice team members can include a registered nurse, a medical director, a home health aide, a ... in a hospice-contracted facility that has a registered nurse on site for 24 hours a day. For ...

  17. Attitudes of older Egyptians towards nursing care at home: a qualitative study.

    PubMed

    Boggatz, Thomas; Farid, Tamer; Mohammedin, Ahmed; Dassen, Theo

    2009-03-01

    The aim of this study was to identify the attitudes of older Egyptians towards receiving nursing care at home and to identify the characteristics that allow differentiating between various types of these attitudes. The number of older persons in Egypt requiring nursing care is increasing. Care was traditionally provided by the family, but the social network is changing in bigger cities. Beside geriatric homes, older Egyptians can refer to private helpers and a small number of home care services. Structured guideline interviews were performed with 33 Egyptians above 60 years of age. Participants were chosen by purposeful sampling. Twelve of them received home care. Interviews were analyzed with qualitative content analysis according to Mayring. Participants could be classified under three main categories of care seeking types: (1) insufficient income, (2) sufficient income and family dependent decision about care, (3) sufficient income and independent decision about care. Variations under these categories were due to differences in the social network and the perceived self-help abilities. Examples for the influence of factors which explained variations were not identified in every category to the same extent. Some types of care seeking that exist in reality may be missing in this study. Findings suggest the hypothesis that care seeking of older Egyptians is related to their social status. Those with insufficient income seem to reject home care whereas independent personalities with sufficient income may be the main winners of this offer.

  18. Home palliative care as a cost-saving alternative: evidence from Catalonia.

    PubMed

    Serra-Prat, M; Gallo, P; Picaza, J M

    2001-07-01

    The aim of this study was to provide a comparative assessment of the health care resources consumed during the final month of life of patients undergoing palliative treatment and who died from cancer in the town of Mataró, Spain, in 1998, with respect to whether they benefited from home care teams or not. Relevant differences in the use of health care resources were found between the groups. Patients in the standard care group presented more hospital care admissions and longer length of stay, higher use of emergency and outpatient visits, and greater use of palliative care units within nursing homes than patients in the home care group. The monetary quantification of the use of the above-mentioned resources showed a 71% increase in the cost per patient in the standard care when compared to home care. According to the results of this study, home care teams for terminal cancer patients allow for savings to the health care system. A series of policy making and health services research implications are discussed.

  19. Quits and Job Changes among Home Care Workers in Maine: The Role of Wages, Hours, and Benefits

    ERIC Educational Resources Information Center

    Morris, Lisa

    2009-01-01

    Purpose: Figuring out how to make home care jobs more attractive has become a top policy priority. This study investigates the impact of wages, hours, and benefits on the retention of home care workers. Design and Methods: Using a 2-wave survey design and a sample of home care workers from Maine, the factors associated with turnover intentions,…

  20. The potential for deprescribing in care home residents with Type 2 diabetes.

    PubMed

    Andreassen, Lillan Mo; Kjome, Reidun Lisbet Skeide; Sølvik, Una Ørvim; Houghton, Julie; Desborough, James Antony

    2016-08-01

    Background Type 2 diabetes is a common diagnosis in care home residents that is associated with potentially inappropriate prescribing and thus risk of additional suffering. Previous studies found that diabetes medicines can be safely withdrawn in care home residents, encouraging further investigation of the potential for deprescribing amongst these patients. Objectives Describe comorbidities and medicine use in care home residents with Type 2 diabetes; identify number of potentially inappropriate medicines prescribed for these residents using a medicines optimisation tool; assess clinical applicability of the tool. Setting Thirty care homes for older people, East Anglia, UK. Method Data on diagnoses and medicines were extracted from medical records of 826 residents. Potentially inappropriate medicines were identified using the tool 'Optimising Safe and Appropriate Medicines Use'. Twenty percent of results were validated by a care home physician. Main outcome measure Number of potentially inappropriate medicines. Results The 106 residents with Type 2 diabetes had more comorbidities and prescriptions than those without. Over 90 % of residents with Type 2 diabetes had at least one potentially inappropriate medication. The most common was absence of valid indication. The physician unreservedly endorsed 39 % of the suggested deprescribing, and would consider discontinuing all but one of the remaining medicines following access to additional information. Conclusion UK care home residents with Type 2 diabetes had an increased burden of comorbidities and prescriptions. The majority of these patients were prescribed potentially inappropriate medicines. Validation by a care home physician supported the clinical applicability of the medicines optimisation tool.

  1. Older care-home residents as collaborators or advisors in research: a systematic review

    PubMed Central

    Backhouse, Tamara; Kenkmann, Andrea; Lane, Kathleen; Penhale, Bridget; Poland, Fiona; Killett, Anne

    2016-01-01

    Background: patient and public involvement (PPI) in research can enhance its relevance. Older care-home residents are often not involved in research processes even when studies are care-home focused. Objective: to conduct a systematic review to find out to what extent and how older care-home residents have been involved in research as collaborators or advisors. Methods: a systematic literature search of 12 databases, covering the period from 1990 to September 2014 was conducted. A lateral search was also carried out. Standardised inclusion criteria were used and checked independently by two researchers. Results: nineteen reports and papers were identified relating to 11 different studies. Care-home residents had been involved in the research process in multiple ways. Two key themes were identified: (i) the differences in residents' involvement in small-scale and large-scale studies and (ii) the barriers to and facilitators of involvement. Conclusions: small-scale studies involved residents as collaborators in participatory action research, whereas larger studies involved residents as consultants in advisory roles. There are multiple facilitators of and barriers to involving residents as PPI members. The reporting of PPI varies. While it is difficult to evaluate the impact of involving care-home residents on the research outcomes, impact has been demonstrated from more inclusive research processes with care-home residents. The review shows that older care-home residents can be successfully involved in the research process. PMID:26790454

  2. Exploring the Barriers of Home Care Services in Iran: A Qualitative Study

    PubMed Central

    Heydari, Heshmatolah; Shahsavari, Hooman; Hazini, Abdolrahim; Nasrabadi, Alireza Nikbakht

    2016-01-01

    With increasing chronic diseases, the use of home care is rising in the world. Home care in Iran has many challenges and to improve that, we should identify the challenges and barriers of home care. The aim of this study was to identify and explore the barriers of home care in Iran. This is a qualitative study with content analysis approach that was conducted in Iran in 2015. Fourteen key informants comprising health policymakers, faculty members, nurses, and physicians as well as patients and families engaged in home care purposefully participated in this study. Data was obtained using face-to-face semistructured interviews. A focus group discussion was also used to complete the findings. Graneheim and Lundman's approach was used for analysis of data and Lincoln and Guba's criteria were used to confirm the trustworthiness of study's findings. The data were divided into three main categories and eight subcategories. Main categories included treatment-based approach in the healthcare system, cultural dimensions, and the lack of adequate infrastructure. A position for home care in the healthcare system, considering cultural dimensions in Iranian society and providing an appropriate infrastructure, can be beneficial to improve the situation of home care services in Iran. PMID:27127677

  3. Older widows' speculations and expectancies concerning professional home-care providers.

    PubMed

    Porter, Eileen J; Ganong, Lawrence H

    2005-09-01

    Little is known about older persons' expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women's experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with 13 women aged 82 to 96 years. Among the five key structures of experience were 'finding that someone has the job of helping me here' and 'determining where the helper's field lies'. Two subsets within a category of expectancies were differentiated: speculations about helpers' possible actions and expectancies about outcomes of helpers' actions. As parameters of relational ethics, clients' speculations and expectancies are appropriate bases for dialogue about older widows' relationships with home-care professionals and the foci of home-care policies.

  4. 76 FR 55570 - Per Diem Payments for the Care Provided to Eligible Veterans Evacuated From a State Home as a...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... veteran receiving nursing home care, domiciliary care, and adult day health care in State home facilities... continues to provide care. VA provided a 60-day comment period that ended May 23, 2011. VA received no..., Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Foreign relations,...

  5. Home care artificial heart monitoring system via internet.

    PubMed

    Chung, J; Lee, J H; Choi, J; Lee, J; Kim, W G; Sun, K; Min, B G

    2004-10-01

    The availability of a remote management system, which provides both physiological-related information about the patient and device-related information about the implanted device, would be helpful during in vivo experiments or clinical trials involving artificial heart implantation. In order to be able to monitor the course of the in vivo experiment continuously regardless of the patient's location, an internet-based remote monitoring system was developed, which can monitor physiological-related information such as pressure (AoP, LAP, RAP, PAP) and flow data, as well as device-related information such as current, direction and pump operating conditions. The home care artificial heart monitoring system which we developed consists of four main components, which are the transcutaneous information transmission system (TITS), local monitoring station (LMS), data server station (DSS), and client monitoring station (CMS). The device-related information and physiological-related information can be transmitted in real time from a patient in a remote non-clinical environment to the specialist situated in a clinic depending on the current capabilities and availability of the internet. The local monitoring station situated at the remote site is composed of a data acquisition and preprocessing unit connected to a computer via its RS-232 port, and which communicate using a Java-based client-server architecture. The remote monitoring system so developed was used during an in vivo experiment of the artificial heart implantation for 2 months and performed successfully according to design specifications.

  6. Prolonged weaning: from the intensive care unit to home.

    PubMed

    Navalesi, P; Frigerio, P; Patzlaff, A; Häußermann, S; Henseke, P; Kubitschek, M

    2014-01-01

    Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed.

  7. Ultra-Rapid dUT1 Measurements on Japan-Fennoscandian Baselines - Application to 24-hour Sessions

    NASA Technical Reports Server (NTRS)

    Matsuzaka, Shigeru; Kurihara, Shinobu; Sekido, Mamoru; Hobiger, Thomas; Haas, Rudiger; Ritakari, Jouko; Wagner, Jan

    2010-01-01

    GSI, NICT, OSO, and MRO have been engaged in Ultra-rapid dUT1 experiments since 2007 aiming at the technological possibility of real-time dUT1 results using the e-VLBI technique. We have already successfully determined dUT1 in less than four minutes after the end of an experimental Intensive session in 2008, and at present we routinely get the results within 30 minutes for regular Intensives. In 2009 we applied the technique to 24-hour sessions and continuously obtained dUT1 values by processing and analyzing Tsukuba Onsala data in near real-time. It showed a detailed behavior of UT1 variations, which could be very valuable for scientific study as well as for precise prediction of UT1-UTC.

  8. 24-hour energy expenditure and substrate oxidation rates are unaffected by body fat distribution in obese women.

    PubMed

    Buemann, B; Astrup, A; Quaade, F; Madsen, J

    1994-01-01

    Twenty-four-hour energy expenditure (EE) and nonprotein respiratory quotient (RQnp) were measured by indirect calorimetry in 19 upper-body-obese (UBO) and 15 lower-body-obese (LBO) women with similar body mass index (BMI) and body fat percent. The measurements were performed in a respiration chamber on a predetermined physical activity program and a controlled diet. No differences between the UBO and LBO groups were found in 24-hour, daytime, and sleeping EE after adjustment for differences in fat-free mass (FFM). Furthermore, no group effect was observed in RQnp, but a positive correlation was found between RQnp and age. Despite the fact that an increased free fatty acid (FFA) turnover has been found in UBO subjects, the present study does not support the contention that upper-body obesity is accompanied by an increased lipid oxidation.

  9. [The university hospital palliative care team's approach to the transfer of end-stage cancer patients from hospital care to home medical care].

    PubMed

    Yoshino, Kazuho; Nishiumi, Noboru; Kushino, Nobuhisa; Tsukada, Michiko; Douzono, Sachiko; Saito, Yuki; Yagame, Mitsunori; Tokuda, Yutaka

    2009-12-01

    The palliative care team's roles are to provide a symptom relief to cancer patients, help them accept their medical conditions, and offer advice regarding the selection of appropriate medical treatments to suit their needs. Seeking the comfort of their homes, patients prefer a home care of superior medical care provided at hospitals. In 2008, 25 of the end-stage cancer patients at hospitals were expressed their desires to have a home medical care, and 10 of them were allowed to do so. We considered the following contributing factors that a patient should have for a smooth transition from hospital care to home medical care: (1) life expectancy of more than 2 months, (2) no progressive breathing difficulties experienced daily, (3) good awareness of medical condition among patients and families, (4) living with someone who has a good understanding of the condition, (5) availability of an appropriate hospital in case of a sudden change in medical requirements, and (6) good collaboration between emergency care hospitals, home physicians, and visiting nurses. To treat the end-stage cancer patients at home, there is a need for information sharing and a joint training of physicians specialized in cancer therapy, palliative care teams, home physicians, and visiting nurses. This would ensure a sustainable "face-to-face collaboration" in community health care.

  10. The physician's role in patients' nursing home care: "She's a very courageous and lovely woman. I enjoy caring for her".

    PubMed

    Zweig, Steven C; Popejoy, Lori L; Parker-Oliver, Debra; Meadows, Susan E

    2011-10-05

    More than 1.5 million adults live in US nursing homes, and approximately 30% of individuals in the United States will die with a nursing home as their last place of residence. Physicians play a pivotal role in the rehabilitation, complex medical care, and end-of-life care of this frail and vulnerable population. The reasons for admission are multifactorial and a comprehensive care plan based on the Minimum Data Set guides the multidisciplinary nursing home team in the care of the patient and provides assessments of the quality of care provided. Using the cases of 2 patients with different experiences, we describe the physician's role in planning for admission, participating as a team member in the ongoing assessment and care in the nursing home, and guiding care at the end of life. The increasing population of older adults has also promoted community-based and residential alternatives to traditional nursing homes. The future of long-term care will include additional challenges and rich innovations in services and options for older adults.

  11. The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada.

    PubMed

    Chai, Huamin; Guerriere, Denise N; Zagorski, Brandon; Coyte, Peter C

    2014-01-01

    With increasing emphasis on the provision of home-based palliative care in Canada, economic evaluation is warranted, given its tremendous demands on family caregivers. Despite this, very little is known about the economic outcomes associated with home-based unpaid care-giving at the end of life. The aims of this study were to (i) assess the magnitude and share of unpaid care costs in total healthcare costs for home-based palliative care patients, from a societal perspective and (ii) examine the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty-nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home-based palliative care programme provided by the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, Toronto, Canada, until death. Information regarding palliative care resource utilisation and costs, time devoted to care-giving and sociodemographic and clinical characteristics was collected between July 2005 and September 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care-giving costs were the largest component - $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out-of-pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. Seemingly unrelated regression estimation suggested that the share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care-giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home-based palliative care in future.

  12. Prognostic Significance of Initial Serum Albumin and 24 Hour Daily Protein Excretion before Treatment in Multiple Myeloma.

    PubMed

    Chen, Jia-Hong; Hsu, Shun-Neng; Huang, Tzu-Chuan; Wu, Yi-Ying; Lin, Chin; Chang, Ping-Ying; Chen, Yeu-Chin; Ho, Ching-Liang

    2015-01-01

    Renal failure is a common morbidity in multiple myeloma (MM). Although proteinuria has been increasingly reported in malignancies, it is not routinely used to refine risk estimates of survival outcomes in patients with MM. Here we aimed to investigate initial serum albumin and 24-hour daily protein excretion (24-h DPE) before treatment as prognostic factors in patients with MM. We conducted a retrospective analysis of 102 patients with myeloma who were ineligible for haematopoietic stem cell transplantation between October 2000 and December 2012. Initial proteinuria was assessed before treatment by quantitative analysis of 24-hour urine samples. The demographic and laboratory characteristics, survival outcome, and significance of pre-treatment 24-h DPE and albumin in the new staging system of MM were analyzed. Pre-treatment proteinuria (>300 mg/day) was present in 66 patients (64.7%). The optimal cut-off value of 24-h DPE before treatment was 500 mg/day. Analysis of the time-dependent area under the curve showed that the serum albumin and 24-h DPE before treatment were better than 24-h creatinine clearance rate and β2-microglobulin. A subgroup analysis showed that an initial excess proteinuria (24-h DPE ≥ 500 mg) was associated with poor survival status (17.51 vs. 34.24 months, p = 0.002). Furthermore, initial serum albumin was an independent risk factor on multivariate analysis (<2.8 vs. ≥ 2.8, hazard ratio = 0.486, p = 0.029). Using the A-DPE staging system, there was a significant survival difference among patients with stage I, II, and III MM (p < 0.001). Initial serum albumin and 24-h DPE before treatment showed significant prognostic factors in patients with MM, and the new A-DPE staging system may be utilized instead of the International Staging System. Its efficacy should be evaluated by further large prospective studies.

  13. Biomechanical evaluation of three fixation modalities for preperitoneal inguinal hernia repair: a 24-hour postoperative study in pigs

    PubMed Central

    Guérin, Gaëtan; Bourges, Xavier; Turquier, Frédéric

    2014-01-01

    Purpose Tacks and sutures ensure a strong fixation of meshes, but they can be associated with pain and discomfort. Less invasive methods are now available. Three fixation modalities were compared: the ProGrip™ laparoscopic self-fixating mesh; the fibrin glue Tisseel™ with Bard™ Soft Mesh; and the SorbaFix™ absorbable fixation system with Bard™ Soft Mesh. Materials and methods Meshes (6 cm ×6 cm) were implanted in the preperitoneal space of swine. Samples were explanted 24 hours after surgery. Centered defects were created, and samples (either ten or eleven per fixation type) were loaded in a pressure chamber. For each sample, the pressure, the mesh displacement through the defect, and the measurements of the contact area were recorded. Results At all pressures tested, the ProGrip™ laparoscopic self-fixating mesh both exhibited a significantly lower displacement through the defect and retained a significantly higher percentage of its initial contact area than either the Bard™ Soft Mesh with Tisseel™ system or the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system. Dislocations occurred with the Bard™ Soft Mesh with Tisseel™ system and with the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system at physiological pressure (,225 mmHg). No dislocation was recorded for the ProGrip™ laparoscopic self-fixating mesh. Conclusion At 24 hours after implantation, the mechanical fixation of the ProGrip™ laparoscopic self-fixating mesh was found to be significantly better than the fixation of the Tisseel™ system or the SorbaFix™ absorbable fixation system. PMID:25525396

  14. Family Day Care in the United States: Family Day Care Systems. Final Report of the National Day Care Home Study. Volume 5.

    ERIC Educational Resources Information Center

    Grasso, Janet; Fosburg, Steven

    Fifth in a series of seven volumes reporting the design, methodology, and findings of the 4-year National Day Care Home Study (NDCHS), this volume presents a descriptive and statistical analysis of the day care institutions that administer day care systems. These systems, such as Learning Unlimited in Los Angeles and the family day care program of…

  15. Quality of Mental Health Care for Nursing Home Residents: A Literature Review

    PubMed Central

    Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.

    2010-01-01

    Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors. PMID:20223943

  16. Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care.

    PubMed

    Feld, April; Madden-Baer, Rose; McCorkle, Ruth

    2016-01-01

    The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

  17. [The importance of longitudinality, comprehensiveness, coordination and continuity of nursing home care].

    PubMed

    Corrales-Nevado, Dolores; Palomo-Cobos, Luis

    2014-01-01

    Home care is essential for dependent persons, in order to support the high levels of morbidity, for the elderly as well as their caregivers, as it enables patients to remain in their familiar environment as long as possible, fulfilling the wish expressed by most of the population. Home care is the activity that best represents the essential attributes (longitudinality, comprehensiveness, continuity, coordination) of the primary, and that suffers most when these attributes are not included in the activities undertaken by primary care teams, or due to cuts in health-care. Home care requires highly skilled, versatile and committed nursing staff, with whom the population identifies as a source of care, and where they are assessed for their relevance and effectiveness. Nurses with wide clinical care skills, with a balanced content of treatment and prevention, and the freedom to develop their work, are needed in order to continuously monitor the health problems of their acute and chronic patients, in the family and community.

  18. Using integrated bio-physiotherapy informatics in home health-care settings: A qualitative analysis of a point-of-care decision support system.

    PubMed

    Canally, Culum; Doherty, Sean; Doran, Diane M; Goubran, Rafik A

    2015-06-01

    The growing need to gain efficiencies within a home care setting has prompted home care practitioners to focus on health informatics to address the needs of an aging clientele. The remote and heterogeneous nature of the home care environment necessitates the use of non-intrusive client monitoring and a portable, point-of-care graphical user interface. Using a grounded theory approach, this article examines the simulated use of a graphical user interface by practitioners in a home care setting to explore the salient features of monitoring the activity of home care clients. The results demonstrate the need for simple, interactive displays that can provide large amounts of geographical and temporal data relating to patient activity. Additional emerging themes from interviews indicate that home care professionals would use a graphical user interface of this type for patient education and goal setting as well as to assist in the decision-making process of home care practitioners.

  19. One-stop shop. The houseworks experience: redefining innovations in private-pay home care.

    PubMed

    Cohen, Andrea

    2005-07-01

    For more than thirty years, forward-looking gerontologists and entrepreneurs have realized the potential market for private-pay home care services and have proposed creative approaches to meeting the projected demand. Innovative ventures ranging from "life care at home" to "virtual retirement communities" have been launched throughout the country in an attempt to meet a growing need while responding to an unprecedented business opportunity. While these ventures reflect intriguing ideas, the story of an unconventional private-pay home care company in Greater Boston suggests that innovation and creativity are most needed to transform the fundamentals of private-pay service delivery: responsiveness, reliability, customer service, and sales.

  20. Adding home health care to the discussion on health information technology policy.

    PubMed

    Ruggiano, Nicole; Brown, Ellen L; Hristidis, Vagelis; Page, Timothy F

    2013-01-01

    The potential for health information technology to improve the efficiency and effectiveness of health care has resulted in several U.S. policy initiatives aimed at integrating health information technology into health care systems. However, home health care agencies have been excluded from incentive programs established through policies, raising concerns on the extent to which health information technology may be used to improve the quality of care for older adults with chronic illness and disabilities. This analysis examines the potential issues stemming from this exclusion and explores potential opportunities of integrating home health care into larger initiatives aimed at establishing health information technology systems for meaningful use.